Review of massage literature / page 4


	Review of bodywork literature: Page 4

Reminder: When a bulleted notation appears in parentheses, it is my comment or opinion as opposed to the author's.

From “The Complete Book of Shiatsu Therapy” (1981) by Toru Namikoshi
Conspicuously devoid of theory.

Shiatsu strives to call forth innate self-curative powers.
Treat the entire body, and only then deal with irregularities.
In his practice, the author generally accesses each point for a duration of three seconds.
The diaphragm tends to tense easily.
Insomniacs are stiff in the abdomen and cervical region.
The liver is comparable in size to our brain.
The gallbladder is shaped like a small eggplant.
One cause of nocturnal cramping in the calf can be fatigue.

From “Pain Erasure” (1980) by Bonnie Prudden
A noted exercise instructor who chummied up to several leading physicians and celebrities of her day.

Muscle splinting, a ‘foreshortened’ condition, interferes with function, posture and balance. The term refers to when an aggravated muscle shortens and stiffens, forming a type of splint to prevent further injury.
Spasm tears fibers.
Satellite trigger points don't harbor the same potential for referring pain as do the key – or matrix – trigger points.
Frigidity and impotence may originate with trigger points in the floor of the pelvis.
Trigger points can originate from strokes, high fever, plus diseased organs and joints.
One of the surest signs myotherapy is doing its job is a good night’s sleep.
‘You are denying the trigger point oxygen.’
– Dr. Janet Travell
Very few doctors like other doctors’ x-rays.
‘Ruptured disc’ is a meaningless term.
– back specialist Paul Magnuson, Washington, DC
The back pockets of our pants indicate the placement of three or four trigger points each.
Muscles listen to rhythm.
Rest leads to post-inertial dyskinesia (impairment of voluntary movement).
When legs are freed of spasm, varicose veins subside and the feet get warm.
Pain does not travel through the head, it moves over the head. 95% of the time it's ON the head.
Splinting = shortening and is a form of guarding.
Injury initiates a deteriorative biochemical cycle.
– Dr. Janet Travel (re spasm perpetuating itself)
Muscle can actually lose its very ability to relax.
Spasm can exhaust the sufferer even while the pain is alleviated by medication.
Iconic baseball pitcher Dizzy Dean (1910-1974) ruined his arm by muscular overcompensation – substituting wrong muscles after sustaining a broken toe.
When a joint enlarges from rheumatoid arthritis, the ligaments get stretched as the synovial lining thickens. This weakens the joint and interferes with function. Trigger points get laid down.

From “Integrated Sports Massage Therapy” (2011) by Anders Jelvéus
Too much integration, too little focus on core basics.

After an endurance event such as a marathon, monitor your client for mental coherence. Exhausted participants can go into shock, especially if their heart rate remains high.
When overdone, static stretching can decrease power performance, endurance and speed. Multiple studies support this conclusion. Dynamic stretching exercises are preferred, especially pre-performance, though static stretching can work post-performance. Static stretching essentially holds a muscle at its end-point for a few moments. In contrast, dynamic stretching involves carrying muscle groups through their full range of motion, emulating the movements that will occur during the upcoming sport or activity.
PNF was originally developed by Dr. Herman Kabat (1913-1995) as a method for stroke rehab. Kabat built upon the findings of Charles Sherrington (1857-1952), a Nobel laureate.
It is virtually impossible to injure or traumatize a client using positional release techniques (PRT).
Dr. Oakley Smith, an early American chiropractor from Iowa, noticed in the 1930s how scar tissue could account for some otherwise unexplained symptoms.
Based upon his anatomical research, Smith discovered that when dense or fibrous connective tissue (muscles, tendon and ligaments) become damaged through overuse, they produce a scar-like condition in the body. This scar tissue can impede the performance of nearby nerves. Smith termed his treatment protocol ‘naprapathy.’
Fascial connective tissues are not passive structures. There is evidence they contain contractile cells.
Trigger points can diminish performance even when no pain is felt.
Regarding the cause of trigger points, some form of trauma damages the end sacs of the sarcoplasmic reticulum as well as the sarcolemma. A sarcolemma is the cell membrane of a muscle cell. This damage produces an overabundance of calcium ions. The main function of the sarcoplasmic reticulum is to store these calcium ions.
Regarding trigger point activity, if the endplate dysfunction is allowed to continue for any length of time, chronic fibrotic changes may occur.
When stimulating a trigger point, the pain may appear immediately or after a 10-to-15 second delay.
The referred-pain area of trigger points can display lowered skin temperature caused by constriction of superficial blood vessels.
Trigger points can also increase the moisture of the skin at the site of the point.
Only a few muscles are known to generate what has been term ‘referred autonomic phenomena’. These muscles include trapezius, SCM and the masseters. Note how these muscles are close to the accessory nerve, also known as cranial nerve XI. It’s also known as the spinal accessory nerve and it joins with the vagus nerve. Referred autonomic phenomena include blurred vision, tinnitus, dizziness, and pilomotor response (goosebumps).
Leon Chaitow developed what he called 'integrated neuromuscular inhibition technique' (INIT). This procedure combines ischemic pressure, positional release, stretching and reciprocal inhibition.
The three wide muscles in the back of the thighs are known as the ischio-crural (hip-leg) muscles. They include the bicep femoris, the semitendinosus and the semimembranosus. The ischiocrurals work to stretch the hip and to bend the knee.

From “Therapeutic Massage in Athletics” (2007) by Pat Archer
A textbook that dutifully tries to cover all the bases, relevant or not.

By combining her backgrounds in both athletic training and massage therapy, the author says she has learned to reduce down-time for her athletes.
’Athletic masseurs’ have been hanging around college football fields since as early as 1869.
The effects of massage tend not to set in immediately.
Instead of dwelling on overall blood circulation, pay more attention to venous flow.
Avoid tapotement in areas prone to cramping, especially post-event.
Although GTOs can be scattered throughout the length of a muscle, most of these proprioceptors are found either in tendons or at musculo-tendinous junctions.
A shortened muscle cannot contract with as much force as a muscle at normal resting length. Why? Because the actin-myosin bonding sites have been maxed out.
The precipitating event in the development of trigger points is believed to be dysfunction at the synapse between a motor neuron and the muscle fiber.
The points of attachment for a muscle (origin and insertion) are not the end-points of movement. That is because the fascial sheath continues onto the next muscle and bone. Thus, contractile force is carried beyond the attachment points via the fascial network.
When dehydrated, the ground substance of connective tissue loses its ability to space and lubricate its fibers. The result is thicker and more adherent tissue. Here’s a better reason to drink water after a massage than the idea of ‘flushing out toxins.’
Once 80% of normal pain-free ROM has returned, only then do we shift our goal to that of improving strength.
The proper pressure for alleviating trigger points should approach 5 or 6 on the pain scale.
Tender points (as opposed to trigger points) commonly occur at muscle attachments. They’re often located on the antagonist of the muscle the athlete reports as being tight.
Trigger points in the quadratus lumborum can contribute to pelvic tilt.
The common factors among the various NMR (neuromuscular release) techniques easily outweigh their differences.

From “Connective Tissue Manipulations” (1985) by Maria Ebner
A dense work that skirts around the main point, which is poorly expressed. The core principle appears to be that of restoring circulation to areas of diminished function.

Ebner’s book builds upon the experience of one Elisabeth Dicke of Germany, who in 1929 lost much of the peripheral circulation in a leg.
Ebner calls her work ‘connective tissue massage’ (CTM).
Beginners are inclined to use too much pressure. This prevents movement between layers of tissue. We want tissue to pass as a fluent fold in front of our moving finger.
We don’t force our fingers through tissue. Adherent areas must be freed by short, slow, lifting strokes.
With most clients, peripheral symptoms diminish by improving the proximal part of the circulation.
Repeating a stroke more than nine or ten times does not increase the intensity of the predictable (and desirable) wheal or red line that develops.
Increasing blood supply to the pelvic region helps harmonize the relationship between the sympathetic and parasympathetic aspects of the nervous system.
Never start a treatment on a spot the client is complaining about. You’re better off starting in the sacral area.
Stagnation in veins impedes the flow of lymphatic fluid.
CTM should precede articular manipulation.
Lesions (trigger points) in the back can affect hearing and balance.
The peroneus longus (with brevis) acts like a stirrup for the foot.
The German word ‘haltung’ denotes both posture and demeanor.
The ITB takes origin in a fan-like manner from the anterior part of the iliac crest. The ITB tends to shorten when its blood supply is compromised.
Improved circulation to the sacral region leads to a greater sense of well-being.
One of the first improvements a client will report is an improved sleeping pattern. Wait for them to mention this voluntarily.
When blood supply is diminished, tissues become more fibrous. They eventually become more avascular and thus contract.
A ligament injury without muscle tear is impossible.

From “Structural Integration and Energy Medicine” (2019) by Jean Louise Green
A discussion of the work and legacy of Ida Rolf. Strong when the author mentions other sources, weak when she incorporates her own ideas.

In the foreword, bodywork author James Oschman mentions the pioneering work of a Dr. Joel Goldthwait of Harvard Medical. While performing surgeries, Goldthwait observed that bodies out of alignment (with the vertical axis) exhibited tension in their abdominal nerves and blood vessels. In those whose necks were chronically bent forward, Goldthwait observed “stretching and kinking” of cerebral arteries and veins. He also attributed various cardiac problems with faulty body mechanics.
"Any time a structure departs from the balanced state, energy is wasted and efficiency is reduced.” (Goldthwait et al, Body Mechanics in the Study and Treatment of Disease, 1943)
According to Rolf, symptoms melt as organisms regain balance.
"We so organize the body that the gravity field can reinforce the body’s energy field.” – Rolf
Connective tissue has both structural and fluid components. Collagen protein fibers are the structural component. They lie within a fluid gel-like matrix also referred to as ground substance. (citing Myers in Anatomy Trains)
Fascia is two-thirds water.
"It’s the fascia that crosses joints, not the muscles.” (Rolf)
Joints become the ‘red flag’, telling us when things are out of kilter. (Rolf)
Vitamin C assists with the formation and maintenance of connective tissue.
Baking soda in bathwater helps break up acidic toxins that get stirred up during strenuous activity.
Alignment and release of the body can assist the flow of negatively charged electrons that can neutralize positively charged free radicals.
"A long lean look comes from lengthening the psoas, not from shortening the rectus abdominis." – Joseph Heller, developer of Hellerwork
Rolf called hip rotators ‘so-called’ rotators.
If runners rotate a foot externally, they’re making that leg shorter.
"Any movement which is primarily extrinsic is only an approximation of true movement.” – Rolf
Movement must be initiated internally with the intrinsic muscles. – Rolf

From “The Handbook of Chinese Massage” (1997) by Maria Mercati
Painfully simplistic with a handful of interesting points.

Japanese shiatsu is a modification of tui na techniques introduced from China over a thousand years ago.
Even at its most yin, a system will contain a yang component. (For most of us, this assertion will remain a belief until the day comes when it is directly experienced as a fundamental truth.)
Yin and yang transform into each other. The small circles found in the yin-yang symbol indicate that each contains the other.
Jing is the “prime mover,” the carrier for Qi. Shen is the intention and vitality behind the Qi.
The author mentions the Sanjiao, sometimes known as the Triple Burner or Triple Energizer. Other writers have equated the sanjiao with the fascial or connective tissue network.
Gallbladder (GB) 34 is an effective spot for treating spasm and cramp of the calves. Ditto for Bladder 40, located in the middle of the crease behind the knees.
Pericardium 6, located on the underside of the wrist, two cun above the crease, is an exceptionally potent point, particularly for restlessness.
The spleen controls the emotion of worry.

From “Reflexology (Idiot’s Guide)” (2014) by Bill Flocco
One of the more shallow books ever published in the field of bodywork. The writing offers poor powers of description and is full of filler and fluff. The illustrations are sub-par, of the stock variety, and the editing is at the level of a high school newspaper. The author claims to be a leader in the field, and has fittingly developed a system called The Flocco Method.

Following the discovery of vertical zones in the feet (Fitzgerald), the concept of horizontal zones was presented in 1924 by one doctor Joe Shelby Riley, an associate of Fitzgerald.
In 1957, Dr. Paul Nogier of Lyon, France began to suggest the metaphor of the upside-down human encapsulated within the ear. Nogier, once a civil engineer, is considered the “father of ear acupuncture.”
One prevailing theory (the author does not specify) asserts that when a malfunction occurs somewhere in the body, a corresponding spot on the foot grows an increased number of nerve endings. A larger amount of the neurotransmitter ‘Substance P’ is created as well. Reflexology aims to break down the underlying chemicals that have accumulated around these nerve endings.
The author claims that the ‘inchworm’ technique of thumb-crawling carries certain limitations. He prefers a rolling/gliding technique that he claims misses fewer spots on the foot or hand.
The author claims to have worked single reflex spots for up to 30 minutes. (I find this excessive and possibly counter-productive.)
The author asserts that the longer one works on a spot, the greater the relief. I suggest this is pure disinformation.
Strongest point of the book: You don’t have to work hard over rough, calloused areas. Work gently and patiently so as to soften up the tougher tissue underneath.
'Many people have tightness in their spinal muscles.’ (Thank you for sharing that.)
Near the center of the upper third of the ear we find a master point called shen men, or divine gate. (Master points are more electronically active than other nearby points.) Stimulation to shen men, the prime point on the ear, is said to promote an overall sense of well-being.
The geometric and physiological center of the ear is considered the Zero Point. It aligns with the solar plexus and helps bring the body back into homeostatic balance.
The forward, leading edge of the ear’s main ridge contains another master point called the sympathetic point, helpful in damping down imbalances within the sympathetic/parasympathetic system.
At the bottom of the internal ridge we find the master endocrine point, home to the pituitary grand reflex.
The ear contains an anti-depressant point about two-thirds of the way down the rear ridge, near the lobe.
To the front of the ear, just forward of the tragus, we find an indentation that houses the tranquilizer point.

