We live in an insane culture and society. That is not my opinion, that is a physiological fact. It is important to understand how and why that statement is true because it affects the health and the structural relationships within our bodies, and thus our clients’ bodies. One of many perspectives to understand this is looking at the concept of selfishness versus the reality of self-sabotage.

Selfishness gets a bad rap. Selfishness means I am looking to get the most for myself. Let’s use money for this discussion, but any desirable human condition – love, advancement, security, all will apply. If I am seeking more money from you, our culture and society suggest that, after I seek honest means of getting more, such as selling you something, that I lie, cheat and/or steal. Our culture and society lead us to believe that is selfishness. I am suggesting that is not selfishness, it is self-sabotage. If I lie, cheat, or steal from you, at some point you will probably figure it out, and then I’m done, I’m finished relative to you. Not only will you not have financial dealings with me, you will warn others if the subjects of money and me come up.

Also, this attitude and perspective comes from a position of lack, of scarcity, of not-enough. No matter how much wealth I accumulate, it will never feel like enough. It inherently cannot, not from that perspective. A sense of satisfaction either cannot be attained, or at most be fleeting, and a sense of satisfaction is a universal human goal and desire.

If I am truly selfish and would like the most money I can get from you, I figure out how I can hook you up with more money. Is there someone I can introduce you to who is good for your business? Is there any advice or resource I know of that may be of financial benefit to you? When I can accomplish this, I probably have you for life. You will hook me up with more money whenever you have the opportunity. That is true selfishness; true selfishness requires that I consider others, be it people or circumstances.

Notice how nicely this fits with the concept of true abundance: to be truly abundant show yourself to be a source of abundance. Many of us have come across that idea. Another way of stating it is, if I am causing others to become more abundant, I must of course be abundant. If I cause others to become more prosperous, I must of course be a source of prosperity. In truth, demonstrating oneself to be the source of anything assures the experience of it. There may be a time lapse between the two, although with commitment and single-mindedness the experience always happens presently. Also, from this perspective and with this experience, a sense of satisfaction is the natural result.

Next: the physiology of these two perspectives, true selfishness vs self-sabotage. Peace and love.

Among the back problems we and our clients experience is a situation allopathic medicine refers to as ‘Degenerative Disc Disease’. From our perspective here at LMD, the only word out of those three that is applicable to the situation is ‘Disc’.

The disc here is of course an intervertebral disc, and it is made of cartilage, which is a type of connective tissue. I have never come across any medical  text or article that describes cartilage as a tissue that ‘degenerates’. Degeneration suggests a condition in which something ‘wrong’ is going on inside the cartilage itself, that the tissue is degenerating. Cartilage does not deteriorate from within. It can, however, be worn down.

Think of intervertebral discs as shock absorbers, which is one of their main functions. The discs’ thickness, strength, and resilience is a function of the forces they were designed to deal with. Remember, ‘ideal muscle tone’ is the tone it takes to support the joints in any action the body is doing, and no more. Any tonal value above ideal muscle tone is a hypertonicity. The discs evolved with ideal muscle tone as their basic design parameter.

When hypertonicity becomes chronic in the para-spinal muscle groups, the discs in between the associated vertebrae experience pressures higher than their design parameters. This, over time, is bound to wear them down. They haven’t ‘degenerated’, and they are far from ‘diseased’. They are simply in a situation beyond their design. Everything will wear out prematurely under these circumstances, from your car to your comb.

When a client presents with ‘degenerative disc disease’, your job is pretty obvious at this point, isn’t it? Solve the root cause of the hypertonicities. Of course, our viewpoint here at LMD would be to approach it from a Three-Lever Theory perspective, assessing the SI joints and the Occiput/C1/C2 dynamic, check out rotator cuff, knees, ankles and feet, and proceed from there. A technique I always include in disc issues is: client supine, knees bent at 90 degrees, therapist on table kneeling at client’s feet facing client. Hold the client’s legs above the knees and apply traction. This should always feel good to the client; the more intense the situation the more gentle the traction. I also float the neck, as it’s always a major player in disc issues.

