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Chapter 10 / Therapeutic Applications
Muscles Antagonistic Actions Muscles
Fingers
441
Flexor digitorum
profundus, flexor digitorum
superficialis, flexor digiti
Flexion Extension Extensor digiti minimi,
extensor digitorum, extensor
indicis
minimi
Dorsal interossei,
abductordigiti minimi,
extensor digitorum, extensor
Abduction Adduction Palmar interossei, flexor
digitorum superficialis, flexor
digitorum profundus
digiti minimi, extensor
indicis
Thumb
Abductor pollicis brevis Abduction Adduction Adductor pollicis
Flexor pollicis brevis, flexor
pollicis longus
Flexion Extension Extensor pollicis brevis,
extensor pollicis longus
Hip
Adductor brevis, adductor
longus, iliacus, pectineus,
psoas major, rectus
femoris,sartorius, tensor
Flexion Extension Adductor magnus, biceps
femoris, gluteus maximus,
semimembranosus,
semitendinosus
fascia latae
Gemellus inferior, gemellus
superior, gluteus maximus,
gluteus medius, gluteus
minimus, piriformis,
tensorfascia latae
Abduction Abduction Adductor brevis, adductor
longus, adductor magnus,
biceps femoris, gluteus
maximus, gracilis,
pectineus,psoas major
Gluteus medius, gluteus
minimus, tensor fascia latae
Biceps femoris,
gastrocnemius, gracilis,
popliteus, sartorius,
semimembranosus,
semitendinosus
Gracilis, popliteus, sartorius,
semimembranosus,
semitendinosus
Medial rotation Lateral rotation Adductor brevis, adductor
longus, adductor magnus,
biceps femoris, gemellus
inferior, gemellus superior,
gluteus maximus, gluteus
medius, obturator externus,
obturator internus,
piriformis,quadratus
femoris,sartorius
Knee
Flexion Extension Rectus femoris, tensor fascia
latae, vastus intermedius,
vastus lateralis, vastus
medialis
Medial rotation Lateral rotation Biceps femoris
continues on following page
442 INTRODUCTION TO MASSAGE THERAPY
Muscles Antagonistic Actions Muscles
Ankle
Extensor digitorum longus,
extensor hallucis longus,
peroneus tertius, tibialis
anterior
Extensor digitorum longus,
peroneus brevis, peroneus
longus, peroneus tertius
External obliques, internal
obliques, rectus abdominis
Multifidi, quadratus
lumborum, rotators
External obliques, iliocostalis,
internal obliques, multifidi,
quadratus lumborum, rotators
External obliques, internal
intercostals, internal
obliques, rectus abdominis,
transversus abdominis
Dorsiflexion Plantarflexion Flexor digitorum longus,
flexor hallucis longus,
gastrocnemius, peroneus
brevis, peroneus longus,
plantaris, soleus, tibialis
posterior
Eversion Inversion Flexor digitorum longus,
tibialis anterior, tibialis
posterior
Spine
Flexion Extension Iliocostalis, longissimus,
multifidi, rotatores, spinalis
Lateral flexion
Rotation
Diaphragm
Exhalation Inhalation Diaphragm, external
intercostals, internal
intercostals, scalenus anterior,
scalenus medius, scalenus
posterior
Scalenus anterior, scalenus
medius, scalenus posterior,
sternocleidomastoid
Levator scapulae, longissimus,
semispinalis, splenius capitis,
sternocleidomastoid, middle
trapezius
Multifidi, rotatores, splenius
capitis, splenius cervicis,
sternocleidomastoid
Masseter, medial pterygoid,
temporalis
Lateral pterygoid, masseter,
medial pterygoid
Neck
Flexion Extension Iliocostalis, levator scapulae
longissimus, multifidi,
rotatores, semispinalis, spinalis,
splenius capitis, splenius
cervicis, upper trapezius
Lateral flexion
Rotation
Temporomandibular Joint (or Jaw)
Elevation Depression Lateral pterygoid, platysma,
suprahyoids
Protraction Retraction Temporalis
Chapter 10 / Therapeutic Applications 443
Direct Manipulation
Direct manipulation (DM) is a PNF technique in which
your fingers directly manipulate the muscle spindles and
Golgi tendon organs of a hypertonic muscle to trigger relaxation. The muscle spindles are found between
the muscle fibers and respond to tension in the muscles.