From “Healing Through Trigger Point Therapy” (2013) by Devin Starlanyl and John Sharkey
Strong on theory, weak on practical application and mechanics. Gets cute, trite and preachy at inopportune moments.

Trigger points are one of the main factors generating and perpetuating fibromyalgia pain. The ability to control trigger points is the ability to control fibromyalgia (a claim not substantiated to a meaningful degree).
In fibromyalgia patients, the central nervous system can be set off by a lower threshold level of stimuli. The pain filters aren’t working adequately.
Among patients with fibromyalgia, increased stress can lead to cognitive impairment. This can be mistaken for dementia. This response is neurological, not physiological.
Fibromyalgia patients often suffer from a persistent lack of restorative sleep.
Trigger points are “little land mines.”
As per stretching before a trigger point is deactivated, muscle begins to rip and tear when it’s elongated by more than 5-7% of its resting length. Similarly, strengthening exercises worsen the muscle weakness caused by trigger points.
Attachment trigger points are more difficult to palpate than those near the midpoint of a muscle. The area can be more scarred, fibrotic and calcified.
Avoid provoking a trigger point’s “local twitch response.” The area becomes more acidic. Every time a TP twitches, over 30 irritating biochemicals are released into the body.
Avoid strumming palpation on tight bands of tissue. You’ll produce nothing but non-productive pain. (This point directly contradicts that of bodywork educator Leon Chaitow, whose name carries much more stature than Starlanyl’s.)
Motor endplates, it was believed, are generally found near the center-point or belly of a muscle. Recent research says their locations can be much more dispersed. (A debatable point that demands more than one study as its justification.)
When fascia is constricted, we’re wearing a three-dimensional wetsuit that’s a couple sizes too small. (Nice metaphor.)
Tendons have a limited blood supply so they look pale compared to muscle, and they heal more slowly.
In 2008, the Mayo Clinic announced it had photographed the taut bands of TPs.
Repetitious “work hardening” programs don’t help eliminate TPs.
Tissues may be so tight that care providers can’t feel the TPs.
If a knee or ankle is restricted, it can take up to 40% more energy just to walk.
A primary function of our core’s myofascial structures is to stabilize our center of gravity during movement.
In a joint, fascia provides almost as much stability as does ligament.
The “decrepitude” of advancing age is often due to latent TPs (Travell & Simons, 1999)
Too many “clinicians,” unacquainted with TPs, have inappropriately labeled their patient’s problem as psychological rather than physical (Travell & Simons)
Trigger points can lead to excessive sweating.
When the hyoid bone of the neck (a floater) is out of alignment, the carotid artery may become impinged.
The orbicularis oculi plays an important role in the non-verbal communication of body language.
There’s a link between eye muscles and the sub-occipitals, noted for their role in proprioception. In particular, the obliquus capitis inferior is “intrinsically” linked to eye movement. It contains a very high density of Golgi organs and in fact may be more a muscle of proprioception rather than one of movement.
TPs in the lateral pterygoid can affect speech and singing.
If you’re not honing in on the source of tightness, you’re merely “stretching the symptoms.”
If the shoulder or pelvic axis is uneven, the SCMs and scalenes get called upon to pick up the slack. This is because our brain is hard-wired to keep our eyes level through our “righting reflex.”
Few cases of chronic lower back pain require surgical intervention.
Trigger points can entrap nerves.
Trigger points can lead to blurred vision.
Trigger points in the lower multifidi can lead to irritable bowel syndrome.
The rotators of the spine are highly proprioceptive. So is the serratus posterior superior.
Nervousness and anxiety can activate trigger points in the diaphragm.
Trigger points in the quadratus lumborum can cause cramping in the calves.
Trigger points in the pelvic floor can lead to pain when sitting.
Pelvic floor exercises can be an effective cure for erectile dysfunction.
Beware of performing shoulder exercises from a sitting position; we don’t engage the power of our legs.
Trigger points of the upper trapezius refer pain to the head in a characteristic hook shape.
If your shoulder blade cracks and pops, check for TPs in the rhomboid.
Teres major has been called the latissimus dorsi’s “little helper.”
TPs of the arm biceps are more likely to cause weakness than pain when raising the arms over the head.
TPs in the hand can express themselves with difficulty opening jars.
TPs can entrap the radial nerve, leading to numbness and tingling over the back of the hand.
The thumb's abductor, the pollicis brevis, has been called "the hitchhiking muscle."
Travell and Simons advocated trigger point work in the treatment of arthritis.
Tears of the ACL can begin with imbalances in the hip.
One definition of an ‘inhibited’ muscle is that it responds more slowly to stimuli.
A perpetuating factor for a trigger point is lack of oxygenation of its related muscle.
If an innominate bone slips upward in relation to the sacrum (upslip/shear/displacement), we’re on the road to pain in the lower back and sacrum (Travell and Simons, 1992).
Release the hamstrings before the adductors.
Lower back pain is virtually synonymous with tightness in the gluteus medius.
Rather than producing force, the TFL is designed to control it. Distortion of the TFL/ITB can also lead to ACL problems. Ditto for tightness in the hammies.
In children, TPs in the hammies can be dismissed as “growing pains” (Travell and Simons, 1992).
TPs in the gemelli (a hip rotator) can cause pain that’s particularly intense.
The obturator (another hip rotator) helps steady the head of the femur within the hip socket.
Restricted range of motion within the adductors can go unnoticed for years. When released, the gluteus medius can start to kick up.
Adductor magnus coordinates with TFL to produce gait stability.
Travell and Simons once described a “hornet’s nest” of trigger points located at the midpoint of the vastus lateralis of the quads. A trigger point in the vastus intermedius can lead to the hip giving out.
In cases of plantar fasciitis, explore TPs of the gastrocnemius/soleus and intrinsic toe flexors (Travell and Simons, 1992).
Nocturnal leg cramps can often be sourced to the gastrocnemius. Toe cramps can begin in the long extensors of the calf.
When the tibialis anterior loads up with TPs, we diminish our tolerance for exercise.
Apply pain levels of no more than 8 on a scale of ten. (Gee, we got 90% of the way through the book before the authors mentioned this critical point. We’re still waiting for guidance on manipulating the TP itself.)
The popliteus, behind the knee, has been described as a “kinesthetic knee monitor,” suggesting a highly proprioceptive role.
If the calf fatigues or cramps easily, the popliteal artery may be entrapped.
Flexor hallucis longus helps the big toe propel the body forward when walking or running. (One wonders to what degree speed is affected by tightness in the long flexors of the toes originating in the calf.) Similarly, the achilles is a propellant.
The achilles can withstand extraordinary strain. Spiralling by as much as 90 degrees, its array of fibers contribute to this toughness. The achilles tendon originates in the plantaris muscle behind the knee.
The retinaculum ("retainer") of the foot is a fascial tissue that can house TPs, and it plays a major role in proprioception.
If you’ve got trigger points located deep in the foot, chances are you notice them as soon as you get up in the morning.
Martial arts performers take advantage of their opponents’ tight ligaments and muscles.
Says the author, “Reread Chapter 6.” (Seriously?)
Patients with back and pelvic pain exhibit predictable patterns of compensation, with secondary muscles taking up a slack they weren’t intended to assume.
The longer a TP intervention is delayed, the more treatments it takes to correct it. The likelihood of complete recovery lessens to a commensurate degree (Simons, 1999).

From “The Psoas Solution” (2017) by Evan Osar
Does not expand our awareness of the psoas very far. Unfocused and disorganized. Reads like a brochure for the author’s own pet modalities.

In the author’s experience, professional dancers invariably complain about tightness in the hip flexors. Nearly every one of them exhibits forward pelvic tilt and excessive curvature (hyper-lordosis) of the back. In many cases, their psoas is overly lengthened.
The psoas attaches to every vertebral level from T11 through L5. It blends fascially into the diaphragm, rectus abdominus and the pelvic floor. It also attaches to the pelvic brim. Given this complexity, psoas is far more than a simple hip flexor.
The psoas is the only muscle located on the anterior surface of both the lower thoracic and lumbar spines. This suggests that psoas is also a spinal stabilizer.
Ramus: an arm or branch of a bone. The word is Latin for branch.
The head of the femur is designed to attach centrally within the acetabulum, or socket of the hip. When this attachment is pulled off center, usually forward and upward, the lower back can report pain. After a few years of misuse the socket can start to degenerate. (This is actually the core point of book, frequently repeated.)
The outside edge of the acetabulum (Latin for ‘vinegar container’) is comprised of the raised and circular labrum, which is Latin for ‘lip,’ like the lip of a jar. This lip deepens the socket and creates suction around the head of the femur.
If the hip flexors are impinged, control over leg movement now shifts to the hamstrings. The center point of the femoral head is now pulled forward in its socket, placing undue pressure on the labrum.
The lower extremities can now misalign, placing undue pressure on the ITB.
Achieving centration, such as the precise alignment of the femoral head within its socket, is more advantageous than stretching.
The author asserts that the psoas centers the femoral head within its socket. This is perhaps a stretch of thought, but let’s accept that the psoas assists in this role, with help from the gluteus maximus.
The psoas and iliacus reinforce each other’s roles.
Superficial fibers of the gluteus maximus attach to the ITB.
When the psoas and other deep core muscles aren’t functioning properly, we start to overuse more superficial muscles such as the erectors and hammies.
Many conditioning programs emphasize addressing superficial muscles at the expense of the deeper ones.
(At those moments when the author’s arguments start to hit paydirt, he consistently changes the topic.)
It is common for runners to present with a self-diagnosis of a “tight” psoas and “weak” glutes. They are rarely accurate in their assessments. The culprits are often the proximal attachments of the TFL and rectus femoris.

From “Positional Release Techniques” (1997/2002) by Leon Chaitow
Another strong outing from the preeminent writer in the field of bodywork. The discussion of trigger points is worth the admission price alone, though it doesn’t reveal insight beyond the research of Travell & Simons.

As the developer of the strain/counter-strain approach, Lawrence Jones didn’t want to become the ‘guru of a static cult,’ but preferred to originate a system that evolves.
There’s an old saying: a healthy person bends over and a cripple stands up.
Direct manipulation of misaligned structure can make matters worse. We allow change to emerge rather than force it to do so. We create the space for it to happen.
Nociceptor: a sensory receptor for painful stimuli. Nociceptive responses are more powerful than proprioceptive ones.
Harold Hoover (1969) used the term ‘dynamic neutral’ to describe the optimal state for returning dysfunctional tissue to normalcy. It is not a static condition but one that promotes efficient movement. One aim of dynamic neutral is to encourage muscle spindles to settle down from a state of exaggerated discharge.
In this state, restrictions are given a chance to unlatch, to release, to normalize. In fact, Jones first called strain/counter-strain (SCS) ‘spontaneous release by positioning.’
(SCS aims to ‘give a muscle what it wants’, by exaggerating the adaptive distortion.)
We are attempting to reduce aberrant afferent impulses in order to quiet the neurological confusion.
Change that occurs in these tissues has been referred to as unwinding (decreasing the torque and helical over-twist).
(Distortion: ‘to twist different ways; to completely twist’; note the relation to the word torque)
In the cervical spine the facet plane is toward the eyes.
Instant functional improvement is possible.
By halting the excitatory barrage of hyperactive afferent input for a period, painful movement can be reduced.
It is ‘axiomatic’ that unless trigger points (TPs) are deactivated the dysfunction will sustain itself in a state that’s been called ‘physiological alarm’ and ‘metabolic crisis.’ Any attempt to extend the muscle will now be strongly resisted. The German physiologist M. Bayer (1950) called it ‘a vicious cycle of self-perpetuating impulses.’
Most every chronic pain problem has a TP component (Melzack & Wall, 1988).
Among practitioners of positional release, the terms ‘bind’ and ‘ease’ are just as common as ‘tight’ or ‘loose.’
Short and tight hammies prevent proper pelvic tilt.
The effects of positional release are based on theories that remain unproven.
TPs suffer from ischemia – lack of oxygen, which is required for the synthesis of ATP (adenosine triphosphate), the catalyst for muscle contraction.
At a trigger point, the neurotransmitter acetycholine (ACTH) is released in excessive amounts at the neuromuscular endplate. Calcium buildup at the trigger point prevents the free flow of ACTH, and the muscle takes the easier road of maintaining the contracture rather than dispense with the calcium.
Stephen Levin (1988) says fascia is composed of building blocks shaped as icosahedrons (a structure composed of 20 triangular sides, as in Buckminster Fuller’s Dymaxion Map).
Dean Juhan: There is not a single horizontal surface anywhere in the skeleton that provides a stable base for anything to be stacked upon it.
Jones, who called TPs ‘tender points,’ has noted episodes of an abrupt increase in joint mobility once the spot is addressed. Simons & Travel say that Jones’ tender points are the same as their attachment trigger points.
Felix Mann, acupuncture authority: There are so many points mentioned in some modern books that there’s no skin left that isn’t a point.
Jones noticed that injured muscle was more likely shortened at the time of trauma, not stretched.
When searching for tender spots, don’t rely on verbal feedback from your client. (One reliable source of feedback is screaming, or it is said.)
A muscle spindle has a direct effect upon the muscle’s strength. Per David Simons, a spindle is like a strand of yarn in a knitted sweater. At the core of a trigger point is a spindle that for some reason is in trouble, and it’s suffering an oxygen deficit.
The scalenes are accessory breathing muscles and are highly vulnerable to TP formation.
Stress: anything that requires a muscle to adapt to it. (A definition inspired by Hans Selye).
An effective protocol begins with TP deactivation, followed by strain/counter-strain (SCS), only then followed by stretching. This has been called the integrated neuromuscular inhibition technique (INIT). Don’t stretch first, but don’t leave the stretching out.
Induration: hardness; something we palpate in a TP. The taut band that a TP is encased in will twitch when we strum it. We’ll feel a drag, possibly some sweat, at the right spot, along with reduced elasticity. Also, the skin hesitates to flow over the underlying fascia.
‘Satellite’ trigger points can produced their own satellites.
We still don’t understand the mechanism by which TPs refer pain, but it’s apparent the brain is being misled by aberrant signaling.
(The observations of Chaitow are virtually in parallel with those of Clair Davies, a non-academic who wrote the Trigger Point Therapy Workbook and gets short shrift from other books.)
When worked properly, nearby tissues can often relax in seconds, often permanently.