The hypertonicities wearing the discs down are there for a reason, and the job of quality, effective bodywork is to solve the ‘riddle’ of the pattern that is maintaining those hypertonicities. Every situation is unique, nothing works on everyone, something will work on everyone, and the journey is endlessly fascinating. Please, your thoughts and comments.

Note: We’ve run into a minor glitch on our website and my replies to your comments haven’t posted to the website lately. We’ll have that resolved in the next day or two.

I got an email from one of you and would like to make it today’s subject:

“The whole ‘no expectations of results’ that you mention would also be a much-needed topic sometime to post for all us bodyworkers… I think it’s too easy sometimes to get caught in that trap as a massage therapist (and anyone in the “healing” professions for that matter) and take things personally and too hard. We definitely can’t forget about everyone’s personal responsibility and what they do to help themselves, or not help themselves in their own life.”

I like that this therapist put “healing” in quotes. It is important to establish the ground rules of the meaning here, as it’s much more than semantics. I believe it is without question that we are not healers; the only healer that exists for anyone, both physically and emotionally, is him or herself. What we are is facilitators: ideally, we remove physical circumstances that are currently in the way of the client’s body healing itself. It is simply what we’re good at. To think of ourselves as ‘healers’ puts us on a conceptual plane that is above the one the client is on. It suggests a grandiosity. We then tend to not work so much ‘with’ our clients as ‘at’ them. (By the way, that ‘healer’ way of looking at clients is guaranteed to sap your energy.) The main point here considering our topic: being a healer would of course include serious expectations built-in. If I’m a healer, the client better heal, or I’m not much of a healer. A facilitator helps make things happen, makes goals more achievable. That’s what a competent massage therapist does.

I believe there are two main aspects to this issue of expectations: 1) What is the massage therapist responsible for, and; 2) How does the ‘ego’ function best for the massage therapist?

‘Ego’ – For this discussion, we’ll define ‘ego’ as the totality of the concept one has of oneself, how one sees oneself and how one feels about oneself in the world. Basically, ego does not function well when it requires perceived validation from the world around it. That’s not to say it isn’t nice to get validation from the world; it’s wonderful. It lets one know one is probably on a good course (but not necessarily: ‘they’ could be wrong). Approval by those around us is fine, but it’s not necessary. One way this concept has been put is: be in this world, but not of it. Function in the world by making choices, not by ‘acting accordingly’.
For myself, I’ve come to understand that the ego functions best in massage therapy as a coordinator of information, sort of a mediator between what I’m feeling and sensing, and what I end up doing with my bodywork. It works best to do this with no judgement, not even with an opinion. Some would say this is ‘egoless’, but that’s a different interpretation of the word. In our perspective here, it is impossible to be egoless, just as it is impossible for me to not be me. So you could say the ego functions best as the aspect of me that notices things about the client (from what I’m feeling to what I’m intuiting), notices my technique choices, notices the client’s response to what I do. It coordinates what I feel with what I do.

Responsibility – What is a massage therapist responsible for? A pitfall here would be to think that a bodyworker has the responsibility to be effective with his/her client, that the client should improve as a result of treatment. This inevitably leads to the therapist taking responsibility for the client’s physical complaints. And that, of course, is a recipe for expectations. When you think about it, taking responsibility and having expectations is rude: it’s like the therapist saying, “I can handle your problems better than you can,” and that’s just plain rude. Rather, respect the client and their complaints.

So what is a bodyworker responsible for? I feel number one is show up with, and to, the best of your ability for that session. Be present, pay attention. Show up on time, prepared and clean. That’s pretty much it; if you’re in business for yourself, be able to make change for $100 bill.
In terms of what the client does or does not do with our work or in their whole healing process, that is their business, not ours. Their responsibility is not our responsibility. Again, I’ll make the point that it is rude to judge our clients’ decisions on what to do with our work. I understand clearly how difficult this can be when one feels confident in one’s work and understanding of the situation, and of the client’s circumstances. Remember that it’s about them, so respect their choices.