The Golgi tendon organs are located between collagen
fibers in the tendons and also respond to tension. These
proprioceptors are components of such reflex arcs as the
stretch reflex and the tendon reflex, which are protective
mechanisms that help us to avoid injury. You can use these
proprioceptors to foolthe body into thinking that a muscle
is too short or too long. If the proprioceptors sense that a
muscle is too short,the nervous system can stimulate muscle lengthening, or relaxation. You can accomplish this with
the following steps:
1. Determine the target muscle. Position the target muscle
in a partial passive contraction.
2. Use your thumb and fingers to effleurage the target
muscle with a pinching or gathering action, which
addresses the muscle spindles.
3. Effleurage the tendons toward their bony attachments,
which addresses the Golgi tendon organs.
4. Slowly extend the target muscle to its new length,
stopping at the end feel. Hold the new length for at
least 5 to 10 seconds. During this period, be prepared
for a possible tendon reflex that allows the muscle to
lengthen a bit further. If so, hold it at its new length.
Box 10-6 illustrates these steps with the biceps brachii as
the target muscle.
This technique leads the nervous system’s proprioceptors into perceiving that the muscle is dangerously
hypertonic. When a muscle is strongly contracted and too
short, it is in danger of being torn. Pushing the muscle spindles together sends a message that the muscle fibers are too
close, or that the muscle is contracted too much. Pushing
the Golgi tendon organs away from the muscle conveys a
message that the musculotendinous junctions are being
stressed, or that the muscle is contracted too much. The
nervous system will respond by protectively relaxing and
lengthening that muscle.
These are reflexive responses in which the massage
application causes the nervous system to create a physical change. Once the muscle has been lengthened by the
nervous system, the surrounding fascia must be stretched
for the treatment to retain its effect. The extended hold
at the end of the DM procedure provides the stretch for
the fascia at the same time it allows the proprioceptors
to recognize the new length that should be maintained.
All stretching must be done carefully to avoid a protective
spasm.
DM is a good technique to use on painful muscles and
muscles that are not attached to the limbs, such as the trapezius or rhomboids. Clients who hurt with any kind of movement and clients who are not interested in actively moving
or participating in the massage may prefer DM to some of
the other PNF techniques.
Positional Release
To perform positional release , also called PR and strain/
counterstrain (SCS) , you hold the client’s body in a posi-
tion that reduces the hypertonic muscle pain and wait for
the nervous system to trigger relaxation. This technique
takes advantage of the body’s inherent ability to reduce pain
and release hypertonic muscles. When a muscle develops
a shortened resting length, the body finds a position that
relieves the associated discomfort. Unfortunately, the hypertonicity that reduces the movement and use of a muscle can
start the pain cycle. Using the direction of ease concept, you
can follow the body’s lead rather than work against it. To
perform PR, you apply pressure to a localized hypertonic or
painful spot and move the client’s body into a position that
reduces or eliminates that pain. Basically, PR puts the client’s
body into a position that it may have been in before a protective spasm resulted from stress or strain. When the body
senses that the position is nonthreatening, the nervous system may respond by relaxing the protective spasm. Physical
therapists, osteopaths, and chiropractors frequently use this
technique.
The very small area of pain or hypertonicity is referred
to as a tender point , tender spot, or knot. It is often found
during the massage in the midst of an effleurage stroke.
Sometimes the client will express discomfort as you pass
over it; other times you may feel a difference in the tissue
quality and should ask the client if there is any associated
discomfort. With enough experience, you will be able to
find tender points without any input from the client, but
until then, verbally communicate with the client.
Monitoring the Tender Point
The tender point is monitored with your finger, forearm,
or thumb throughout the process, so you need to use
good body mechanics while you maintain pressure on it.