From “The Encyclopedia of Thai Massage” (1997/2011) by David Rolance and C. Pierce Salguero
Rating: Poor. Far from being an ‘encyclopedia,’ this work reflects a narrow, new-agey, non-documented approach that falls far short of its purpose and potential.

Massage teachers in Thailand are unlikely to give direct answers to theoretical questions.
Thai massage is energy-work rather than bodywork.
The West likes to write about northern and southern styles of Thai massage, but in Thailand the distinction is not of major concern.
Perform energy work first, then joint manipulations, then stretches. (I do like to hear that stretches are saved for last.)
Develop your ability to ‘hear’ with your hands.
‘Press along the psoas to encourage it to relax.’ That’s bullshit, outside the stated modality, bordering on pure disinformation compounded by unexamined assumptions and reckless technique.
Many clients are hesitant to give up control of their hips. (An outstanding point that makes up for the shallower aspects of this book.)
Encourage your client to breath into a stretch.
The authors have an annoying habit of presenting moves and sequences without rationale or discussion of the muscle groups or acupoints involved.
‘Elbow presses on the trapezius and rhomboid muscles are a great option.’ Is that so?
“As a Thai Massage therapist…” There’s no such thing. They’re masseurs.
All sen lines begin at the navel. They seem to travel in pathways aligned with networks of myofascial tissue (this may be the authors’ interpretation, based on the ‘Anatomy Trains’ influence).
These lines can also dip and turn into the body, often depending upon who in Thailand you ask.
Pressure to the sen line is generally applied perpendicular to the skin. The southern Thai style can now add a thumb-roll across the skin, as if plucking a guitar string. (The real value here, of course, lies in addressing trigger points, even if only inadvertently.)
Acupoints usually have a different qualitative feel from the rest of the area. They’re frequently found along major nerves, next to bones, and around joints.
Blocked sen lines can manifest themselves as knots, tendonitis, or muscle weakness.
Some Thai practitioners (perhaps a handful) profess the ability to ‘see’ energy in their clients (a claim that is not without merit).

From “Bowen Unravelled: A Journey Into the Fascial Understanding of the Bowen Technique” (2013) by Julian Baker
A semi-valuable work, screaming with structural errors, regarding a fringe modality doomed to obscurity. Poor editing leads to wild leaps of logic, placing high demands on the reader to figure out what Baker is saying.

Connective tissues carry out regenerative functions (Theophile de Bordeau, 18th century physician).
Going in deep does not mean going in hard.
The abdominals connect as much with the lower back as with the anterior of the body.
Still held as a central belief today, the theory that the brain controls all muscle movement stems from experiments performed by Galen some 2000 years ago.
If an adjustment cannot be made through the release of soft tissue, it’s unlikely a high-velocity movement can do the same.
KEY POINT: Collagen, the primary component of fascia, is laid down in strong spiral units. Each collagen fibril is a triple helix. The more tension we experience, the more energy is present in these tightly wound, spring-like structures (torquing). Like a jack-in-the-box, little pressure or movement is required to release this energy.
The technique described in this book was developed by one Tom Bowen (1916-82), from greater Melbourne, Australia.
An advanced student should apply as few procedures as necessary to achieve the intended result.
Be confident without being aggressive; it’s surprising how deep we can go if we’re patient. The harder we press, the more we stay on the surface.
One of the primary spots for blockage is just below L2, referred to in Chinese medicine as Ming Men (Gate of Fire, Gate of Vitality). [The spot is also called Mei Mon, or Life’s Gate, and it’s complementary to the Tan Den. The word ‘mei’ can be translated as ‘light.’]
Another primary spot is located in the popliteal fossa, behind the knee (Bladder 54).
Some six centimeters of superficial fascia can cover the glutes.
Another primary spot to work is the attachment of the levator scapulae to the superior medial angle of the scapula. A slight raising of the scapula can lead to pain in the arms and hands.
The coccyx, a highly charged area, is the anchor point for the pelvic floor. All abdominal muscles end with a fascial link here. The coccyx is also a balancer of the autonomic nervous system.
The hamstrings are essentially pelvic muscles.
The body seems to have an innate mechanism whereby connective tissue, given the correct stimulus, can return to a default state. (Why there’s no mention of trigger points in this regard begs a serious question.)
The majority of sports injuries are recurrences of old ones.
Psoas major is more a stabilizer than a flexor of the hip.
The pec major is virtually continuous with the deltoid.
SCM fascia is continuous with the fascia of the scalp.
Compensation causes conflict.

From “The Concise Book of Trigger Points” (2005) by Simeon Niel-Asher
In this work, Niel-Asher makes some forward progress in the study of trigger points, the aspect of massage therapy that holds the most promise for the future. The author’s assertions carry strong implications for the field of sports massage as well.

For better or worse, the author has coined his own modality called the Niel-Asher Technique, which of course he has abbreviated NAT.
A trigger point (TP) makes its host muscle shorter and fatter.
Alleviating a trigger point helps open the myofascial environment of the muscle.
The literature offers conflicting advice on the direction of pressure over a TP. Asher suggests finding the direction pressure that most exactly reproduces the pain. (Excellent advice)
Keloid, or scar tissue, can cause a deviation in the myofascial strain pattern and hence the location of the TP.
The presence of nicotine in the system interferes with the repair of tendons.
‘Jump sign’: an indicator that you’re on the right spot.
TPs were first described by Dr. Frank Chapman in 1920 as “small pears of tapioca that are firm, partially fixed, and located under the skin in the deep fascia.”
Some TPs take longer to respond to treatment than others, depending on the type of muscle fiber.
When a TP forms, the sarcomeres have become overactive; microfilaments stop sliding over one another and get stuck. However, most of the dysfunction is occurring at the extrafusal motor endplates and their electrical activity is far above normal. The chemical balance is also out of whack. More energy is now needed to sustain contraction. The TP appears to be a protective mechanism designed to clamp down on this hyperactivity.
Chronic active TPs provide a continuous barrage of afferent signals into the spinal cord.
Left untreated, “degenerative changes” can ensue (Simons).
It’s a bad idea to force muscular activity through pain, as this can activate latent TPs. For similar reasons, don’t lift weights when you’re fatigued.
The area of a TP can be more moist than surrounding tissue. It can also feel a little like sandpaper.
TP activity can reduce lymphatic flow.
Bruising is more likely to occur if you work too fast. Depth is a secondary issue if you’re on the right spot.
The release of especially pesky TPs can improve the functioning of the autonomic system.
TPs tend to occur along predetermined lines of force in the myofascia. Some would equate these lines with the meridians. These meridians are seen by some researchers as lines of force designed to help dissipate the bumps and grinds of daily life.
Stroke a TP in one direction only.
Afterward, a client may report a sensation that a joint is “oiled inside.”
As a result of TP deactivation, a muscle can spontaneously regain strength and power.
Coordinated movement is achieved by triangulation achieved with agonists, antagonists and fixators. Fixators hold a joint still so the other two can do their work.
TPs in the scalp can lead to “jumping text” as we read, in addition to squinting and wrinkles on the forehead.
Twitching most anywhere in the body can be TP-related.
TPs can be caused by prolonged dental work, excessive chewing of gum, and exposure to too much air conditioning.
TPs in the ptergygoid can lead to blocked ears. When found in the digastricus we can find problems with speaking and singing.
The SCM is sometimes injured at birth, which can lead to chronic wry neck. SCM TPs can also lead to diminished spatial awareness.
(It seems a reasonable conjecture that TPs can prevent the muscular lift promoted by Ida Rolf.)
TPs in the rectus abdominis (uptown bus) can lead to indigestion and heartburn.
The diaphragm produces about 60% of our breathing capacity. TPs here can produce a stitching pain when running.
The author does recommend stretching in order to release certain TPs, a practice that is debatable.
TPs can make joints grind, grate, crunch, snap or click. They can produce a stitch in the side of the body.
TPs in the pec major can affect heart rhythm.
TPs in the biceps can reduce arm extension.
When a hand loses its gripping power, the source may be a TP in the palmaris of the forearm.
The gluteus maximus contains the most coarse fibers in the body. TPs here can lead to pains at nighttime. Injections into the butt can also set up TPs here.
A large amount of leg pain begins in the gluteus minimus and hammies, which are loaded with potential TPs.
Persistent, internal groin pain may begin in the pectineus, which is sandwiched between the psoas and the adductor longus.
Trigger points in the quads can affect the glide of the knee as well as full leg extension. The knee can also unexpectedly give way. TPs in the quads can also lead to restless leg syndrome.
The TP of tibialis anterior lies right at the classic acupoint ST36, and it can lead to what we call shin splints. Working here can possibly head off cramping as well. Working TPs of the gastrocnemius are also helpful in this regard.

From “The Concise Book of Acupoints” (2010) by John Cross
Short on theory but strong on creative assertions that can open up new lines in one’s massage practice. Effective illustrations. As a kid, the author probably liked to categorize things and make lists.

The names of meridians were standardized in 2003 by the World Health Authority. For instance, the names Pericardium and Triple Energizer have supplanted Heart Constrictor and Triple Heater, respectively.
When working a point, a practitioner should evoke ‘deqi,’ which means ‘acquiring the qi.’ This appears similar to the ‘reaction pulse’ described elsewhere on this site. Indicators of deqi include a traveling tingle sensation and stomach rumbling.
'Source points' are located around the ankles and wrists, reinforcing the importance of including the wrists in a standard massage sequence.
It is a pity, the author says, that modern meridian charts do not show the deeper channels.
On the stomach meridian, some traditional charts say the first point is actually ST8, which the author feels makes more sense than ST1.
Some of the most important points along the meridians are now spelled out:
Lung 7, or Narrow Gap. In the depression about 1.5 cun (width of two forefingers) southwest of the radial styloid of the wrist. Assists with depleted energy and addictions.
Stomach 36, of course, is a key point for addressing lethargy and even a lack of resolve. The author says we treat it with some “aggression,” but I’ll settle for assertion, thank you. Found atop the tibialis anterior, ST36 is also an excellent ‘pre-event’ acupoint for athletes. Ditto for the nearby Gall Bladder 34, located a little to the front and beneath the head of the fibula.
Spleen 6 (Three Yin Intersection) is located 3 cun up from the outer ankle, just behind the tibia. It sits where the meridians of the kidney, spleen and liver meet up, and it’s helpful in cases of fatigue. Note that the area just distal to the tibia, anterior portion, is rich with beneficial points.
Shen Men (Spirit Gate) is point number 7 along the heart meridian. It’s found on the wrist, at the proximal border of the hand’s pisiform bone, the base of the pinkie. It’s a wonderful point for people who have difficulty sleeping.
Hou Xi (Back Stream) is found just beneath the knuckle of the pinkie finger, on the edge of the hand. It’s said to clear excess energy from the neck and shoulders. It is considered point number 3 along the Small Intestine Meridian.
A canthus is a corner of the eye. The inner canthus, adjacent to the nose, is a meeting point for several meridians and is therefore a helpful spot for balancing energies. The inner canthus is designated as the first point along the Bladder Meridian. It goes by the Chinese name Jin Ming, or Bright Eyes.
The first point on the Kidney Line is the well-known Gushing Springs, located a third of the way from the toes to the heel. The author considers this spot superior to the solar plexus reflex in enhancing the relaxation level of the client.
A related point is found in a similar spot of the hand, point 8 of the Pericardium Channel (Labor Palace or Palace of Anxiety). As related elsewhere on this site, it helps direct excess energy from the heart. Note that some other points along the wrist assist with this function as well. Some have nicknamed P8 the ‘stigmata’ point.
Gallbladder 21, or Shoulder Well, is located at the midpoint of the top of the shoulder, midway between C7 and the acromion. It is helpful with rotator cuff restrictions, including difficulty lifting the arm. A multipurpose point, the author says it also assists with matters of self-expression.
An essential spot to hit is point 3 along the Liver Meridian, found in the webbing between the big toe and the adjacent metatarsal bone. A sister point of Hoku in the hand, it’s helpful in addressing muscle pain and spasm. It also assists with headaches, dizziness, and agitation. Known as Great Surge, the point is also beneficial to athletes with sprains and strains or who over-exert themselves. Thirty seconds of simple pressure here can also help relieve cramps.
The conception channel is sometimes called the Intake Channel.
In most people the solar plexus chakra/point (Conception 14, located one cun beneath the xiphoid process) is either over-stimulated or congested.
Conception 17, or Dan Zhong, is located at the center of the chest, between the nipples. Called the center point of the body, it’s useful in calming the mind.
The most important point on the body could be Governing 1, Chang Qiang, or 'Always Strong'. It’s located at the tip of the coccyx, though it can be worked a little further north for modesty purposes.
Governor 14, or Great Vertebra, is located between C7 and T1. It forms the center point of various physical forces as well as five meridians, some of them running deeply.
Another powerful spot lies between the eyebrows and is known as the third-eye point. The ancients didn't always recognize it officially, so over the years it got "slipped in" as point 24.5 along the Governing Meridian.
Working the webbing of the hands and feet can alleviate various forms of arthritis.