So, my position is we can forget about the clients’ “…personal responsibility and what they do to help themselves, or not help themselves in their own life.” In fact, I believe it’s best if we do forget about the client’s decisions regarding themselves. To re-emphasize, their decisions are their business, and to recognize them is to have a judgement or opinion of their decisions, which will lead to expectations of them (unfair), and that road leads us to resent the client. I’d like to emphasize that it’s not easy to let go of these thoughts and attitudes, and I face this regularly in my work. But it is worthwhile to be conscious of such thoughts and attitudes, understanding that they are not serving us as massage therapists nor our clients.

Greetings All and Happy Holidays

One of you asked in an email:

“Any chance you can address your take on Pleurisy? (especially not virally caused) And, what a treatment may look like….It’s really frustrating doing research when there’s all this Western medicine point of view – I was trying to look at pleurisy as not the problem, but of course, can’t find any info going down that route.”

Excellent question that leads to many interesting points for our consideration.

This is from The A.D.A.M. Medical Dictionary, and is common to the Western medical viewpoint:

Pleurisy is inflammation of the lining of the lungs and chest (the pleura) that leads to chest pain (usually sharp) when you take a breath or cough.

Causes, incidence, and risk factors

Pleurisy may develop when you have lung inflammation due to infections such as pneumonia or tuberculosis. This inflammation also causes the sharp chest pain of pleurisy.

Symptoms

The main symptom of pleurisy is pain in the chest. This pain often occurs when you take a deep breath in or out, or cough. Some people feel the pain in the shoulder.

Deep breathing, coughing, and chest movement makes the pain worse.

Pleurisy can cause fluid to collect inside the chest cavity.

When you have pleurisy, the normally smooth surfaces lining the lung (the pleura) become rough. They rub together with each breath, and may produce a rough, grating sound called a “friction rub.” 

Treatment depends on what is causing the pleurisy. Bacterial infections are treated with antibiotics. Surgery may be needed to drain infected fluid from the lungs.

Viral infections normally run their course without medications. Patients often can control the pain of pleurisy with acetaminophen or anti-inflammatory drugs such as ibuprofen.

When I read something like the above, I’m looking for: key ideas that suggest the cause, what I’m going to begin treatment with, and how I’m going to proceed at the beginning.

The number one key idea from the dictionary is that pleurisy is an inflammation of the pleural membrane. So I immediately know that the pleural membrane is ‘pissed off’. It’s angry because there are unbalanced forces operating in the body, and their most noticeable current effect is to congest the pleural membrane, and so annoy the hell out of it. And it’s letting everyone know.

Check out the effect in terms of connective tissue dynamics. “…normally smooth surfaces (of the pleura) become rough…” We know what makes smooth connective tissue rough – rhymes with ‘fresher’, and of course it’s PRESSURE. I’ll be looking to solve where that’s coming from in terms of dynamic tensegrity.

The first piece, for me, would probably be to see if I can get the area to drain; open up the lymphatics. I would put the client on the table in their most comfortable position – pillow them up, whatever. I’ll start with the SI joints, look at how forces are feeding into Occiput/C1/C2, don’t overlook rotator cuff scar tissue, thoroughly go through SCM, temporalis and masseter, psoas/iliacus/diaphragm, float the rib cage and head, float anything else that occurs to me.

There are points at the spaces between the ribs next to the sternum called Chapman’s Reflexes, and they are claimed to be neuro-lymphatic reflexes, meaning they narrow the lumen of the lymphatic vessels when fired up. I’ve gotten good results using them. The ones for the lungs will be around the upper sternal area, bilateral. They should be ‘burners’ when you press on them, like very active trigger points. You can work them like trigger points, and/or do small local myofascial stretches to them, anything to bring down their sensitivity. Also see what you can do with pec minor, seratus, everything around the lungs. They will be big players, you can count on it.

Now here’s a key technique concept as I see it: the work can be tricky, because if the pleurisy is fired up, you don’t want to cause pain while addressing these things, and that may be difficult. Do your best to avoid a protective response from the client.

An overall thing you’re looking to get is a parasympathetic response from them. Pay close attention: if they tighten and protect in response to what you’re doing, immediately back off and look for another way ‘in’. Work gently. It’s key that the client can rely on you not to hurt them (or at least not to sustain any work that does), that you won’t further annoy the pleural membrane.