You should put enough pressure on the tender spot that
clients notice the discomfort, but not so much that they
are distracted by it. You can ask clients to rate the pain or
discomfort on a scale of 0 to 3, where 0 indicates no pain
and 3 indicates severe pain, or a scale of 0 to 10, where 0
indicates no pain and 10 indicates severe pain. For clients
who do not like to use a rating scale, you can ask them
to indicate whether the discomfort is absent, mild, moderate, or severe. With experience, you will be able to feel
resistant tissues soften up when you apply the appropriate
444 INTRODUCTION TO MASSAGE THERAPY
Direct Manipulation of the Biceps Brachii
1. Determine the target muscle: biceps brachii.
2. Put the biceps brachii into a partial passive contraction.
3. Use your thumb and fingers to effleurage the biceps brachii
with a pinching or gathering action.
4. Effleurage the tendons toward their bony attachments at
the radial tuberosity and the glenohumeral joint.
5. Slowly extend the biceps brachii to its new length by
extending the elbow and the shoulder, stopping at the
end feel. Hold the new length for at least 5 to 10 seconds.
During this period, be prepared for a possible tendon reflex
that allows the muscle to lengthen a bit further. If so, hold it
at its new length.
amount of pressure with proper body mechanics and palpation skills.
Positioning the Body
Once the correct pressure and body mechanics have been
found, start moving the client’s body to minimize the
discomfort. Based on your knowledge of the major skeletal
muscles and their attachments and actions, you can begin
positioning the client by putting the target muscle into a passive contraction. Occasionally, this passive contraction of the
target muscle eliminates the pain, but most of the time, you
have to fine-tune the position by moving other body parts or
changing the position slightly. Since the three-dimensional
fascial pulling can be a component of the client’s discomfort,
the process of positioning can sometimes require you to
move a part of the client’s body that is seemingly unrelated
to the target muscle. For example, you may flex the client’s
other elbow, laterally rotate a leg, or rotate the neck to
reduce the pain further.
When moving in the primary direction of ease does
not decrease the discomfort, continue to adjust the position
until the pain diminishes. Since the body has an inherent
tendency to find the most comfortable position in any given
situation, you can also ask the client to try to find the right
position. At times, however, the pain does not seem to
diminish in any position. In these cases, another PNF technique may be the better option.
Chapter 10 / Therapeutic Applications 445
Once you find a position that significantly diminishes
or eliminates the pain, hold the client’s body in that position for at least 90 seconds. It is not critical to maintain the
same amount of pressure with your monitoring finger, but
this is a good practice. If you vary the pressure, the client
may suspect the pain is gone because you are not pressing
as hard. Because you must hold the client’s body in position,
you must maintain good body mechanics.
Releasing the Tender Point
During the hold, your monitoring finger may feel a difference
in the tissues as the tender point is released. It can feel like
the tissues are melting or softening under your pressure.
Sometimes the release is accompanied by a change in the
client’s breathing pattern or a sigh. Whether or not you notice
the release, you need to hold the position for 90seconds.
After the 90-second hold, slowly and gently return the
client’s body to the anatomical position. With your monitoring finger on the tender point, ask the client to rate the
discomfort level following PR. If the tender spot has been
released, there will be no discomfort. If pain is still present
but is reduced, you may want to repeat the process. If there
is no change, you can try PR with a different position or you
can try another technique.
Once the target has been satisfactorily relaxed, the fascia in and around the target muscle needs to be stretched.
Slowly extend the target muscle until you reach the end feel.
You will sense the end feel better with good body mechanics
and proper lean technique. Were you to push the client’s
body with your own strength, you would be more likely to
pass through the client’s comfort barrier and the end feel,
possibly causing injury. Once you reach the barrier, hold the
extension for at least 5 seconds, waiting for a possible tendon reflex to relax the target even farther.
PR is a good technique to use with clients who are not
interested in actively moving or participating during the
massage. As always, use good body mechanics with PR—
especially if your clients are large or heavy—because of the
physical work required to lift and hold their limbs or body
parts. The PR process is described in Box 10-7.