From “Muscle Energy Techniques” (1996) by Leon Chaitow, MD
A strong academic overview of the technique, with the typical academic lack of spirited assertions.

The attempt to restore joint integrity before restoring muscle normality is like putting the cart before the horse.
– Andrew Taylor Still
There are no contra-indications to the use of MET (muscle energy technique) if it is applied thoughtfully.
MET is less likely than PNF to induce cramp.
Localization and precision of force is more important than intensity.
MET is useful in the treatment of trigger points.
As the abdominal muscles are freed and lengthened, there is a general elevation of the rib cage, which in turn elevates the head and neck.
“After stretching of the tight muscles, the strength of the weakened antagonists improves spontaneously, sometimes immediately, sometimes within a few days, without any additional treatment.”
– Dr. Vladimir Janda (1928-2002), Czech expert in chronic musculo-skeletal pain
Muscle imbalances change the equilibrium point of a joint.
“The spinal cord is the keyboard on which the brain plays.”
– Dr. Irwin Korr, osteopath (1904-2004)
In shortened muscle, connective tissue will become orientated in random fashion, less capable of handling stress along normal lines of force.
The erector spinaes do not actually move vertebrae, as many believe. In reality they’re more like stabilizers and proprioceptive receptors.
Fascia is the tissue that surrounds the central nervous system.
A tight biceps femoris (a hammy) can tighten up the sacrotuberous ligament. This in turn decreases the range of motion of the sacroiliac joint.
The word spasm is used very loosely, even by professionals.
The author refers to the center of a trigger point as a “nidus.”
Trigger points, spots of “neurological mayhem,” can be relieved by MET.
After applying an isometric contraction there’s a latency period of 15 to 30 seconds.
Let the client apply no more than half of their strength.
Increasing the duration of a contraction – up to 20 seconds – may be more effective than any increase in force.
When a patient actively participates in moving a released muscle into stretch, you’re reducing the chances of activating the myotatic stretch reflex.
When applying isometric contractions on the hammies, use no more than 25% of your client’s effort so as not to induce cramp.
PNF was originally developed for stroke victims and was later discovered helpful for children with cerebral palsy.
“Poor results are most often due to improperly localized forces, usually too strong.”
– osteopath John Goodridge
MET typically calls upon the athlete to apply about 20% to 30% force against resistance. This lower level of force may fail to activate a necessary threshold of fibers housing a trigger point.

From “Are You Tense?” (1978) by Ben Benjamin
One or two authors in the field have bandied this title about as an early classic, but the content falls far short of this stature.

As early as page four, the author whips out the patronizing phrase “as I have already stated,” an indicator of mediocre things to come.
Tension reduces our ability to breathe deeply.
Watch your client’s face. A good point, taken from reflexology, that should also be applied on the table.
Chapters are presented as “lessons” without the requisite level of theory to back up the technique.
The author takes a standard massage sequence and elevates it into his own particular “system.”
Good point: “Flaccid tension” represents an energy withdrawal from the musculature. Muscles seem loose but actually harbor deep tension, with little energy flow. They feel weak, and we notice cold hands and feet. The body is flabby.

From “Shiatsu: Japanese Finger Pressure Therapy” (1976) by William Schulz
Not even good enough for the bargain bin.

For an ill person, applying one or two pounds of pressure can be comparable to ten pounds of pressure on a healthy person.
Most arthritis headaches start in the cervical region due to calcium spurs forming along the vertebrae. These spurs strike nerves between the vertebrae, and the pain can also be felt down the arm. (Calcium is also a culprit in the knee and foot.)
The calcium will have the consistency of coral, with sharp edges.
Many tension headaches can be sourced to the serratus posterior superior muscle. The levator scapulae may also be involved.
Assertion: most shoulder and neck problems start in the scapula muscles.
Yin and yang can be described as Dr. Jeckyll and Mr. Hyde. (Spare us.)

From “The Art of Russian Massage” (2005) by Olena Melnikova Adams
A disappointment, full of technique with virtually no grounding in theory. The author was raised in Odessa, Ukraine.

After a massage, we need to clear away the energies of our clients, if only by washing our hands and arms thoroughly.
Legends tell how ancient Russians (and Chinese and Indians) received precious knowledge from “Sirs of God.”
Russian massage was first formalized by a Dr. Matvei Mudrov (1776-1831), whose lifetime coincided with that of Sweden’s Pehr Ling.
In 1941, Dr. A.F. Verbov published an authoritative textbook on massage.
Russians have practiced a form of cupping for hundreds of years. An earthenware pot called a krinka is used to create a vacuum seal over the skin.

From “Tao Shiatsu” (1995) by Ryokyu Endo
A disappointing precursor to Endo’s stronger “New Shiatsu Method” that came out nine years later.

In the East, the motive for writing is to reproduce an experience. The dissemination of academic knowledge is secondary.
Treatment consists of stimulating the “dormant vital energy” in the patient and restoring its circulation.
Cause and effect are inseparable because each has the potential to become the other. This dynamic is known as simultaneous cause and effect
One of the basic techniques of Chinese martial arts is to block the opponent’s ki flowing through the meridians. (Place him into a startle pattern?)
“Where there is no internal scar, there is no external evil.”
– Japanese proverb
The Chinese character for ‘sage’ is made up of two characters meaning ‘ear’ and ‘to develop.’
“The sage is one who knows by listening.”
– Chinese proverb
The Classics state that the patient who is filled with toxins is jitsu. (Perhaps one of these toxins is excess calcium.)
A treatment transfers the toxins elsewhere by the ‘sha’ (dispersal) method, and the ki that has stagnated is allowed to flow again.
“Flexibility overcomes rigidity.”
– phrase in judo
The word ‘judo’ literally means 'the way of flexibility.’
The expression “black hara” means slyness.
Technically kyo means 'a state that is void of ki energy'. The character for kyo represents something that is sunken in the middle.
Kyo is the world of emptiness (as in ‘hollow’ or ‘not ready’ or ‘broken concentration’).
Meridians in the hara, as displayed in traditional diagrams, do not offer a clear indication of where the meridians are actually positioned. Rather they illustrate the part of the body where a response (referred pain?) may appear.
Shizuto Masunaga noted that meridians in the ancient classics were conveniently simplified according to the practical needs of acupuncture and moxibustion. In order to train growing numbers of students in past eras, the positions of the meridians were clearly defined (even though, in actually, their positions float). At the same time, the number of tsubo was established at around 360.

From “The Vital Glutes” (2014) by John Gibbons
Slightly academic, but still readable. The text calls for at least two read-throughs to digest the material properly.

”Where you think the pain is, the problem is not.”
– Ida Rolf
By correcting a dysfunctional pelvis, other presenting symptoms can often settle down.
Pain and dysfunction are usually traced to an imbalance somewhere in the body. Any imbalance usually involves the gluteals.
The iliopsoas finds itself in a shortened position most of the time. A shortened psoas leads to a lengthening of its antagonist, the glutes. If the glutes are held in a lengthened position for too long a time, weakening develops.
Because of their resistance to fatigue, postural muscles are mainly composed of slow-twitch fibers. Most problems with muscle shortening will occur here, in the posturals.
Walking and running impose high loads on the sacro-iliac joint.
Core muscles such as the obliques can be treated individually, but it’s much more effective to work on them as one whole group.
Because our society sits down too much, most of us have actually altered our center of gravity.
Blood flow through a muscle is inversely proportional to its level of contraction or activity, reaching almost zero at 50-60% of contraction. Some studies indicate that the body cannot maintain homeostasis with a sustained isometric contraction of over 10%.
A weakened gluteus maximus is believed to decrease the efficiency of our gait.
The gluteus maximus (Gmax) itself does not normally present itself with pain. As a result, many physical therapists place its importance on the back burner.
Weakness or misfiring in the Gmax calls upon the hamstrings to compensate and remain overactive.
The author has treated many rowers at Oxford University in England. At least a third of them complain of pain in the lower back. For at least half of these rowers, the lower back pain can be traced to the Gmax.
The gluteus medius (Gmed) should be assessed in every running injury. Even when the injury appears in the trunk or leg, most of the time the Gmed is still functioning at a sub-par level.
Patients with weakness in the posterior fibers of the Gmed tend to have overactive abductors. The ITB and piriformis can also act up.
A weakened Gmed can also lead to over-pronation of the sub-talar joint (where the talus meets the heel). The foot now lands more on its inner margin, and this can contribute to shin splints, plantar fasciitis, or problems with the Achilles.
Athletes are sometimes told they need to strengthen a weak Gmed. Instead, they should focus on the shortened and tight tissues of the adductors, TFL and QL. As a result, the Gmed should naturally shorten and regain strength within a couple weeks.
METs (muscle energy techniques) were first discussed by Fred Mitchell in 1948.
METs can improve flexibility, but their primary purpose is to facilitate range of motion.
The contraction that the client applies against resistance might average around 50%. The contraction helps stimulate more motor units to fire. This in turn increases stimulation to the Golgi tendon organ (GTO), leading, perhaps contrary to logic, to a more relaxed muscle.
A stiff joint can become a tight muscle, and a tight muscle can become a stiff joint.
When a MET is applied, the protective relaxation of the GTOs overrides the protective contraction from the muscle spindles. The tone of the muscle spindles is now reduced, a reduction that lasts for about 20 to 25 seconds. It is during this window of opportunity that muscle tissue can be more easily moved to a new resting length.
Reciprocal inhibition is considered less powerful than post-isometric relaxation (PIR). PIR is usually the technique of choice for muscles that are classified as short and tight.
During an isometric contraction, it takes about 10 to 12 seconds to load the GTOs. We are now overriding the influence of the muscle spindles. The client should experience no discomfort or strain.
Sherrington’s law of reciprocal inhibition (1907) states that a hypertonic antagonist muscle may be reflexively inhibiting its agonist.
Innominate bone: hip bone. ‘Innominate’ means ‘not named.’
Consider the psoas major a filet mignon. Filet mignon means “tender filet,” and the portion of beef comes from the psoas major of the steer or heifer.
The author asks, can injuries related to the knee joint be traced the glutes?
The ITB has a direct effect on the tracking mechanism of the patello-femoral joint.
Weakness/inhibition of the glutes has been related to ankle instability.
A tight muscle will pull a joint into a dysfunctional position, and a weak muscle will allow it to happen.
The most frequently injured joint is the ankle.

From “Tsubo: Vital Points for Oriental Therapy” (1976) by Katsusuke Serizawa, MD
A recipe manual (“touch this point, achieve this result”) from a teacher whose reputation far exceeds the worth of the text. A helpful reference guide for advanced students concerned with learning the classic names of acupoints. The author was a full professor at the University of Tokyo.

To overcome an illness, a person must be restored to harmony with the rules of nature. (We know this, but it’s a point worth repeating.)
There are 365 tsubo on the human body. They occur in places that are physically weak. For example, we find them in the depressions at the junctures of muscle, places under the skin where nerves emerge from muscle, the trunks of muscles and nerves, and the spaces between wrinkles in the skin.
Tsubo are weak spots where organic disturbances produce powerful reflex actions.
Skin and muscular alterations in ailing people are concentrated in the regions of the tsubo.
The sciatic nerve controls the muscles of the calves. Impingement of the sciatic can therefore lead to cramping in the calves. (We can deduce a possible connection here between cramping of the calves and a glued psoas.)
Nerves controlling the diaphragm emerge from the third and fourth cervical vertebrae. (Perhaps here is where we can concentrate out efforts in cases of diaphragm disturbance.)

From “Sport & Remedial Massage Therapy” (1996) by Mel Cash
Cash previously co-wrote the book Sports Massage, reviewed on this site and published in 1988. In comparison, this 1996 work is text-booky and plodding. A national-level instructor once told me this one is a "classic," but I beg to disagree.

