On change

I've been thinking a lot about change the last few weeks as I am recovering from hip arthroscopy. Other than getting over the operation itself and the challenges of being on crutches, plus not being able to 'do' activities I normally don't give a thought too, I've been doing lots of exercise as part of my rehabilitation. Much has been written about the challenges of rehabilitative exercise. When I talk about this I am not just speaking about exercise given post-operation (which is generally termed 'rehabilitative'), but also exercises that are given in order to aid recovery from an injury, or movement which aids in reducing muscular tension, correcting postural imbalances, managing chronic pain etc., Movement is so fundamental to life, and we know that we feel better physically and physiologically when we do move, yet many of us struggle when we are given a set of exercises to do. Why is this?

There are many barriers to committing to a programme of exercise including pain, fear, a perceived lack of time, depression, anxiety, helplessness, low self-efficacy and poor social support. Socioeconomic factors also play a role as does personal outlook and our relationship to our body. Some people are able to engage much better than others when it comes to taking on the responsibility for self-care, while others find that the mental and physical challenges of a programme exercise can be hard to overcome. 

Clearly though, for anything to change, we need to be the facilitator of the change. It is generally well reported in professional journals that people who are able to engage with their exercises and do them regularly, will usually recover more quickly and fully than those who do not. In cases where we are dealing with chronic pain, injuries or musculoskeletal tension, engaging with a programme of exercise regularly is fundamental to reducing pain, muscular tension, restoring lost movement and healing ourselves. In all situations it is important that you take on board responsibility for your own well being. This requires a making a commitment to care for yourself.

For many of us, making that commitment can be quite hard to do. Deep down we all have a powerful ego which resists change at all costs, because it sees change as something dangerous. That ego is at work even when some deeper, more intuitive part of us knows that the things we are trying to engage with will be good for us!

Something which yoga and meditation have taught me is that we are constantly viewing the world through the mirror of emotions. When I first started my yoga practice over 10 years ago it never occurred to me that it might bring up fear, anger, resentment, frustration even boredom. Much the same thing happened in my meditation practice. I remember quite clearly when I was training at Yogaview and found out that I was going to be learning to meditate. When I first started sitting 20 mins a day felt unbelievably hard, and I frequently thought that I could not do it. I used to sit with (what felt like) overwhelming waves of emotions inside me, numb feet and somedays constant fidgeting. But slowly and surely I trained myself to sit, and I started to see those emotions for what they really were, just reflections of my ego and its view of the world around me. After a while meditation became something very profound. I started to enjoy it and see how it was changing my life. I spoke to my teacher Tom one day towards the end of my training, and he told me that a time would come where I would drift out of my meditation practice........I almost feel over with disbelief! It could not be possible, I reasoned, that this wonderful, life-changing thing that I had discovered would leave me. But you know, it did, and when that day came I realised that everything changes.

The reason I am sharing this story is because I want to say that it is always possible to change, but that change takes time, and it almost never happens as quickly as we think that it should. Part of the reason why we are sometimes are resistant to doing things that would be good for us, such as rehabilitative exercise, is because the ego fears that the change might involve us having to let go of something, or that the status quo of our lives will be disrupted. It may also try to tell us that it will be to frightening to do this new thing, that we don't have time, or that what we have been given to do won't work. The ego is great at this kind of talk!

What my yoga and meditation practice have taught me is that we must try to become unattached to outcomes in order that we can allow change to happen at its own pace. They have also taught me that change is always happening but often so slowly that we find it hard to see it. Which brings me back to where I started. If you are recovering from an operation, or suffering from some form of pain in your body, then making a commitment to yourself to engage with the process of self-care through exercise is really important. Exercise may be quite specific, such as the targeted exercises I have been given to do post-op, but it might also be things like doing restorative yoga, walking, tai chi or somatic movement. Whatever it is that you are doing you need to do it often and with an open mind. There will be days when it seems like a chore, or when it feels dull, and almost certainly some when it feels like nothing is changing. On those days remind yourself that change is a slow process, enjoy moving your body and don't worry about what your mind wants. The words of Yodi are very apt here, "Do or do not. There is no try".

The art of practice

 
 
You must forget what you know because what you know is what you have learned, but what you do not know is what you really are
— Farhelnissa Zeid

Last week I was fortunate enough to spend three days training down at Jing in Brighton participating in part two of the Advanced Myofascial Certificate. One of the places I consider 'home', at least in terms of bodywork training, being at Jing is always intense, challenging, tiring, wonderful and through-provoking. As such, I always come home and have to spend time processing what it is that I have learnt in my time there.

John F. Barnes was one of the first people to develop indirect myofascial techniques, and many people who now teach these techniques in the UK have trained with him. Indirect myofascial release is widely accepted as a powerful set of techniques which allow therapists to work more effectively with common pain conditions, emotional trauma and systemic conditions that do not respond to traditional massage approaches. Conditions such as fibromyalgia, chronic fatigue syndrome, sciatica and whiplash are just some things that respond well to indirect techniques. These are all things in which I am interested, both as a practitioner who sees many clients with chronic pain conditions and as someone who has suffered from chronic pain in the past. Describing the techniques used in indirect work is difficult however, because so much of it happens only when the therapist is able to 'let go' and develop a listening touch. Developing this kind of touch takes time and practice.