Post-isometric Relaxation
opposite knee acts as a physical barrier. The PIR technique
involves the following steps:
1. Determine the target muscle and its action.
2. Extend the muscle to its end feel.
3. Pull back from the barrier by a few degrees, or a small
amount.
a. Stabilize the client’s body in that position to provide
a physical, immovable barrier to the target muscle’s
contraction.
b. Ask the client to gently push against the barrier,
using only about 10% of his or her strength, and
hold the push.
4. After 5 seconds, clearly explain that you want the client
to slowly relax and let go of the push.
a. Gently extend the target muscle to the muscle’s
new length.
b. Hold the position for at least 5 to 10 seconds, wait-
ing for a tendon reflex to lengthen the muscle further. If it does, hold it at its new length.
Box 10-8 demonstrates PIR applied to the gastrocnemius.
Positioning the Body
Because a fully extended muscle has very little leverage and
cannot contract efficiently, synergists are often recruited to
perform the desired movement. In an effort to isolate the muscular contraction for PIR, the target muscle is positioned with
a slight contraction. To position the target muscle for PIR, you
passively extend it, stretching the muscle to its end feel, and
then relieve some of your pressure and back away from the
end feel, allowing the muscle to rest just short of full extension.
Stabilizing the client’s body requires some practice to
incorporate good body mechanics. Use a solid lean, either
into or away from the client’s body, with as little arm or back
strength as possible. You may need to remind clients that this
technique is not a strength contest, and tell them simply to
“hold against my pressure” or to use only 10% of their strength
during the contraction—just enough to signal some of the
muscle fibers to contract. If you do not, you may get pushed
or pulled off balance. Then ask the client to push or pull
against the physical barrier and hold the isometric contraction.
Post-isometric relaxation (PIR) is a PNF technique that can
reduce hypertonicity in a muscle by actively contrac ting and
relaxing the target muscle. Also known as tense and relax, it
requires work from the client and is often more effective and
longer lasting than DM or PR. PIR uses an isometric contrac-
tion of the target muscle followed by slow relaxation and elon-
gation. Isometric contractions use active muscle contraction
without producing any movement. For example, if you
squeeze your knees together, the adductor muscles are all
actively contracting, but no movement occurs because the
Relaxing the Target Muscle
After the client activates the muscle for about 5 seconds,
ask the client to slowly relax. This works best if you slowly
relieve the counterpressure. As the client relaxes the target
muscle, the nervous system relaxes and lengthens the muscle. Slowly take the target muscle into extension, using good
body mechanics, and stop at the end feel. Hold the stretch for
at least 5 seconds, allowing the proprioceptors to integrate
the new muscle length while you wait for a possible tendon
446 INTRODUCTION TO MASSAGE THERAPY
Positional Release of the Lower Trapezius
1. Apply a small amount of pressure to a tender point or small knot
in the trapezius muscle. Ask the client to rate the discomfort
on a scale of 0 to 3 (where 0 is pain free and 3 is very painful).
Adjust the pressure of your monitoring finger using good body
mechanics until the pressure elicits a pain rating of 1 or 2.
2. Maintain the contact and pressure on the tender point and
move the client’s body into a position that eliminates or
significantly reduces the discomfort.
3. Hold the client’s body in this position for at least 90 seconds
with your monitoring finger still in place. Ask the client to
take a few deep breaths.
4. Slowly return the client’s body to the original position,
maintaining contact with your monitoring finger.
Asktheclient to rate the discomfort again, using the
samescale.
5. After the tender point has been relieved, extend the target
muscle to its new length. Hold the new length for at least
5 to 10 seconds to see if the tendon reflex will allow the
muscle to lengthen a bit farther. If so, hold it at its new
length.
reflex. The tendon reflex will lengthen the muscle even more,
and the increased extension provides the CT stretch.
The client must relax the target muscle slowly to prevent a sudden, complete absence of muscular tension.
Abrupt relaxation may cause your counterpressure to
quickly push the muscle into a stretch, activating the stretch
reflex and a protective spasm.
This technique requires the target muscle to contract.