When blood is pushed up a vein by stroking, a momentary vacuum is created. This is the dynamic by which fresh blood re-enters the spot.
As we know, it’s muscular contraction that aids in the process of lymphatic flow. As we can imagine, muscle injury can hinder this process.
Since adhesions contain no blood vessels, no damage can occur when they are broken down, though some pain may be felt.
Often a large knot will appear to subside a mere 10% during a massage. But when palpated a few days later, the reduction in size can approach an additional 20% to 30%.
Perhaps the most important contraindication a massage therapist needs to be aware of is deep-vein thrombosis (coagulation/clotting). Fungal infection is another major disqualifier.
Exercising can affect a person’s blood-sugar level, and so can vigorous massage. A diabetic client needs to be aware of this possibility.
With a good working posture you can assess tension with your whole body, not just with your fingers and hands.
Clients with very low levels of Qi energy can literally drain some of it from the practitioner.
Sometimes just a few fibers of tissue no thicker than a human hair are damaged.
To gauge the level of pain a client is experiencing, don’t just watch the face. Watch for curled toes or a clenched fist (or screaming).
To simply provide direct pressure to a troublesome spot is relatively ineffective. Glide your fingers in various directions to assess for any textural changes. (Other professionals would challenge this contention.)
After breaking up scar tissue with deeper work, superficial strokes will flush circulation through the area, clearing away scar debris.
Don’t break up scar tissue for more than a minute lest you stimulate a local reflex contraction.
The influential Dr. James Cyriax (1904-85) advocated working for up to 15 minutes, though some practitioners may consider this excessive. (Cyriax spent much of his career at arms-length from the British medical establishment. Those men are dead and forgotten while the name of Cyriax lives on.)
Soreness that accompanies hard exercise is due more to micro-tears of small muscle fibers, not necessarily actual strain. Nor is this soreness generally due to the common misconception of the buildup of lactic acid. (Later research bears this point out, and we just got our first indication that Cash is an independent thinker.)
Muscular imbalances lead to problems in the bone structure.
Bursa not only reduces friction, it acts to distribute lines of stress.
Most tendons can tolerate a stretch of about five percent.
For large tendons encased within a sheath, such as the Achilles, you can sometimes feel a creaking sensation (termed crepitus) during movement. Crepitus is an indicator of scarring within the sheath itself.
If we don’t clear away particles of scar tissue that remain after friction, they can reform and recongest. Once cleared of debris, stretch these tissues to help restore normal length.
(The author challenges the common notion that pre-event sports massage needs to be stimulating as opposed to sedating. He claims that most athletes are already pumped up enough and can actually benefit from a little settling down.)
The 24 vertebral discs make up a third of the spine's length.
You can help release the inaccessible psoas by working its cousin, the quadratus lumborum.
Tension in the scalenes can impinge the brachial nerve plexus and thus refer pain down the arm.
What we call “groin strain” can actually result from tissue damage near the pubis attachment.
Though the lats cover most of the lower back, they are really a shoulder muscle. Though large and strong, the force of contraction is focused at a small area of attachment at the humerus.
Injury to the rotator cuff muscles is often mistaken for “frozen shoulder.”
To have large muscles in the hand would restrict their dexterity. Their power comes from the forearm and is transmitted through the tendons.
Regarding the gluteals, the gluteus medius is commonly the most tense of the group. It controls the lateral stability of the hip joint and is in constant use during running activities.
With the aging process, lubrication to tendons becomes less efficient. They can become drier and less pliable.
Deep pressure to the Achilles helps to clear congestion and improve circulation.
Sometimes a chronic leg, hip or back condition can be alleviated only after treating the foot problem first.
Postural imbalances almost always involve the psoas. Whenever dealing with pain in the lower back or hip, always place the iliopsoas on your list of suspects.
Imbalances within the quad group are the most common cause of chronic knee pain. They can also affect the tracking of the patella.
In effect, the ITB (ilio-tibial band) is the tendon of the TFL (tensor fascia lata). It connects the TFL to the tibia and controls lateral knee stability.
Success requires considerable subtlety.
Excessive tension in a muscle makes it pull tighter through the tendon and its attachment. Located at this point are the golgi tendon organs (named after the Italian physician Camillo Golgi.) These organs are load detectors. They feed information to the central nervous system and help regulate muscle tone. Precise pressure here will inhibit the neural messages emanating from the organ, facilitating relaxation throughout the entire muscle. (Our old friend the “turn off to turn back on” technique.) This method can be effective for releasing tension in deeper, less accessible muscles.
For example, you can help relax deep hip extensors by working along the iliac crest. This approach can also work for traumatized muscle that won’t tolerate direct pressure.
Nearly every musculoskeletal problem involves some type of imbalance.
PNF stretches call for only about 50% exertion on the part of the client, held for about ten seconds. (A current rule of thumb is about three-quarters strength for about 7 seconds.) This approach of less effort for a longer time appears more effective than the “more intense for a shorter time” approach. The governing factor appears to be time rather than intensity. (Here’s another reason why it’s difficult to adequately treat an aching client within the standard 60-minute time frame.)
It takes time and effort to strengthen muscle fiber, but nerve conductivity improves quickly when stimulated.
When muscle tissue becomes fibrotic, the fibers become matted together and cannot glide independently. It takes a powerful force to break these bonds, such as PNF (proprioceptive neuromuscular facilitation). PNF provides a strong shearing force between the fibers, helping to break the adhesive bonds. (Shear: a strain in the structure of a substance produced by pressure, when its layers are laterally shifted in relation to each other. Wind shear: a sudden change in wind velocity and/or direction.)
PNF is an advanced form of MET, or muscle energy technique (a rather broad and vague classification).
Connective tissue manipulation (CTM) has origins in Germany in the 1930s (an early proponent was Elizabeth Dicke, though some people may trace the origins of CTM back into the nineteenth century). It was discovered that nerves that supply a given organ contain a peripheral segment that innervate a particular segment of the skin and its subcutaneous layers. Thus, an organ dysfunction would also reveal itself as poor plasticity in a particular skin region. By addressing the skin you affect the related organ.

From “Stories the Feet Can Tell Thru Reflexology” (1938/63) by Eunice Ingham
Ingham (1889-1974) is considered a “founding mother” of foot reflexology. The edition listed here contains Ingham’s follow-up work “Stories the Feet Have Told Thru Reflexology.”

It wasn’t until the end of the 16th century that the medical minds of Europe began to accept the fact that blood circulates through the body. This new awareness followed years of bitter ridicule of the notion.
As soon as we allow the muscles of our body to weaken, the muscle tissue in our feet gives way. Waste matter or crystal-like formations begin to gather.
Usually it is the second or third reflexology treatment that produces the desired effect. Each treatment takes 20 to 30 minutes, or even faster with experience and proper training.
When examined under a microscope, acid crystals that form in nerve endings of the feet resemble particles of frost. They act like obstructions in the fuel line of a car while we unknowingly blame the motor. This congestion occurs in the fine, hair-like capillary system where the circulation makes that important transfer from the arteries to the veins. In similar fashion, water can’t flow through a garden hose when we’re stepping on it.
Use a slow forward creeping motion, not with the flat ball of the thumb but with the corner. Develop a sensitivity toward finding gritty substances in the foot. These indicate areas of tenderness that will gradually disappear with treatment.
As long as the slightest tenderness remains in the nerve endings of the feet, you are still fighting to break up and scatter crystalline deposits. These points of congestion are potent poisons.
When a bodily ailment causes any trouble with the eyes, you will find the spots between the toes very tender.
A stiff lame neck responds very well to treatment of the large toe.
Nature is constantly struggling to eliminate waste matter from our body. Our skin, for instance, throws off three pints of poison per day. If this poison were injected back into the bloodstream we’d be dead in three days. When we worry, we tighten up our pores and reduce the eliminations of these poisons, straining our kidneys and heart.
In cases of glandular trouble, especially when coupled with a diabetic condition, the pituitary reflex in the center of the big toe will invariably be tender. Tenderness is the result of congestion that must be released before one can experience any degree of relief. This congestion is in the form of crystals in the nerve endings which create resistance to their proper signaling. Nerve tissue is more sensitive than any other tissue of the body.
The author never found a case of asthma where the reflexes to the adrenal glands were not tender. Adrenal secretions stimulate the action of the heart and are thus key to our sense of well-being.
At first, go easy when treating the heart reflex. Find the tenderness, move somewhere else, and then come back.
No harm can be inflicted by working a reflex point. This is a certainty.
When the liver is sluggish the person will experience a lifeless, lethargic feeling.
Treating a severe case of sciatica can bring tears to the eyes of the recipient. To prevent this, pay attention to facial expressions. Beginners watch their hands. In time, watching facial expressions is a more precise method of finding reflexes than watching your hands and the client’s foot.
If any one of the 26+ bones of the foot become displaced, nature fills in that misplaced joint with a calcium deposit.
For constipation, thoroughly work the area of each inner ankle, beginning with the heel and working up 6 to 8 inches. In some cases this can produce a bowel movement in short order.
Circulation is life, stagnation is death.
For troubles in the knee, we can work the elbow. For the ankle, we can work the wrist and vice-versa. This same principle holds for the hip and shoulder.
The center of every cell in the body is composed of the same gray matter as the brain.
“Pain is the cry of a hungry nerve for better blood supply.”
– Dr. Frank Chapman, famed osteopath of the early 20th century. (Chapman favored gentle over strong pressure to a point. Over-treatment can fatigue the reflex arc.)
The average practitioner of reflexology needs to get more specific in the points they apply pressure to. Avoid trivial conversation so you can watch your client’s face better. You need to develop your self-concentration so you know when to leave one reflex point – when the application is complete – and move onto the next. If you neglect this level of self-concentration, you will fail.
Concentrate your attention on the intensity of pressure each client can endure.
Imagine a few grains of granulated sugar in your left hand. Now break them down with your right thumb. This is proper pressure. With this thumb, creep forward slowly and then slightly pull back. Steady pressure is less effective.
Let us manifest a spirit of meekness.
Definition of worry: carrying tomorrow’s load on today’s truck. Regret is akin to worry.
Anger produces more poison that does fear.
If the reflex to any particular gland is tender, try that of other glands also. This will help ensure you’re reaching the true source of your client’s disturbance.
The thyroid hormone contains iodine, which is necessary for our sanity. The thyroid produces about two milligrams daily, which is our buffer zone between sanity and instability. It is believed that many criminals and mental patients suffer from a thyroid deficiency.
You can work both solar plexus points simultaneously. Increase the pressure while the client inhales deeply. Repeat six to eight times. This helps jump-start the process of relaxation.
A disturbed pituitary interferes with our ability to reason normally. It can also lead to insomnia. Its reflex on the big toe is only the size of a pinpoint, so hook in with the corner of your thumb. If the pituitary is the orchestra conductor, the thyroid is the first violinist.
Dry and scaly surfaces on the skin indicate congestion. Every corn, callus and bunion affects some organ or tissue of the body.
Migraines may be the result of gastro-intestinal disorders.
Kidney function appears related to the condition of the eyes.
“Each portion of the surface of the body is related directly to a physiological function through its sympathetic connection with the brain. The map of the organs of the brain is reproduced on the body.”
– Dr. Joseph Buchanan, Therapeutic Sarcognomy, 1846
Also from Buchanan: Intense stimulation of the lower limbs has the power to arouse the dormant vitality of the base of the brain.

From “Sports Massage” (1988) by Dr. Jari Ylinen and Mel Cash
A noteworthy contribution to the field. Ylinen is an acupuncturist and ‘remedial masseur’ from Finland. Cash is an instructor, author and therapist in London.