With pleurisy, as with anything connected in any way to the immune system, the sympathetic response is the ‘enemy’; the sympathetic response is certainly part of the true cause, and very well may be the ultimate cause.

In terms of whether it’s viral or bacterial, for us I don’t think that’s much of a factor. The more successful I am in increasing a parasympathetic response, the stronger the immune system becomes, helping the client in either case.

The goal is to increase circulation around the pleural membrane. To repeat, pleurisy is an inflammation, and ‘inflammation’ means ‘pissed off’. If you can figure out what’s pissing the area off, you’ll increase the circulation. This should get the condition to at least improve. Let me know if you have any questions on dealing with the Chapman’s Reflexes, or anything else, and I’ll go into greater detail. Later, Friends

Inflammation is for the most part looked upon by the health care community as an entity more or less unto itself. Inflammation may be accompanied by other conditions, but it is usually seen as its own aspect and exists coincidentally with the other conditions.

I see inflammation as both a result of certain situations and, even more, as an indication that an underlying dynamic exists, an underlying dynamic that will potentially cause more insidious problems in the near future if not addressed and resolved.

Many of you have heard me suggest that a phrase that can be substituted for inflammation is ‘pissed off’. Pardon the crudeness, but I believe the euphemism is appropriate.

When tissue is inflamed it is angry, and it is angry for the same reasons you or I would be angry when we’re on the job – it is being required to do something unreasonable and beyond its job description, and it is being required to do this repeatedly or constantly. Like you or I in these circumstances, the tissue is under excesive pressure. In this case, the pressure is coming from some combination of hyper-tonicities, The focus of the hyper-tonicities, or the most vulnerable tissue within the lines of force of the hyper-tonicities, would be the location of the inflammation. Often, the location of the inflammation has no actual physical malady occurring; it is simply the location of the most ‘pissed off’ tissue under the circumstances.

Let’s take plantar fascitis as an easy example. If that is the client’s complaint, and the therapist thoroughly works the plantar fascia, results will much more than likely be temporary at best. The key to effectively addressing the inflammation is to find where the pressure being placed on the plantar fascia is coming from. In truth, it could be coming from anywhere, even (though it would be very unusual) scar tissue from anywhere in the body. You can see that we are now getting into the investigative or ‘detective’ aspect of massage therapy.

This is where we at LMD believe the tensegrity concept of body organization, and even further adding “Three-Lever Theory”, comes into play. If the plantar fascitis is in one foot, the opposite sacro-iliac joint will be the location to begin your investigation. In the detective analogy, it’s the prime suspect. The cool thing about bodywork is that the SI joints are always the prime suspects, because all the forces generated in the body must flow through them effectively for graceful, purposeful movement. And of course, the dynamic of the arms and the balance of the head, focused on Occiput/C1/C2, are the next suspects. It’s like these guys are always in cahoots, and if they are not the cause of the inflammation, they will practically always point you in the direction of the culprit(s).

If the cause of an inflammation is very unusual, like say scar tissue in one finger actually being the root cause in a pattern that results in plantar fascitis, you can trace the cause by following it backwards. If this were the case, the pattern would have to flow through the arm into the neck, where it would create a compensation through the pelvis, and so the SI joint(s), to create pressure in the plantar fascia. The pattern will be there, follow the hyper-tonicities and fascial thickenings. They will be having an effect on the fluidity of the #1 & #2 levers. In this case, they will lead you to thoroughly investigate the arm, elbow, wrist, and hand, and you have a good shot (detective pun intended) at coming across the guilty scar tissue.

So, I feel the bodywork perspective on the subject is that inflammation is a symptom. It is a warning sign that unbalanced forces are now operating. If they are not addressed, the next phase will probably be worse, and a downward spiral is in the making. Look for clues, figure out what is operating, and solve the mystery. Getting good at this is one of the most intriguing and rewarding aspects of effective, advanced massage therapy.

More on this subject next week in a look at pleurisy.

As the last blog suggested, there is a singularity of thought and purpose that is characteristic of creating effective energy, and it begins as an internal process/phenomenon on the part of the bodyworker. Here we will look at the energetic interaction between the therapist and client, and how to use that for therapeutic effect.