By using the neuromuscular communication path for contraction and relaxation of the target muscle, PIR can be very
effective for muscles that have been hypertonic for more
than 3 weeks. Contracting a muscle involved in a situation
of protective muscle guarding or splinting may be painful or
make the original condition worse.
Any time there is muscle guarding, which often happens
with conditions that have been present for less than
3weeks, or any time there is pain upon contraction
of thetarget muscle, you should avoid PIR.
Reciprocal Inhibition
The PNF technique called reciprocal inhibition (RI) is
based on the agonist/antagonist principle. Movement
Chapter 10 / Therapeutic Applications 447
Post-isometric Relaxation of the Gastrocnemius
1. Determine the target muscle and its action: the
gastrocnemius is responsible for plantarflexion.
2. Extend the gastrocnemius to its end feel. Stabilize the
ankle. Client and therapist push; no movement occurs.
3. Pull back from the end feel by a few degrees, or a small
amount.
a. Stabilize the client’s body in that position and provide a
physical, immovable barrier to plantarflexion.
b. Ask the client to gently plantarflex against the barrier, using
only about 10% of his or her strength, and hold the push.
Client and therapist push;
no movement occurs
4. After 5 seconds, clearly explain that you want the client to
slowly relax and let go of the push. Gently extend the target
muscle to the muscle’s new length. Hold the position for at
least 5 to10 seconds, waiting for a tendon reflex to lengthen
the muscle farther. If it does, hold it at its new length.
Stabilize the ankle
can only be created by the agonist, or prime mover, if
its antagonists relax to some degree. During the process
of RI, the client contracts the opposing or antagonistic
muscles to reflexively relax the target muscle. In other
words, by using the reciprocal muscle action, the target
muscle’s contraction can be inhibited. RI is performed
as follows:
1. Determine the target muscle, its action, and the antagonistic action.
2. Position the target muscle in a partial contraction.
3. Stabilize the client’s body in that position.
a. Provide a physical, immovable barrier to the anta-
gonistic action.
b. Ask the client to gently push against the barrier,
contracting the antagonist muscle and using only
about 10% of his or her strength, and hold the push.
4. After 5 seconds, tell the client to slowly relax and let go
of the push.
a. Gently extend the target muscle to the end feel at
its new length.
448 INTRODUCTION TO MASSAGE THERAPY
b. Hold the stretch for 5 to 10 seconds, waiting for a
possible tendon reflex that lengthens the muscle a
bit farther. If so, hold it at its new length.
Positioning the target muscle for RI is not a precise
step. As long as the muscle is held toward the end of its
range of motion, the position should be adequate for RI.
Understanding the action of the target muscle and its antag-
Box 10-9 illustrates how to apply RI to the quadriceps
femoris.
onistic action is important. Often, if you can determine the
target’s action, the antagonistic action is second nature.
Reciprocal Inhibition of the Quadriceps Femoris
1. Determine the target muscle, its action, and the
antagonistic action: the quadriceps femoris is responsible
for hip flexion and knee extension. Antagonistic actions
arehip extension and knee flexion.
3. Stabilize the client’s body in that position by placing a hand
near the knee.
a. Provide a physical, immovable barrier to the
antagonistic action of knee flexion by leaning into the
client’s Achilles tendon.
Stabilize
knee
Client activates
antagonist
(hamstrings),
no movement
occurs
2. Position the quadriceps femoris in a partial contraction.
b. Ask the client to gently flex the knee, pushing against
the barrier, using only about 10% of his or her strength,
and hold the push.
4. After 5 seconds, ask the client to slowly relax and let go of
the push.
a. Gently extend the quadriceps to the end feel at its new
length by flexing the client’s knee.
Gently extend target,
stop at end feel
b. Hold the stretch for 5 to 10 seconds, waiting for a
possible tendon reflex that lengthens the quadriceps
femoris a bit farther. If so, hold it at its new length.