In the preface, the authors explain why they don’t categorize massage methods, unlike other books, according to the specific needs of various sports. They note that even within the same sport, training methods and body conditioning may vary, so such a list would be misleading. Say the authors: Treat the sportsman, not the sport.
Incomplete recovery from training and competition reveals itself as muscle and joint pain in addition to tendon and bursa discomfort.
Traditional stretching tends to affect all the myofascial structures in a given area equally. With sports massage we hone in on specific localized areas for greater effect. For instance, we aim to “unbunch” muscle fiber so as to increase intramuscular circulation and break up adhesions between muscle bundles.
According to ‘gate control’ theory (Melzack & Wall, 1965), the stimulation of massage helps to reduce pain by limiting the amount of pain impulses that extend beyond the dorsal horn (‘gate’) of the spinal cord.
Don’t treat just the belly of the muscle. When treating an attachment point, work toward the belly. This applies a stretch to the tendons and induces a 'reflectory relaxation' of the muscular unit. (Reflectory in this case appears to be used in the sense of an indirect and involuntary reflex action, as if we’re fooling the muscle into compliance.)
In many cases of muscle tension, tenderness is found at the muscle/tendon junction (a key point of sports massage guru Jack Meagher). This is where strains and scar tissue most commonly show up because the tissues are more compact, resulting in less movement between fibers.
In the abdomen, problems frequently occur near the attachment of the rectus abdominis to the pubic bone. (The author spells it abdominus, a possibly British variant that has given me confusion in the past.) Instead of working close to the pubic area (and the squeamish-factor involved), concentrate on the muscle’s lateral border.
It usually takes up to two days for the full effect of a massage to be achieved.
When contracting a muscle in isometric fashion against resistance (muscle energy technique, or MET) the athlete should apply only about 20% of his strength. (PNFs – discussed elsewhere on this site – generally call for a stronger force, up to about two-thirds of full strength. Also note that the line is blurred regarding how various professionals define a PNF vs. a MET. Technically, a PNF is a form of MET.)
(A good rule of thumb, as presented by Leon Chaitow, is that with a MET the therapist can feel the resistance but the client can’t. By the time the client can feel the stretch you’re now in PNF territory.)
With long-term painful conditions there is usually a disturbance of the autonomic nervous system. The sympathetic system is often overactive, causing constriction of blood vessels.
The smallest division of a muscle that may be in contraction is a single motor unit. Several motor units in contraction will feel like a small nodule or piece of string in line with the fibers surrounded by otherwise normal muscle. (A point noted by Thomas Myers in his book Anatomy Trains, reviewed below on this page.)
Larger muscle ruptures can be felt as a hard bulk of contracted tissue which may be located a short distance from the site of the actual trauma. The muscle naturally goes into contraction when a break occurs between attachments. At the site of the trauma a hollow area will be felt if there is not excessive swelling.
Stroking applied away from an attachment is more effective than applied toward the attachment. If working away from the heart, keep the strokes shorter.
Diffuse aching in the knee joint is often referred from the quads.
Stretching the ITB (iliotibial band/tract) releases tension and improves circulation in the entire leg. You can’t relax the quads properly without working the ITB.
The most vulnerable adductor is the adductor longus, particularly at its attachment to the pubic bone. Because of fascial overlap, tenderness can continue onto the nearby attachments of the rectus abdominis.
Longstanding ischemia (inadequate blood supply) inevitably leads to muscle necrosis (death of cells).
A tight gluteus maximus can produce tension in the thigh and diminish function of the knee. Many athletes consider the quads their most important muscles, yet it’s the gluteals that should take center stage. Their muscular component is very strong, so most injuries are found around the distal attachments.
Gluteus maximus originates over the sacroiliac joint, so work the lateral borders of the sacrum and you’ll also help free up the hammies. Note that attachments in the hip joint run very deep, so maximum relaxation is called for first.
Bursitis should not be treated directly, but working over the ITB can help bring relief to the knee.
An athlete in training will pay a price someday if he or she overtrains the quads at the expense of the hamstrings.
Excessive tension in the calf muscles can cause pain in the back of the knee.
Due to their relative inaccessibility, deep back muscles are less affected directly by massage. The way to induce relaxation here is to address the more superficial erectors.
A prolapsed disc (slipped/herniated) is not necessarily a contraindication for massage. (There is slight disagreement on this point, so a go-ahead from a physician is advisable.) However, the masseur can provide relief indirectly by alleviating secondary muscle tension. (Such discs can impinge a nerve root, sometimes causing pain and other symptoms in the leg.)
Pain from the teres minor (‘little wheel’ / and it's been described as the 'little helper' of the infraspinatus) can sometimes radiate down to the fingers. Being a small muscle it is prone to strains, usually located near the attachment with the upper arm. Massage treatments usually concentrate on the belly of the muscle, where some pain is felt, but the source is usually the attachment area.
Subscapularis is the strongest inward rotator of the arm.
The author refers to the rhomboid as rhomboideus.
Over 80% of headaches originate in the neck and masticatory muscles.
With the triceps, give more attention closer to the olecranon (elbow).
Rest in itself is seldom an effective treatment.
Crepitation: a cracking or rattling sound.
About 5% of the population has a sternal (breastbone) muscle that runs downward along the sternum and has no known function.
Excessive strain in the abdominal muscles can often lead to pain, some of which can simulate internal diseases including urinary tract disorders or even appendicitis.
Abdominal massage can induce general relaxation because we're in close contact with the autonomous nervous system. (Yes, it’s more customary to use the word autonomic.)
In cases of prolapsed disc in the upper lumbar vertebrae, the psoas may go into protective spasm, restricting all movement in the back. If the spasm occurs on one side, we can see rotation of the vertebra. Spasm on both sides can lead to a forward-leaning posture. The spasm is the body’s attempt to prevent nerve endings from being compressed even more.
The center of the diaphragm features a clover-leaf-shaped tendinous area through which passes the esophagus, the aorta and vena cava.
When an athlete’s performance has been sub-par even though training has been going well, one should consider the respiratory muscles. Sharp pain felt in the upper chest or back, particularly during endurance sports, is usually vertebrogenic in origin, due to tension in the deep muscles of the back. Remember that the spine straightens upon inspiration and becomes more curved during expiration.
If you’re going to apply deep massage, give it to an athlete at least a week before a significant event. This allows plenty of time for the full benefits to accrue. Then have the athlete train lightly for the next couple of days.
Endurance sportsmen such as marathoners can have up to 90% slow-twitch fibers in their quadriceps. These muscles tend to be small, softer and more relaxed. On the other hand, a fast-burst sprinter can have up to 90% fast-twitch fibers in the quads. These muscles are larger and contain more natural tension. The masseur must adjust accordingly, trying to restore the level of tension that’s normal for the athlete and not try to achieve the same level of softness as the endurance sportsman. In sports requiring fast performance and reaction times, too much relaxation can yield negative results.
If you concentrate on only one side of the body due to a client’s request, you can end up paving the way for an injury on the other side in the near future. Work both sides. For instance, when treating a right tricep, pay some attention to the left. When working the quads, don’t neglect the hammies, even though these are smaller than the quadriceps and generally don’t require the same degree of strength.
Regarding trigger points, the authors mention of course that, when pressed, pain or dull aching can radiate to the area where the referred pain exists. The authors also mention the possible sensation of water running towards the area in addition to warm and cold sensations. Stimulation to a trigger point may also cause hair on the skin to stand up. By tapping a trigger point one can also cause a small local muscle to twitch.
The bodywork approach known as Connective Tissue Massage (CTM) was developed by a German physiotherapist named Elizabeth Dicke (1884-1952). As a young woman Dicke suffered from circulatory problems so severe that a leg amputation was considered. By using a particular type of massage as a form of self-treatment, Dicke avoided amputation and was able to return to work. Her self-treatment caught the attention of some in the medical community, and a correlation was discovered between some internal diseases and dysfunctional skin conditions in various parts of the body. By treating these cutaneous areas, some relief was obtained in certain symptoms and diseases. (Sounds similar to the case of Terese Pfrimmer.) Dicke first published her findings in book form in 1953 (Meine Bindegewebs-massage), key ideas of which were later popularized by Maria Ebner in Connective Tissue Manipulations (1985).
CTM helps release tension by mechanically tearing across layers of superficial connective tissues, breaking adhesions subcutaneously and enhancing relaxation through the reflexes. Fluids are also released, helping renourish connective tissue.
In this regard, one indicator of skin abnormality can be observed by applying finger pressure: if the depression and pale color remain for an abnormal amount of time, you’ve got a circulation problem where the skin meets the fascia.
(Henry Head, MD [1861-1940] was a leading British neurologist who first reported that when internal organs were diseased, they manifested such disorders on the surface of the skin. He named these spots “maximal points,” painful areas that were extra sensitive to touch and temperature changes. It has also been claimed that Head’s maximal points correspond to some degree with traditional Chinese acupressure points.)
The use of CTM in sports therapy is limited.
Lymphatic massage was introduced by the Danish biologist Emil Vodder in the 1930s.

From “The Runner’s World Massage Book” (1982) by Ray Hosler
The author approached this book not as a bodyworker but as a journalist. The flat, vicarious result does not work, except for a few interesting tidbits of massage history.

One of the chief physicians of ancient Rome was Asclepiades of Bithynia (124-40 BC). He eventually abandoned the use of all medicines and relied exclusively on massage, claiming it affected a cure by restoring the free flow of nutritive fluids. (In an era when many physicians treated their patients coldly, Asclepiades was known for his warmth. His popularity was also due, in no small part, to his inclination for prescribing wine for his patients.)
Aulus Cornelius Celsus (about 25 BC to 50 AD), used massage extensively and recommended manipulations of the head for the relief of headaches. He used general manipulations to provide relief from fever and he also promoted the use of percussion.
Wrote the Norwegian Hartvig Nissen in Practical Massage and Corrective Exercises (1916): Many a poor woman of the Middle Ages was burned at the stake because she attended to suffering men by means of massage, “a magic which was looked upon as the power of Satan.”
Friedrich Hoffman (1660-1742) was a physician to the King of Prussia. He recommended medical gymnastics and “rubbing” for the royal court, as did other physicians in Scandinavia, France and England.
John Harvey Kellogg’s The Art of Massage (1895) takes note of a Japanese amma session from that era, saying it succeeded in driving away headache and languor (lethargy). Kellogg’s work in the field of physical rejuvenation was met with great skepticism by some, including charges of quackery.
The oft-cited Pehr Henrik Ling (1776-1839) of Sweden was a former gymnastic instructor and champion fencer. He took special interest in the recuperative power of massage and exercise after it helped cure him of rheumatism in the arm.
Dr. Johann Georg Mezger of Amsterdam helped further the cause of massage in the late 1800s through his success in treating the Danish Crown Prince. His work helped paved the way for greater acceptance of massage from the general public as well as the medical community.
In 1884, the Boston physician Douglas Graham published his Practical Treatise on Massage. This was perhaps the first extended discussion of the topic printed in America. (Graham cited the work of the Russian J.B. Zabludowski, mentioned in the sports massage section of this site.)
By the mid-20th century, physical therapy schools adopted the style of massage promoted by Albert Hoffa and described in his Technik der Massage, published in 1900. One of Hoffa’s stated goals was to reduce nerve irritability.
Champion marathoner Alberto Salazar has said that two deep-tissue massages per week enabled him to maintain, without interruption, a 17-week training schedule. Previous to receiving massage he was never able to train for this length of time. Salazar also credited massage with offering him quick recovery times from marathons.
Julius Erving, the ‘Dr. J’ of basketball fame, received private sessions from somatic educator Moshe Feldenkrais. In 1979, one Jack Heggie published the book Improve Your Skiing which was based on Feldenkrais’ training methods.
Ligaments provide stability but they can also facilitate movement in various directions.

From “Anatomy Trains” (2001) by Thomas Myers
This one strives to become a top-tier massage text but falls one shelf short. It also begs to be read twice.

Stealing ideas from one person is plagiarism, from ten is scholarship, and from one hundred is original research.
The author properly name-drops Ida Rolf, Moshe Feldenkrais, Buckminster Fuller, Leon Chaitow and Dean Juhan. (This literature review includes works from each of them.)
Tibialis anterior extends deeper than we generally give it credit for.
Myofascia can flow in body-length pathways that approximate the paths of traditional oriental meridians.
We are trained to think in terms of individual muscles and their attachments, but the body itself doesn’t see things this way. Seeing muscles as isolated discrete units is simply a holdover from the days of knives and scalpels carving up cadavers.
Sometimes divisions between muscles are barely discernable, except on an artificial anatomy chart.
In an active area of the body, the ground substance changes its state constantly to meet local needs. In a ‘held’ or ‘still’ area of the body, it tends to dehydrate to become more viscous, more gel-like, and to become a repository for metabolites and toxins.
Virtually all the tissues of the body generate electrical fields when they are either compressed or stretched.
Any mechanical force that creates structural deformation engenders such a piezo-electric effect, which then distributes itself around the connective tissue system. The term piezo-electric basically means electricity resulting from pressure.
Stress passing through a material deforms that material, even if only slightly, thereby ‘stretching’ the bonds between the molecules. This creates a slight electric flow through the material known as a piezo-electric charge.
Chronic mechanical stress through an area results in increased laying down of collagen fiber and decreased hydration of the local ground substance. Metabolites are less free to travel from blood to cell and back again. The cell suffers from lack of nourishment.
The electric charge passes into neighboring fascia, the properties of which have been studied little.
In a tendon, almost all the fibers line up in rows like soldiers.
Cut open a grapefruit and notice the walls that divide the sections. Inter-muscular septa (dividing walls) are similar.
“There is but one disease, and its name is congestion.”
– Paracelsus (1493-1541)
Few practitioners can navigate the entire fibrous body with ease and set it into balanced motion as well.
The fibrous myofascial net communicates more quickly than the nervous system.
“If your symptoms get better, that’s your tough luck.”
– Ida Rolf (who was more interested in resolving patterns of compensation underlying the symptom)
We may view the connective tissue as a living, responsive, semi-conducting crystal lattice matrix that stores and distributes mechanical information.
Muscle never really attaches to bone. The movement of muscle pulls on fascia, which is attached to the periosteum (or joint capsule); the periosteum pulls on the bone.
All structures are compromises between stability and mobility.
A body is designed to take strain and distribute it, not localize it. A whiplash may restrain itself to the neck for a few weeks, after which the strain may spread to the spine. Within a few months we’re seeing stress and strain spread through the entire body.
Though the concept of tensegrity (as per Buckminster Fuller) was unavailable to them at the time, this model is closer to the original visions of Ida Rolf and Dr. Andrew Taylor Still (1828-1917), the founder of osteopathy.
A lighthouse is a brick-upon-brick structure of continuous downward compression. A herniated disc is surely the result of trying to use the spine as a lighthouse, contrary to its original design which was to provide lift against gravity. If it were designed as a lighthouse, it would need much greater length to perform its assigned work.
There is virtually no discontinuity between a tendon and its surrounding sheath. Polyhedral bubbles provide the lubrication needed to maintain the balance between the need to move and the need to transmit force.
Fascia is arranged in planes, jumping from one depth to another. Without the surrounding and investing and attaching fascia, muscles are merely ground beef.
Balancing myofascial lines may help extend the life of joints.
Limitation in the plantar surface of the foot may register as tight hamstrings.
The calcaneus (heel structure) functions like the patella – pushing soft tissue away from the fulcrum point to give it more leverage. If and when the myofascial continuity around the heel tightens, the heel can be drawn into the ankle.
Individual muscles of the hamstring group can bind together, reducing function.
Even in healthy spines we can find instances of vertebrae moving together as a unit rather than individually.
The sub-occipital area is crucial to releasing the entire back of the body, from foot to head. The sub-occipitals play a role in eye movement, coordination, and helping to release back musculature. They have 36 muscle spindles per gram of tissue, in contrast to the gluteus maximus which has 0.7.
Any eye movement will produce a change in tonus in the sub-occipitals. Other spinal muscles tend to ‘listen’ to these sub-occipitals and tend to organize themselves by following their lead.
(The previous two points reveal an additional clue in our study of leverage, as discussed on the sports massage page.)
Loosening the neck is often the key to intransigent problems between the shoulder blades, in the back and even in the hips.
Let’s stop thinking of two separate SCMs (sterno-cleido-mastoids, one on either side). Functionally they operate more like one single sling looping around the back of the skull.
It is very important clinically to distinguish between muscle that is tense because it is shortened vs. muscle that is tense because it is strained. If one myofascial unit is locked short, the antagonist is locked long. Muscles ‘locked long’ are often more painful, but it’s the short and plump ‘locked short’ muscle that needs to be addressed before balance returns.
“All negative emotion is expressed as flexion.”
– Moshe Feldenkrais (perhaps taking a cue from Wilhelm Reich)
The posture of the startled person includes rigidity in the legs. This posture can continue, in some form or another, for years.
It is now the custom to call the peroneals of the calf the ‘fibularis’ muscles.
On the side of the body, the iliac crest is a frequent site of connective tissue accumulation, and ‘cleaning’ these layers off the bone can be helpful in coaxing more length from the body.
We can imagine the rib cage as being suspended in space between the quadratus lumborum pulling from the lower end and the scalenes pulling from atop.
Consider for a moment that the intercostals of the ribs might actually be muscles of walking and running rather than muscles of breathing. Like a spring on a watch, they wind and unwind with each successive step.
The rhomboids and serratus anterior act almost as one continuous unit designed to suspend the scapula between them. Moving along, the serratus anterior (the so-called 'boxer's muscle') has strong fascial continuity with the external oblique. The scapula itself functions as a railroad ‘roundhouse’ with many competing vectors of pull.
The TFL and ITB form one fascial sheet.
One’s postural ‘set’ is more determined by deeper and shorter muscles rather than the more superficial, longer ones.
The abductors have sometimes been called the deltoids of the hip.
Hamstrings can sometimes ‘glue’ themselves to the posterior adductors. The intervening septum can feel like strapping tape.
The iliacus is in some ways the functional equivalent of the subscapularis. The femoral triangle is the leg’s equivalent to the armpit.