There are two aspects to the therapist’s attitude toward the client that come strongly into play, and they are acknowledgement and respect.

One of the most satisfying feelings we experience as human beings is the deep satisfaction we get from being acknowledged, from being recognized. This should come into play from the very beginning of the client/therapist relationship: the first contact and initial interview. It is a product of becoming intrigued by all of the client’s complaints and comments. Dismiss nothing nor downplay anything the client has to say. Rather, encourage the client to go into detail. Most often, details suggest approach options and possible root causes, and so is at the same time in the therapist’s best interest.

Acknowledgement puts the client at more ease. It honors the client’s circumstances and with that will come some degree of relief for them. This will in turn encourage a parasympathetic response on their part, and that response is essential for a healing energetic field.

Acknowledgement and respect go hand-in-hand. In your attitude toward the client, see him/her as a success story. The client, and their body, has done what they’ve had to to get through life. And so far they’ve made it. I think of everything going on in a client’s body that causes pain, discomfort, or dysfunction as ‘badges of honor’.

Another facet of purposeful energy is that the therapist have no judgment of the client and the client’s experiences, even to the point of having no opinion. Judgment never works: when you think about it, judgment says, “I know everything about you and your circumstances,” and that could not be. Judgment always assumes, and we know where that goes. Worse for the therapist, judgment narrows one’s ‘vision’, one’s perspective, and that impairs the therapeutic potential. Accept the client with an open mind, and heart, and listen with your ears and then with your hands. You are hearing and feeling part of their life story.

I like the way the book Conversations With God put it: ‘life is simple for spirit, but it’s not easy’. No one here is having an easy time of life, not with any consistency anyway. Life is often very difficult and it takes a toll on the body. Addressing that is, of course, our job. Show honor and respect for the client’s experience (you may be one of the few who do) and the stage is set for purposeful, healing energy.

“Energy Work” in massage therapy usually refers to therapeutic massage in which the technique is physically minimal on the practitioner’s part, often not even touching the client’s body. This can be misleading because all bodywork of any type is energy work, since everything is energy. Things without energy don’t exist in the physical, relative universe.

In any case, I have found that there are certain truisms concerning energy as it functions in massage work and during a massage session, and they apply across the board regardless of technique or approach.

Since everything is energy, what we are talking about here is how to get energy to help us accomplish our goals in our massage sessions. Simply put: focused, purposeful energy is a function of presence and intention.

Presence means being in one place and not another. Seems pretty straightforward, and it is; but that doesn’t mean it’s easy to do. In fact, it can be very difficult for most of us. We have, by training and experience, very cluttered minds; lots of thoughts going every which/way. We doubt ourselves, most of us most of the time. Every thought has a clear and purposeful energy, but contradictory thoughts have contradictory, and so diluted, energy.

An example in a bodywork session might go like this. The therapist is working on a stiff neck probably causing headaches per the client’s complaint. The therapist is focused on the techniques he/she is employing and wondering if they are the ‘correct’ choice. The energy of the therapist is not going to be particularly functional at that moment – it is diluted, basically going in two directions at once which will cancel the effectiveness. Any time thoughts have incongruent directions, the net energetic effect will be weak. It would be similar to accelerating and braking a car at the same time – a lot of energy is being expended to little desired effect.

The ‘trick’ here is to hold one thought at a time, with no contradictions.

An example, and another analogy, is something I noticed while working with my dogs. I can usually communicate clearly with my dogs if I hold one thought while I speak simply and directly, having a clear and singular intention in mind. I walk them in the woods daily. I don’t want them to eat stuff off the ground, but it’s okay if they eat snow (which there is a lot of up here). It was not going well until I focused and unified my thought and intention. When I would say, “Don’t eat deer poop,” and I would picture in my mind simultaneously deer poop and my dogs not eating it, with my intention focused on that being a positive happening, the dogs began getting it. I started saying, “Eat snow,” and I pictured them eating snow and that being a positive thing, they did it. It surprised me how well it worked, and then again I wasn’t surprised, because that’s how energy goes.