An unscheduled visit to the Tate gallery on Saturday morning got me thinking about the processes involved in learning and developing skills, and about the dichotomy that exists between what we learn and what we do, and indeed, what we think we know and what we think we do. As someone who has recently taken up drawing and painting I see many parallels between how artists work and how massage therapists work. One thing I did not understand about art until I started to do it is the amount of practice that it takes to master the techniques needed to create a piece of art. I think we are often blinkered in this respect because we generally see the finished masterpiece and not the many hours of work and practice that preceded it. We sometimes assume that artists are born with their skills and don't have to practice - the truth is that we can all be artists if we engage with the process of learning the techniques!

For an artist, exploring different techniques is what enables them to handle different mediums, see perspective, understand colour and composition etc., Practice is the key to learning, and it is an exploration that never really ends, with each phase of learning influencing our growth and development. I would argue, however, that techniques alone do not make art, because there is always something more profound in action when an artist creates a piece of art, that piece of art being reflection of their ability to draw on their own perceptions, ideas, and experience of the world around them. 

Massage therapists work in much the same way, needing to learn and explore techniques, along with anatomy and physiology, in order to be able to practice what it is that we do. Our learning never really ends because humans are such mysterious and fascinating creatures - we know so little about how our bodies and minds work. When we first learn a new technique we often struggle to feel comfortable with it, we may meet tension in our own bodies (often caused by the effort involved in just doing said new technique) and our minds work overtime in an effort to understand what it is we are doing and how it might bring about a positive change for our client. We can get very wrapped up in this 'doing' and so attached to an outcome where positive change to takes place that we forget that what we are really doing: listening intently to our client and helping them to heal themselves through the medium of bodywork.

The paradox of bodywork, at least from the therapists perspective, is that we need to learn new techniques in order to be able to use them, but if we become attached to the techniques and forget about listening and responding to what we feel, we may find ourselves unable to give our client what it is they need. We end up 'doing' to the client rather than working with them. This is what I have taken away most from my three days training last week: that a  'listening touch' only comes with practice. It comes when we are able to hold a safe space for our clients, and when we are able to let go of technique to the point where we are simply responding to what we feel and experience. I remember one of my teachers at Yogaview telling us that we would one day 'throw away all the techniques we had learnt and end up teaching from a place much deeper within ourselves, where the techniques were the foundation but not the place from which we did our work'. This is the place where magic happens!

National Massage Day

It's National Massage Day on the 16th May. Massage and myofascial release are real tools for reducing the effects of stress, insomnia, muscular aches and pains, chronic pain and restricted movement. How about some time just for 'you'? A space to relax in and time where you don't need to 'be' or 'do' anything.

For one day only on May 16th I am offering new clients a really special offer, a 60 min session for only £35! That's a £10 discount on my usual price. Be quick though, as I don't have many sessions. Give me a call on 07719 261956 to book your slot!

Less is more

On day three of training at Jing we worked with two techniques which were very new to me: Craniosacral Therapy and Visceral Manipulation.

Craniosacral therapy is a very subtle form of bodywork where the therapist uses the gentlest of touches to rebalance the flow of cerebrospinal fluid, this work can actually be done on several parts of the body including the back of the head, feet, sacrum and pelvis. It was developed by John Upledger in the 1970's and is an offshoot of cranial osteopathy which was developed by William Garner Sutherland in the 1930's. It is quite difficult to describe what if feels like and how it works, but this quote from the CTA sums it up very well:

 

 'Think about the therapist as a facilitator who, by placing his/her hands on the head or sacrum or feet is listening to the rhythm within the body and through this contact enables the body to release tensions, calm its chaos and finally to reach a point of absolute silence where both client and therapist are in unison.  It is in this silence that the body “does its work”. In this gentle space where mind and body are “held” safely by the therapist who is also focusing on the movement apparent inside the body, a deep sense of relief is often experienced.'

I'm going to be very honest now and tell you that this work was by far the most challenging work I have done for a long time. Being so still and having to listen so intently to another persons body are skills that can only be developed from practice - it was not easy to find that 'rhythm' of the body and work with it. I also found that I was expecting to feel things, both as a giver and as a receiver, which them did not materialise, leaving me with a void of expectation and a lot of questions. This is often how learning a new skill is, even when we try to come to it with the beginner's mind we can find ourselves waiting for 'something' to happen. Yet I can clearly see how the treatment could be hugely beneficial for people, especially those who cannot tolerate or do not want deeper forms of touch. The evidence base for CST is sparse and there have been many claims that it is a bogus type of therapy which does 'little or not good'. Yet lots of people (including many other therapists I know) report huge shifts in their bodies when they undergo the treatment. So we maybe have to ask ourselves the question, do we need science to validate it or are we happy to explore the unknown elements of what make us human?