'The Reflexology Manual’ (1995) by Pauline Wills
Generally a basic approach, though with quality illustrations and a unique point or two thrown in. The inclusion of Bekhterev’s name in the history of reflexology is long overdue in book form, and it allows us to digress into other aspects of the topic.

The word ‘reflex’ is used in the sense of ‘reflection,’ or mirror image. The hands and feet 'reflect' the condition of the entire organism. The hands and feet, in this sense, are mirrors.
Cellini (1500-71), the Florentine sculptor, reportedly used strong pressure on his fingers and toes in order to relieve pain in his body.
President James Garfield reportedly used pressure methods to his feet to relieve pain resulting from his shooting at the hands of an assassin. (Garfield was shot in July of 1881 and lingered until his death in September of that year.)
In the sixteenth century a book on foot pressure methods was written in Europe (1582) by Italian doctors Adamus and A’tatis. Shortly afterwards, a manuscript was published in Leipzig, Germany by a Dr. Ball. He discussed the treatment of separate organs of the body by using foot-pressure methods.
(It is claimed by some that when our foot-work to a certain spot is complete, a certain “reaction pulse” registers and can be perceived by palpation. If we keep working beyond this point we can overdo matters and overwhelm the patient’s body.)
The American doctor William Fitzgerald (1872-1942) is sometimes heralded as the current father of reflexology. While in Vienna in the early twentieth century, he studied the work of a Dr. H. Bresslar who had published his findings in the book Zone Therapy. Bresslar noted that therapeutic foot massage was practiced as far back as the fourteenth century.
In 1970, a German reflexologist named Hanne Marquarett, author of Reflex Zone Therapy of the Feet, added the concept of three transverse zones. This complemented Fitzgerald’s theory of ten longitudinal zones.
If an area on the body is sensitive, you can still do effective work without pressing very deeply.
The reflex for the sacro-iliac joint can help in cases of sciatica. The spot is located just anterior (forward) of the lateral malleolus (outer ankle).
Another sciatic point lies anterior of the proximal (topmost) portion of the Achilles tendon. It’s about one-third of the way down the calf from the knee, on the lateral (outward) side. On the hands, the sciatic line runs across the base of the wrist.
American-born Eunice Ingham (1889-1974) is considered the great proponent of foot reflexology for the Western world. She found that an alternating pressure on the foot was more powerful and effective than a continuous one.
The point known as Large Intestine 4 (hoku / he gu) lies within the webbing of the hand adjacent to the thumb. Besides its traditional role in helping to alleviate headache and toothache, it’s also considered a reflex point related to the vocal cords and is a valuable reflex for those suffering with throat problems. Work this point until you perceive grittiness/graininess dissolving.
Russian physicians of the early 1900s followed up on the research of Nobel Prize winner Ivan Pavlov (1849-1936) to develop their own form of reflex therapy. Their basic intent, that of influencing brain/organ dynamics, survives as a medical practice to this day. (Pavlov’s “reflex system” research concluded that organ systems respond involuntarily to external stimulation, such as stress or pain.)
To physicians/researchers such as Vladimir Bekhterev (1857-1927), who reportedly coined the term ‘reflexology’ (unrelated to the foot) in 1917, an organ begins to dysfunction when it receives inappropriate operating instructions from the brain. By disrupting the dysfunctional biofeedback loop, the reflex therapist prompts the body into issuing more coordinated signaling. Building upon the work of Pavlov, the research consensus was that a higher degree of functionality is achieved by applying a series of such interruptions, including electrical. (Apparently similar to the southeast Asian concept of “stopping the blood”.)
(Bekhterev, working mainly in St. Petersburg, saw no difference between mental disorder and disorders of the nervous system. He also noted that all mental processes are accompanied by physical counterparts. In other words, “thoughts are physical things,” as Werner Erhard claimed, not “inanimate stuff.” For a period of time through the 1930s, Bekhterev’s reflexology threatened to supplant traditional psychiatry as Russia's premier model of human behavior.)
Working in Berlin in the late 1800’s through the early 1900’s, Dr. Alfons Cornelius demonstrated that by applying pressure to certain precise points, the body could be affected. He noted changes in blood pressure, muscle contraction, variation in temperature, and moisture in the body as well as changes in the mental state of the recipient. He called this approach “reflex massage.”
(In 1893, Cornelius suffered from an unspecified infection of moderate severity [possibly strep]. At the spa where he received daily massage as part of his ongoing treatment, he noticed that one particular medical officer worked longer on painful areas. Cornelius also noted that this particular approach was more effective with patients. He instructed his own masseur to follow a similar course, a tactic that led to his full recovery within four weeks. Cornelius pursued the use of pressure techniques in his own medical practice and published the manuscript Pressure Points, The Origin and Significance in 1902.)

"Total Reflexology" (2007) by Martine Faure-Alderson
Unfocused and overly theoretical at the expense of offering practical guidelines. Tries to cover too much territory to create the false impression of breaking new ground.

The pituitary was long believed to be the master gland, but it is now recognized that the secretions of the pineal gland are the true regulators of the pituitary. The pineal reflex points are located at the top of the toes.
The vagus (pneumo-gastric) nerve innervates all the digestive organs. It innervates both the lung and stomach, hence the latter name. To a masseur it is accessible on the sides of the neck.
The author pays particular attention to zones, both horizontal and vertical, found within the occipital region. (The importance of the occipital region continues to gain traction in recent years.)

From “The Complete Idiot’s Guide to Acupuncture & Acupressure” (2000) by David Sollars
Rating: Two steps shy of worthless, even for the newcomer.

The ‘ah shi’ point was described by Sun Si Mao (581-682), whose knowledge of medicinal herbs was encyclopedic. ('Ah shi' has been commonly translated as “oh yes,” as in “you hit the spot.”)
The Chinese meaning of ‘acupoint’ entails a combination of ‘hole’ and ‘position.’
If an organ is removed or if the tissue crossed by an energy channel is destroyed, the electrical potential decreases or even disappears.
The author repeatedly refers to practitioners as ‘acu-pros,’ a somewhat self-serving term laden with annoying trendiness. So instead of explaining vital concepts, which a discriminating reader would assume is the purpose of the book, the author says, “Go check with your acu-pro.” Apparently the author hopes the ‘acu-pro’ in question would be himself (after he offers to host a national television series on the topic -- no ego here).
Tokyo has an acupressure/shiatsu school named for Helen Keller, whose postwar appeals to General MacArthur helped keep the practice alive.
Deficient qi pulls the practitioner inwards. Excessive qi repels our touch.
If a condition feels worse with pressure, it usually means qi is deficient.
Sometimes our focus and intention will dissolve a blockage better than physical pressure.
The term qi-gong first appeared in 1936 in Dong Hao’s work Special Therapy for Tuberculosis.
Qi-gong has been defined as ‘life energy’ or ‘benefits from persistent efforts.’
One section of the book is labeled ‘Bursitis: the Cursa the Bursa,’ a prime example of the level of cutesie-ness we find here at the expense of substance, a book rife with chummy talk, fluff and filler, and vague generalities.
In China the traditional “barefoot doctor” tended to work poorer villages. They were often lesser-educated or else politically undesirable in the city, rolling up their pants to get down to business in the rice paddies and rural areas in order to serve the common man.

From “Athletic Massage” (1984) by Rich Phaigh
The author studied under the Therese Pfrimmer method and was a sports masseur for Olympic athletes. Like so many books in the field of bodywork, we start out with some interesting theory while the section on practical application falls short, failing to provide rationale for the techniques illustrated.

Says former Olympian Mary Decker-Slaney, Phaigh’s treatments helped shorten her recovery times, helping her to train at consistently higher levels. In particular, Phaigh’s work on Decker’s legs greatly improved her progress as a runner, particularly after injury.
The author suggests that a proper massage rivals the benefits of a two-day layoff in training.
Ten minutes of deep stroking and kneading the calf can double the blood flow to that area for up to 40 minutes. On the other hand, ten minutes of exercise can increase, but not double, the blood flow for but 10 minutes.
When over-exerted, muscle fibers can protect themselves by torquing. The torquing can then spread, leading to a protracted shortening of the muscle. At this point you can pull or tear the muscle under normal use.
Jim Nance, a star running back for the New England Patriots (1965-71), once said that his legs were usually dead by the fourth quarter. He once had trainer Jack Meagher massage his legs right on the field. (Meagher’s classic book SportsMassage is highlighted elsewhere on this literature review.)
Electric stimulation to a muscle, says Phaigh, is a less effective method than direct manual stimulation. The electrical method merely mimics the normal expansion/contraction cycle, lacking the ability to break up adhesions.
Marathoner Alberto Salazar, a client of Phaigh, says that massage is “one of the basics of training that somehow got lost.” Salazar is a three-time winner of the New York City marathon and one-time winner in Boston.
In 1977, the Nike shoe company founded the Athletics West Track Club in Eugene, Oregon. The lead masseur was Ilopo Nikkoli, a Finn whose deep pressure work was met with skepticism by some. That is until various runners began to experience fewer injuries due to his work. The author took on the job when Nikkoli left.
When left untreated, scar tissue can irritate a muscle as much as a grain of sand in the eye.
It has been determined that capillaries remain dilated after light stimulation to the skin. The length of time increases, to a certain extent, with increased pressure. The dilation can be verified by the flushed appearance to the skin.
Damaged muscle tissue does not regenerate itself, hence the healing cells are of a different quality. They are strong and pliable yet somehow irritating to the main tissue.
For years, physiologists believed that massage led to the absorption of scar tissue back into the body. In actuality, deep massage merely realigns the cells of the scar tissue with the surrounding area. It helps re-weave the rough edges of the scar tissue, helping to reduce the pain and irritation that takes place when scar tissue contacts healthy tissue.
Massage will also help break adhesions between scar and healthy tissue. It can also increase fluid circulation within the scar tissue itself, increasing its pliability. Massage cannot eliminate this scar tissue, nor will massage eliminate fatigue.
The author says he performs about 3,000 half-hour massages per year.
The author says he finds the technique known as tapotement (pummeling/hacking) rather useless. (He hasn’t run across the Eastern/Russian theory behind it, or else he’d sing a different tune.)
Deep strokes have a more sustained effect upon musculature than mere kneading.
(One disappointment: the book lacks a bibliography.)
Tightened or problematic muscle tends to “snap back” into place rather than easily roll over into adjacent muscle. (Perhaps here we’re seeing some Pfrimmer theory, which is ordinarily difficult and expensive to come by in print.)
Cross-fiber friction to tendons helps loosen their bindings to their surrounding sheaths. It should be avoided, of course, on newly injured areas.
Jostling (gentle shaking) of a muscle helps break down the protective reflex response (related to the startle pattern), our natural tendency to tighten or contract a muscle when touched. When this happens, the sheath of the muscle gets the main benefit of the massage at the expense of the muscle itself. (A well-expressed point, and perhaps a direct glimpse into Pfrimmer theory, which would be unavoidable in this author’s case.)
“Tell the athlete to relax.” (This doesn’t work on anyone.)
The buildup of lactic acid can form a “marinade.”
Any tendon is weakest at the point it attaches to muscle.
Our hamstrings are generally not used to their fullest until called upon to perform at optimal capacity during athletic competition. If fatigue has set in, the hammie loses its ability to relax after use. Since the opposing quad is naturally stronger, the overworked hammie is forced to extend further, causing or worsening a pull.
Tendons don’t shorten with exercise. It’s the shortened muscle that can lead to a tendon tear at its attachment point. Our intent then is to lengthen the muscle that pulls on the tendon, relieving the strain.
Unlike many other muscles, the buttocks rarely stretch to their limit during competition. As a consequence they don’t experience the micro-tears in their fibers that other muscles do. However, butt muscles nearly always tighten when the hammies are torn. While this tightening helps protect the hammie, it doesn’t promote healing.
When properly applied, sports massage helps align torn muscle fibers so scar tissue can form parallel to the main fibers. This will help avoid the irregular, thick and weak scarring that creates muscle spasm.
In her teen years, Mary Decker-Slaney seriously over-trained her talented legs. By 1980, due to lack of recovery time, her calves felt like “a sack of marbles.” As a sports masseur, Phaigh took it upon himself to massage Decker’s legs so deeply that the body’s own fluids could once again permeate the scar tissue and soften it. In cases like this, the fibro-vascular network (circulation) of and to the scar tissue is now enhanced. The scar tissue is now more pliable and less likely to tear. It now feels less like a callus and more like skin, less irritating to surrounding tissue, reducing the likelihood of spasm.
Don’t apply heavy-duty sports massage on days of heavy workouts.
Don’t use deep strokes parallel to the Achilles. They can inflame, worsening any pre-existing tears.
Deep stroking is the most productive movement for the elimination of knots. (This point is not universally agreed upon, and it screams out loud for documentation and extended discussion.)
If a muscle snaps back like a taut rope when you apply cross-fiber strokes, you’ve located a problem area. If the “snap back” area is small, you’ve probably found the spot of a pre-existing injury where the fibers are still clinging to one another. If the entire length of the muscle snaps back, you’ve probably found a muscle in general spasm.
Don’t worry about applying too much pressure unless the injury is acute. (Source? Opinion is evolving on this issue.) Even on the worst of spots, spend no more than 15 minutes.
The most common foot injury is plantar fasciitis (which my spell-checker suggests changing to “fascists”).
Achilles tendonitis develops slowly (I’d concentrate primarily on the calf). Cross-fiber friction directly to the Achilles can help break adhesions between this tendon and its sheath. (Actually the Achilles is enwrapped less in a formal sheath and more by an apparently-thick layering of fascia which some have termed a 'paratenon.')
In the author’s experience, lower back pain is most often eliminated by deep massage of the hammies and buttock muscles. The author also recommends deep cross-fiber friction to the hammie origins just proximal to the lower crease of the butt. Each stroke should last about 10 seconds.
The sheath that encloses shin muscles needs to expand in conjunction with them. If not, blood circulation will be reduced and increased pressure will be placed upon nerves, leading to shin splints. Shin splints are usually caused by fatigue of the lower leg muscles where tendons attach to the tibia. If you have shin splints, your shins can feel sore when you walk and on fire when you run.
(When presented with knots and trigger points the author prefers cross-fiber friction to the affected region rather than precise work on the spot itself. Perhaps this is a remnant of his massage training at a Pfrimmer-oriented school, though Phaigh fails to explain the theory and rationale behind such an approach. In addition, the author seems to prefer ‘loosening’ tight tendons by cross-fibering at the attachment point rather than probing for a trigger point closer to the belly of the muscle. He turns cross-fibering into dogma, a rigid belief that isn’t appropriate nor optimally effective under all circumstances.)
The origin/attachment-point of the hamstring group is sometimes difficult to isolate when an athlete is lying on his stomach. Illustrated here is a good position for reaching them properly. (One of the finer contributions of the book.) Go tenderly at first and then apply more cross-fiber pressure. Small tears are common here and may have left deposits of scar tissue, so don’t be afraid to work through small amounts of soreness.
The best treatment for an injured shoulder is rest. (Half correct. Trigger points must be addressed also.)
“Administer” deep strokes to the spinae erectors. (Wouldn’t it be easier to skip the drama and just apply these strokes?)