Decide on an intention, hold that thought, and feel positive about it. If other thoughts intervene, and they will, practice gently putting them aside and return your focus to your original intention. Now, you can change your intention to suit the moment and the circumstances as you perceive them; the functional piece to get is to hold one thought/intention at a time so the energy is clear at any given moment. That would be the definition of presence for the therapist in a massage session.

Self-doubt is a problem for most of us, because most of us were taught not to trust ourselves, most unfortunately. One good way to diffuse that learning is to practice recognizing your first idea and go with it before wondering about it. Can you see how self-doubt inherently dilutes energy? Self-doubt is two thoughts going in opposite directions. When you practice and get used to going with the first idea that comes to mind you avoid the whole situation. The first idea is almost always a very good one anyway, and is most often tied to intuition and inspiration, so it’s a safe bet. And, of course, if it doesn’t seem to be working at that moment, you can always switch. And switch the focus, presence, and intention to the next idea. As you become more facile at this, the power of your energy and its influence on the moment will follow.

Keep at this, practice presence, intention, and focus. We will revisit these concepts from different perspectives in future articles, because when energy becomes more functional and operative in massage sessions, magical things can happen, and happen regularly. Peace and love.

Temporal mandibular joint dysfunction is one of those issues similar rotator cuff problems in that we all have it, it’s a question of how bad is it. At some point Western medicine will consider patient’s complaint classifiable as TMJ: basically when you go to a doctor and complain.

Like any chronic pain, there is a ‘sponsoring pattern’ to TMJ, at least in LMD’s view and in bodywork’s view in general.

Definitely in LMD’s view, begin with the SI joints, looking to get movement and balance in them. Analyze the movement and balance in the ankles, feet, and hips. In a client with TMJ, it is highly unlikely the SI joints are issue-free, and so any anomalies in ankles, feet, and hips are directly related to the TMJ.

No surprise, psoas-iliacus-diaphragm will be integral players in TMJ, count on it. Go slow, be thorough (see last week’s blog for reference).

For those of you who have taken our Advanced Tensegrity Techniques course or my Patterns class at WMTI, TMJ is really a part of the #2 Lever. Briefly, the #2 Lever is focused on Occiput, C/1 and C/2, but it includes the dynamic of how the forces of the arms and the balance of the head interplay, and how the body deals with them.

Appreciate, or begin to appreciate, how much the emotions will always be a factor in every issue that plays out in our bodies; certainly with TMJ, which is probably directly a stress issue. We have an emotional response to everything. The primary way a massage therapist makes progress with the client’s emotional factor in any situation is to elicit as powerful a parasympathetic response as possible. We will reiterate this in many of these articles, and will devote an entire future article to the subject.

There are four areas I believe are of particular significance in TMJ: the masseter, temporalis, sternocleidomastoid (SCM), and pectoralis minor, all bilateral. Always go through these with particular attention – go slow and be thorough.

Some tips for these areas are:

1. With the masseters, the classic finger stripping works fine. My two favorites are using the base of my palm just below the zygomatic arch, working the tissue down and around, and combining that with a Floating Joint-type following of any joint movement. I use this move in virtually every treatment; with TMJ I spend more time and pay more attention.
2. Finger stripping and palm circles work fine on temporalis; again take more time with TMJ and absolutely include the ears. Work them thoroughly within the client’s comfort zone. A Floating Joint technique for the ears is to pull straight out on them, feel the connection between them through connective tissue, and look for balance.
3. The classic ‘pinching’ of the SCM’s between the therapist’s thumb and side of the index finger is probably the most effective technique. Shorten the SCM by rotating the head away from the one you are working, and flex the head. Add mobilizations as the tone of the muscle softens. (Note: if head mobilizations make the client dizzy or nauseous, the eustachian tubes are congested – I have never seen it otherwise. Hold the head still or leave it still on the table while you work the lateral neck muscles. I always suggest the client ices the side of the neck post-Tx, or do it during Tx.)
4. Pec minor very often doesn’t get the massage attention it deserves, especially in female clients. After working pec major, address pec minor thoroughly. Finger stripping is fine: I also like using the base of my palm and working both same side and contra-laterally. Mobilize the entire shoulder while you work into pec minor; you can put one hand under the shoulder blade while working into the muscle with the other. Come at pec minor from as many directions and angles as you can think of.