Chapter 10 / Therapeutic Applications 449
Stabilizing the client’s body and providing a physical barrier to the antagonistic action requires good body
mechanics. The barrier must not move when pushed by
the client, because the muscle contraction must be isometric. With experience, you will develop techniques that work
well. As with PIR, ask clients to push against the resistance
using only about 10% of their strength and hold the isometric contraction. Ask clients to slowly relax the muscle after
about 5 seconds. Once the neurological lengthening (relaxation) has occurred, the surrounding CTs must be stretched
to maintain the change in length. Relieve the counterpressure slowly to facilitate smooth relaxation and avoid the protective spasm of a stretch reflex.
RI requires the client to actively participate in the massage but does not require the target muscle to do the work.
In conditions that involve an extremely hypertonic or painful target muscle, RI is particularly useful. As with all other
PNF techniques, there is a wide variation in the amount
of neurological relaxation that occurs as a result of RI.
Chronically hypertonic muscles generally require more time
and treatment to be restored to their normal resting length
because of the fascial restrictions that develop, the compensation patterns that develop, and the nerve tracks that make
the compensation patterns habitual. Stretching is important for reinforcing and maintaining RI work on chronically
hypertonic muscles.
Myofascial Techniques
Myofascial techniques manipulate the fascia that runs
throughout the musculature. Fascia is so pervasive that any
restrictions, adhesions, or buildups of fascia can create problems for the musculature. Fascial restriction can often be felt
during an effleurage stroke because it causes an irregularity
in the speed or quality of the stroke. Sometimes the effleurage stroke will seem to skid across the tissue or get stuck
and be difficult to move across the tissue.
Fascia is thixotropic (THIK-soh-TROH-pihk), which
means that with deformation and mechanical manipulation,
fascia becomes warmer and more liquid. This is primarily a
result of the piezoelectric (pee-AY-zoh-ee-LEHK-trihk) quality of collagen. When collagen is mechanically compressed
or squeezed, it develops an electric charge on its surface that
liquefies the collagen to some degree, and the components
of the tissue are rearranged. Recall that CT is made of living
cells suspended in a matrix of proteins that are secreted by
those cells. The proteins, including collagen, elastin, and reticular fibers, provide strength, elasticity, and structural support.
Without sufficient movement, nutrition, and hydration, fascia
stiffens and dries out.
Myofascial techniques take advantage of the thixotropic nature of fascia to mechanically change the shape and
position of restricted tissues. Due to the three-dimensional
structure of fascia, the tissues might move in different directions, circles, or wavy lines as the collagen fibers change
shape and get rearranged. This slow process is sometimes
referred to as unwinding or myofascial unwinding . These
techniques require that you maintain your original point of
contact on the client’s skin without slipping, so little or no
lubrication is used. Because these techniques are sometimes
uncomfortable, you should perform them slowly and with
care. Myofascial techniques include general CT applications
as well as specific techniques, including scar release, craniosacral therapy (CST), and friction techniques.
Connective Tissue Techniques
CT techniques make the fascia more fluid, break up fascial
adhesions, and can reduce scar tissue. CT techniques specifi-
cally soften the fascia to create more space and allow more
movement within the tissues.
the tissues slowly melt away as the fascia softens. CT techniques include the 45° stroke, skin rolling, and variations of
skin rolling.
45° Stroke
The most general CT stroke is called the 45° stroke. The
degree indicates the direction of pressure applied to the
client’s skin. The effleurage stroke, which moves along
thesurface of the client’s skin, is considered to be applied at
0°. Compression, which pushes directly into the client’s tissues, is considered a 90° stroke. The 45° stroke uses a pressure midway between that of effleurage and compression.
Once a restriction is found, you can alter your body position slightly to change the direction of your stroke to apply
pressure at 45°. As you contact the client at this angle, the
slip across the client’s skin will almost disappear (Fig.10-3).
Maintain your contact point, continue the 45° pressure, and
wait for the client’s CT to soften and unwind. In a variation
of the stroke, you use one hand to stabilize tissue with compression while the other hand applies the 45° stroke.
This general 45° CT stroke can be applied with the
fingers, thumbs, heel/s of the hand/s, whole hand, or even
forearm. The restricted area on the client’s body determines
whether you use your fingers or forearms. For a large area,
you may use your forearms, but to release a localized point,
the fingers may work better.