From “Five-Point Touch Therapy: Acupressure for the Emotional Body” (2007) by Pierre-Noel Delatte MD
Though not without potential, this work is highly speculative, especially given the lack of research citations and history.

“Nowadays it is a common mistake for doctors to separate the soul from the body.”
-- Plato
The author presents a model that consists of 22 sets of acupoints consisting of five points each. Each set is geared to counteract the effects of a particular negative or unwanted emotional condition such as grief.
Working a certain 5-point set can produce results, the author contends, in a matter of minutes.
The ‘universal energy,’ known in various cultures as ki, elan vital, or prana, has gone by the name of chula in some shamanistic cultures.
It goes without saying that we receive energies from the foods we eat. In addition, it’s thought-induced energies that are liable to disturb our brains.
But by stimulating certain ‘circuits’ that the author demonstrates, an “energy antidote” will start flowing. In a matter of minutes, says Delatte, our energy will be restored and relief will ensue.

From “Bodywork Shiatsu” (1997) by Carl Dubitsky
Starts off with promise and strong theory, but occasionally becomes overly speculative. The section on practical application of technique falls on its face as a mere “do this, do that” recipe book.

Says top-tier bodywork writer Dean Juhan in the foreword: a certain ambiguity plagues almost all graphic illustrations of the Oriental energy system.
Oriental bodywork therapy has been known as anmo (press & stroke, a.k.a. amma) since the Han dynasty beginning around 200 BC, and tuina (lift & grasp) since the Ming dynasty of the middle ages.
Blind from the age of one, Waichi Sugiyama (1614-1694) has been called the “father” of Japanese acupuncture and bodywork.
By 1800 the Japanese aristocracy began adopting Western healing methods and began to discourage, if not outright ban, traditional methods. By 1911, the first laws in Japan began to codify this ban outright, forcing practitioners underground in some respects.
As a Research Fellow at Tokyo University School of Medicine, Dr. Katsusuke Serizawa was able to scientifically measure the tsubo/acupoint system in the body. In 1976 he published his landmark book Tsubo: Vital Points for Oriental Therapy.
The most famous practitioner of Japanese shiatsu was Tokujiro Namikoshi. Working under a virtual ban imposed by occupational forces in the post-World War II era, Namikoshi was able to effect an impressive healing for Marilyn Monroe (for insomnia) during a visit in 1953 after Western treatments had failed her. Shiatsu was officially recognized by the Japanese government the following year. The author suggests that Dr. Janet Travell’s trigger point approach was based on information she received from Namikoshi during his first visit to America in 1953.
After the war, General MacArthur may have received exaggerated reports of “torture” from American prisoners of war in Japanese camps. The Americans told stories of being burned and stuck with needles, when in fact the Japanese could have been trying to apply humanitarian medical treatment. Nevertheless, MacArthur managed to ban acupuncture and moxibustion at least temporarily.
The most effective way to lower energy in a specific region is through needles. The most effective way to increase energy is to apply heat through moxibustion. The use of the hands forms a middle ground.
The Triple Heater serves to bring the root energy, or source Qi, from the tan den to the source points of the organ meridians in two-hour intervals.
The red, physical liquid that we call blood is only a portion of the physical-energetic spectrum the Chinese call Blood. (This point helps us further understand the eastern concept of “stopping the blood” in non-literal terms.)
Emotional balance and clarity of mind, which Western medicine ascribes to the proper function of the nervous and endocrine systems, are considered to be controlled by the Heart and Heart Envelope organ functions.
Because Lung Qi is so essential for circulation in both the meridians and blood vessels, we can determine the state of all the internal organs at the Lung source point (Lung 9) overlying the radial pulse of the wrist.
The Small Intestine channel is responsible for mental clarity and sound judgment.
While the Liver system controls our ability to make plans, the Gallbladder channel controls the courage and initiative needed to make decisions. In fact, the Chinese say an audacious person has “a big gallbladder.” (In English, of course, to say "he has gall" suggests a certain arrogance and effrontery, associated with the bitterness of bile, a synonym for gall.)
Knowledge of the meridian system predates that of the points themselves.
Like electrical wires, meridians are perceived as having a high-density solid energetic core with a surrounding field that diminishes in density and intensity as we move outward from the core.
In addition to meridians, the eight Extraordinary Vessels perform the function of reservoirs, absorbing excess energy from the regular pathway system when Qi overflows.
Because Qi is so superficial in the extremities and because it is here that polarity changes from Yin to Yang and back, these points present a very large repertoire of functions. (A point seen elsewhere but still one of the key contributions of this book, one that we must take advantage of in practice.) It is here that the appropriate and timely application of the various techniques of Oriental medicine can be most effective. Polarity tends to flip about 1/10 inch from the edge of the nails.
Depending upon the intensity of the condition they reflect, acupoints can vary in size from non-existent to that of a quarter. They also can be found in different locations on different bodies.
While the tendon/muscle channels are relatively wide and therefore somewhat forgiving of inaccurate treatment locations, precise finger placement yields infinitely better results.
The more gentle and superficial you are pressing when you get a response from your client, the more serious the imbalance. If you need deep pressure to elicit a response, you’ve found a less chronic and more easily correctable imbalance.
If you’re aiming for the re-creation/restoration of homeostatic balance, you don’t need a specific disease “entity” to target for therapy.
Qi dysfunctions can be characterized as Deficiency of Qi, Sinking of Qi, Stagnation of Qi, and Rebellious Qi.
The medulla oblongata, the oldest and most basic part of our brain, contains an "ongoing program" that determines the resting length of every muscle fiber in the body.
The nervous system lacks an effective mechanism for resetting hyper-facilitated (over-used and exhausted) muscle spindles. Without appropriate manual intervention, strains can return whenever the affected tissues are stressed, as every serious athlete knows.
By mechanically lengthening muscle fibers through compression (a speck off-base here; we’d probably be better off treating the trigger point, aiming for a spontaneous lengthening), we then maintain the stretch (hold the points) long enough for the proprioceptive feedback system to complete its feedback loop. This process can take three to five seconds, though it can take longer in muscles contracted due to jammed neural pathways or by imbalanced meridian Qi. The brain (medulla oblongata) can now reset the involved muscle's resting-length pattern.
(A lot of vital information is implied in the previous notation. One, we’re seeing precisely why a point is held for an average of five seconds or so, as described elsewhere in the literature. Second, we’re seeing why there’s professional disagreement as per the length of time for the hold. There is no set time, it depends on the circumstances, though the window should probably be framed anywhere from 3 to 10 seconds.)
Chronic low back pain related to lordosis (swayback) is frequently caused by overdeveloped quadriceps and shortened hamstrings that develop to compensate for a dysfunctional psoas muscle. Deeper tissues such as the psoas are generally freed by indirect manipulation, helping to release larger and more accessible muscles from their need to overcompensate.
As we’ve seen time and time before, here’s another author who cites the work of Dr. Hans Selye.
When it perceives a threat, the sympathetic nervous system activates the well-known fight-or-flight mechanism. In effect, it turns on all its switches at once, a phenomena known as mass discharge. In addition to other known responses (which can inhibit athletic performance), the diaphragm locks, the pelvis goes rigid, the anus tightens, genitals go numb, leg muscles lose their equilibrium, we go “into our heads,” peristalsis is suspended, and we go into more hyperactive beta mode.
On the other hand, the parasympathetic system engenders a calmer state that features softened and lengthened myofascial tissue and slower brain rhythms.
Adrenaline, "the fear hormone," leads to shallow breathing and anal contraction.
One of the areas where BodyWork Shiatsu is so valuable (the author here is attempting to coin his own modality for posterity and perhaps beyond) is by directly addressing the autonomic balance and “clearing peripheral neural static.”
By fostering deep release, we’re encouraging the brain to alter the tissue resting-length pattern stored in the medulla oblongata. (Here's another aspect of the "null point" at work.) The sensory overload we’re conveying to the brain serves to clear the static from the lines, much like blowing out a clogged pipe.
Cross-fiber friction is called kenbiki in Japanese.
When we pull a muscle, the spindles send signals to the brain long after the movement has ended. The brain now thinks the neutral position is one of overextension. This results in chronic hyper-contraction. Fibers, joints, balance and nearby muscle are now affected.
Because the nervous system lacks (why?) an inherent mechanism for resetting these dysfunctional proprioceptors, the condition can remain indefinitely, even for life. From now on, even minor insults to the muscle can reactivate stressors that would have ordinarily been shrugged off.
This chronic bad ankle, back, and so on has led both the medical and athletic communities to view myofascial strains as more pernicious than fractures, which at least have the ability to heal stronger.
Digital compression to the appropriate trigger points results in their neutralization. Equally effective (and less painful) is the osteopathic technique of counter-strain, called positional release or orthobionomy. In either case, until treated the proprioceptors are screaming for attention.
From an Eastern viewpoint, a restriction in Qi flow eventually affects the entire region. From a Western view, myofascial contraction at any level results in the formation of a static charge or field in the area of restriction.
In the East, shiatsu treatment is applied less often on floor mats than we might think. In China it often takes place on sturdy, low tables or on chairs. In Japan, most clinical practice is now performed on a table as well, though some traditional practitioners still work on a futon.
Most of us hold our bodies upright by contracting the muscles of the torso and shoulder girdle rather than by the legs. This method is inefficient and it wastes energy. Gravity is now unable to flow through our energetic center, and finger pressure now requires more effort.
Muscle splinting is an automonic reflex controlled from the medulla oblongata. If it becomes habitual, the injured tissues literally fall off the radar screen of the sensorimotor cortex and the contracture can endure for life.
When “tractioning” the neck (I have hesitations about doing so), 90% of the force is generated by our fingers under the occiput.
Gallbladder 21 (midpoint of upper shoulder) is the motor release point for the trapezius.
The waste and toxic residue that the body has been unable to eliminate from the system progressively increases with age. These materials take the form of a crystalline coating that fills all the interstitial spaces of the body. Much of this material coats the fascial sheaths surrounding the musculature. In large measure, this process accounts for the increasing density and decreasing pliability of aging tissues. The toxic buildup is a slow and gradual process, leaving us unawares until late in the game.
In Oriental bodywork, the “healing crisis” goes by the term mei gen (or menken) reaction. It can be diminished with a good hot bath in plenty of Epsom salts to help open up our pores.

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