Beyond these, rib cage work and mobilizations are always a good idea. Any relaxation techniques will be absolutely indicated, as long as they get a parasympathetic response from the client, so pay attention to his/her reactions. Floating Joint of the head, arms, and shoulders should work great.

As always, thanks for reading, love to hear from you.

Back by popular demand, I’m revisiting psoas, that muscle all WMTI folk came to know and love. Ah yes, psoas, a five-letter word some bodyworkers feel is a four-letter word in drag.

Let’s start with a little history. Many therapists dislike working psoas because they were taught the stupid dive-bomb technique. Forget it. It doesn’t work well, but it does succeed in annoying the client no end – if that’s your idea of a good time (anyone catch the reference?).

Psoas is continuous with the diaphragm and iliacus; I think of them as a dual (left and right) motor unit, they are so tied to each other. In this article, consider them so.

Also in the way of background, psoas is important for a number of reasons.

1. Structurally, psoas supports and stabilizes as well as moves the anterior lumbar vertebrae.
2. Along with the piriformis, psoas ‘locates’ the sacrum, meaning it has plenty of influence on the fluidity of the SI joints, and many of you know how I feel about those guys. (see Thomas Myers article “Poise: Psoas-Piriformis Balance” in the March/April 1998 issue of Massage Magazine).
3. Since it is continuous with diaphragm, and diaphragm is very arguably the most emotional muscle in the body, psoas can carry plenty of emotional energy.
4. Psoas is the deepest hip flexor, receiving the impulse to move forward first. If a person feels like he is being held back, like he can’t get ahead, the unresolved emotional energy will build in psoas (iliacus diaphragm).
5. Hypertonicity in psoas will put pressure on any or all visceral organs, since psoas, iliacus, and diaphragm literally form a ‘bowl’ the organs sit in. This will decrease circulation in the organs, creating multiple levels of problems. (my article “Viability of the Interstitial Space” will post Wednesday this week on our website under ‘Chuck’s Articles’ and explore the issue further).

Psoas affects so much of the body structurally, emotionally, biochemically, (and so hormonally), that I feel effectively working psoas-iliacus-diaphragm and nothing else is more a full-body massage than effectively working everything else and excluding psoas-iliacus-diaphragm.

Okay, let’s get to it – how to effectively work the psoas complex, adding in piriformis.

My favorite technique for working psoas and piriformis together is:

1. Client is supine, therapist is sitting or kneeling at the side of the table at client’s waist
2. Client’s same-side or opposite-side leg is bent at the knee, about 90°, with the client’s arch of the foot on the bolster (I start with same-side and then experiment)
3. Therapist’s lower-table (closest to client’s feet) fist is used to work into the piriformis area, catching all the deep rotators
4. Simultaneously, the therapists upper-table hand can work either psoas muscle

Here, I recommend using a soft base of the palm, working the entire length of psoas from under the rib cage to the inguinal ligament on the near side, and/or pushing over psoas toward the opposite edge of the table on the far side. Note that when you use this technique on the contra-lateral psoas you are in effect ‘pulling’ on the psoas with connective tissue. This is very comfortable on a sensitive psoas. Work the entire length on that side also. (It’s easy to work cross-table into iliacus.)

Your focus is to feel a dynamic balance between psoas and piriformis. Some tips on achieving this is to feel, or even imagine, the connection between the two and focus on that connection balancing out. Remember, affecting the energy of a situation is a function of presence combined with intention. Presence primarily means keeping your attention focused, avoiding extraneous thoughts. Hold the thought of balance (a very good intention), and let your hands do their thing (“Your hands are smarter than your brain will ever be.” from The Legend Of Bagger Vance). Avoid thoughts of ‘second-guessing’ or doubting yourself; those just get in the way. If you find you have too many doubts, simply practice more (confidence is something we get for free as we become competent).