Skin Rolling
Skin rolling is used mainly to break up adhesions in the
superficial fascia. Restrictions in the fascia may be felt during an effleurage stroke as a skidding motion across the tissue or resistance to the stroke moving across the skin. When
a large area of fascial restriction is found, skin rolling can
be effective. Establish a contact point in the restricted area
and palpate the tissues for restricted movement. Without
You can feel the resistance of
450 INTRODUCTION TO MASSAGE THERAPY
Effleurage
(0 degrees)
45 degree
Compression
(90 degrees)
AB
Figure 10-3. 45° stroke. (A) Establish contact points and direct pressure at a 45° angle to the client’s tissues without any slip on the
skin. (B) Maintain pressure as the connective tissue softens and spreads out.
angle
any slip on the client’s skin, push the tissues away from you,
toward you, to your left, and to your right to determine the
direction of restriction , which is the direction in which the
tissues resist movement the most.
First, you work in the direction of ease, grasping and
lifting the client’s tissues into a roll, gently pulling it in the
direction that it moves easily. Slowly, you change directions
to pull the roll of tissues in the direction of restriction. Going
along with the body’s tendencies and then slowly moving in a
therapeutic direction is usually more effective than immediately pushing the body in the direction of restriction.
Tissues
that are more restricted or dehydrated are more difficult to
pick up, roll, and move. Skin rolling is especially uncomfortable when the client has considerable fascial restriction and
therefore must be performed slowly and carefully, paying
close attention to the client’s body language. You may tell
clients that if the work becomes too uncomfortable, you can
slow down or back off a bit. Encourage clients to tell you if
the work is beyond their tolerance. People can manage pain
better when they can breathe easily without bracing, recoiling, or wincing.
After the skin has been rolled for some distance, the
tissues will feel less resistant. At that point, you can slowly release the roll. Use a resting stroke to allow the body
a moment to relax and readjust to the reorganized tissues.
Then return to the close vicinity of the original contact
point and reevaluate the restriction by pushing the tissue in various directions to determine whether a change
has occurred. Box 10-10 demonstrates the skin rolling
technique.
C-Stroke, S-Stroke
You may find it difficult to lift the tissues enough to grasp
them in a roll and even more difficult to keep the roll elevated while transporting it across the client’s body. In these
situations, you can try one of the variations of skin rolling,
such as the C-stroke or the S-stroke.
The C-stroke is a variation of skin rolling in which you
still lift a roll of tissue, but instead of transporting the elevated roll, you bend the rolled tissue into the shape of a C.
The S-stroke is yet another variation in which you deform
the roll of tissue into the shape of an S (Fig. 10-4).
Scar Release
When soft tissues are compromised or injured, the body
automatically responds to repair the damage. In phase II
of the healing mechanism, collagen fibers are produced
to splint the area and prevent further damage. New collagen fibers are relatively easy to align with the fibers of the
original tissue, given gentle movement throughout phase III.
Collagen fibers continue to be produced during phase III,
and without sufficient movement, they become sticky and
hard. As a result, the collagen fibers are difficult to realign
and they easily develop into CT adhesions, or scars, with
far-reaching effects. The scars are visible when the integument is injured, but tissues beneath the surface of the skin
can also develop scars. Invisible scars are equally capable of
affecting structures in other areas of the body.
Once a scar or adhesion is created in one area, it begins
to pull on the fascia throughout the body. The quicker the adhesion is treated, the less likely it is to affect the rest of the body.
Because of its patch-like nature, there is a tendency for all
other tissues to pull in the direction of the scar, which can
lead to more compensation patterns and fascial restrictions.
The above CT techniques are appropriate if the
scar is not sensitive. If the client’s scar tissue is sensitive,
use a gentler technique that promotes the body’s selfcorrecting mechanism and unraveling of the scar tissue.
Although it is very similar to the other CT strokes, the
scar release technique uniquely combines palpation, CT
deformation, and direction of ease. You anchor one end
of the scar with a finger, knuckle, or palm, hold another
point on the scar, and apply a gentle 45° pressure in the