Use the same ideas for psoas work in general. Approach psoas from an angle of 30° – 60° and from the rib cage to the inguinal ligament. Soft base of the palm is my hand technique of choice, but certainly experiment. A bent near- or opposite-leg softens the area, and feel free to mobilize it. Mobilizing the rib cage or the shoulder, same side or opposite, can work: experiment and let the feel of the psoas under your hand guide you. If psoas is too sensitive to work directly, cross over. (“If it hurts to push on it, pull on it.”) Go slow, be thorough.

For a stretch, with the client supine, you can drop their lower leg off the table, push on their thigh with one hand and their rib cage with the other in opposite directions. I like to rock that back and forth, looking for motions their body responds to.

This should be a good start.

There are lots of ways to work and stretch psoas, and you can’t have too many. Any of you with suggestions of techniques you’ve found effective please Comment. I love feedback so please do. Share, learn, and grow, always becoming more. Peace, love, and Happy Thanksgiving.

‘Trigger Finger’ refers to a condition where flexing and extending one or more fingers has a ‘step’ in the action, sometimes a ‘lock’, rather than a continuous smooth movement. Pain is often but not always present through the ‘step’. Interestingly, passive movement through range of motion most often produces no ‘step’ or ‘lock’; the movement is smooth. Somewhere along the path of the tendon(s) connective tissue has built up and the tendon is ‘jumping’ over that build up. There would be only one reason for this build up from a bodyworker’s perspective – chronic hypertonicity focusing pressure on that area. (If there is a ‘step’ with passive movement also, then the buildup of connective tissue is greater than usual, and the pattern has been there longer. Treatment will be the same, but will probably take longer.)

From webmd.com – The problems often stem from inflammation of tendons that are located within a protective covering called the tendon sheath.

I completely disagree. I feel inflammation is never a cause of a problem, but always the effect of a situation, and the root of that situation is chronic hypertonicity. Put another way, hypertonicity causes inflammation, which can then lead to symptoms.
T/F will have a tensegrity pattern similar to ‘frozen shoulder’, just as there would be with anything going on in the arm. Start with the opposite side of the neck, usually mid-neck (C-3/4 area), and go through the sacro-iliac joints. Also (and always), check out occiput/C-1/C-2 on the same side as the T/F; this is the most common pattern producing arm pathologies.
To review the ‘patterns’ theory, the reasoning here is that all forces in the body must pass through the S/I joints (in LMD-speak, the #1 lever), and above that the head must balance over the spine (the #2 lever) along with the forces fed into the structure by the arms as part of #2 lever. A future article (soon) will go through Three-Lever Theory much more thoroughly.
Once you have response from the S/I’s and neck, and so are affecting the ‘sponsoring pattern’, you can address the effect it has in the arm. Using a massage lube of choice, thoroughly strip out the forearm. I like using thumbs and/or fingers to get a feel for the myo-fascial scene going on in there, and then use knuckles to do the work. Very slow and very thorough is the game.
Use the same idea in the entire arm, wrist, and hand. You are looking to break up the myo-fascial restrictions that the pattern in the torso (centered through levers 1 & 2) have created in the shoulder/arm/wrist/hand. I’m emphasizing the wrist, because the ‘trigger finger’ effect usually has created fascial issues/restrictions in the wrist.
The pattern can be further assessed by squeezing the client’s forearm at various points with your fingers while he/she flexes the T/F. In my experience, the degree of severity of the T/F always changes when I’m on the associated tendon, always becoming less severe. This can help with fine-tuning where I focus my fascial stripping.
Check out the range of motion in all the joints of the arm and shoulder looking for associated myo-fascial restrictions and treat as necessary. As you relieve the pattern in levers 1 & 2, this will be easier to accomplish.
Home exercise suggestions I like are using a child’s football and tennis ball to work the neck, SI/low back, shoulder, and any place particularly sensitive. I suggest that the client start face up on the softest, cushiest carpet in the house. Yoga mats work fine. I suggest they go slow and easy, exploring how it feels. Notice the word ‘suggest’ rather than ‘tell’. The difference between staying within our scope of practice and stepping outside of it simply comes down to the words we use: the outcome is the same.