Viseral Maniputaion is another form of facial work developed by Jean-Pierre Barral who descirbes it as: 

 

"The central premise of Visceral Manipulation is that the interrelationship of structure and function among the internal organs is at least as strong as that among the constituents of the musculoskeletal system; and that, like the musculoskeletal system, manipulation of the viscera can be beneficially used in the treatment of a wide variety of problems affecting any of the body’s systems"

So you can perform this type of work on the fascia which lies between and around organs such as the liver, sleep, lungs, colon, kidneys etc., Our work involved testing the springiness of the thoracic cavity (the chest area) and working gentle with the fascia that surrounds the lungs. I'd like to report that I found this easier but I didn't, although I can see the potential of this type of work in freeing up the fascia around the lungs and chest cavity, which is often tight in people who suffer from stress, anxiety & breathing issues.

As I write this post today, having seen two clients this morning, I am reminded of just how much stepping outside of your comfort zone and learning new things does in terms of providing fuel for the never-ending process of learning. Today I used many new techniques, some felt good and others need practice, but what I did mostly was to ask questions of myself while I was working - what can I do better, how can I work more slowly, when can I do more by doing less? Those are the gems from my experience at Jing last week (along with heaps of new stuff for my massage toolbox!). Can't wait till the next three days in June!

Making space

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It's great to be back at Jing in Brighton for the next three days with my Jing family. It is such a great place to train because there is total freedom to explore, ask questions and learn in a safe, nurturing and fun environment. Today was day one of the Fascial Foundation course - part one of a three part course which leads to the Certificate in Advanced Myofascial Release which I am focusing on this year.

Yesterday as I travelled down to Brighton I thought about my first experience of mysofascial release and how this started my interest in everything fascial. In 2012 I spent three months in Chicago taking an intensive yoga teacher training at Yogaview. One of the people I trained with was Liana who just happened to be a mysofasical release therapist. I had several sessions with Liana while I was in the US and quite frankly it blew my mind. I had literally never experiencing anything like myofascial release!

Since then through the mediums of my own yoga practice, workshops and as a receiver of massage, I have come to slowly understand what tight fascia feels like - there is nothing like the experience of your own body to show you such things. I've also begun to understand how it feels to touch fascia and to work with it, but have long known that I have only scratched the surface of a huge subject, hence my desire to come and immerse myself in the study and practice of myofascial release this year at Jing.

I always get a little bit nervous before a workshop. Stepping into a new space and outside of your comfort zone isn't always easy to do, yet it is precisely in this space that we grow and learn. Attending any kind of bodywork training is not just about learning techniques, although that is often a major part of it, but being willing to explore new ideas with other people. A big part of every training is 'giving and receiving' the bodywork and it requires trust and a willingness to fully immerse yourself in the cyclical process of learning. I have always found training to be an intensive experience not just because my body is receptive to touch, but also because many of my perceptions as to who I am, how I work and what I think I 'know' are often challenged! Out of these experiences come great insights and changes which I believe only serve to make me a better skilled therapist.

One of the topics we spoke of today was the importance of developing 'a listening touch'. Myofasial work is far less about technique and more about the ability to listen to the tissues of the body with your hands, allowing you to follow where the fascia wants to move, rather than dictating where it should go. It sounds very simple written here but is quite challenging the first few times you start to work with fascia because it requires faith in your own ability as a therapist. If we listen to the inner critic we often end up constantly fretting 'is anything happening?!'. I certainly had a few moments of that today, but I also had moments where I felt that movement, felt the space open up and allowed the intuitive part of me to guide where my hands moved.

In the afternoon we worked on the arms and legs. Pulling them may not sound very nice but it is an amazing way of releasing tension in the body. It looks and to all extents feels like a gentle dance through which you start to feel where the fascia is tight, and because everything is connected through the fascia, you can be working with a leg and undoing something in the upper back! During my session as receiver I clearly recall feeling tension moving out of the back of my body - an area I have always been tight and hold many injuries - and the relief, well, it was palpable and very real.

Fascia and fascial release

If you are one of my clients you will almost certainly had heard me mention the word fascia. But what is fascia and how can work on fascia help to relieve chronic pain, tension, stiffness and imbalances in our bodies?

Fascia is one of the most important and interconnected systems within the body. Until quite recently is was very much ignored within mainstream anatomical and medical thinking. Interest and research into fascia has increased a huge amount in the last 5 years, to the extent that many new ideas are changing the way we think about the body. Just asking what fascia is, or typing it into Google will bring up over 52,000, 000 results! And it can provoke much heated debate. A good nerdy definition can be taken from the International Fascial Research Congress (which is a wonderful organisation set up by pioneers in the field of fascial research):

 
Fascia is the soft tissue component of the connective tissue system that permeates the human body. It forms a whole body continuous three-dimensional matrix of structural support. Fascia interpenetrates and surrounds all organs, muscles, bones and nerve fibres, creating a unique environment for body systems functioning.
— International Fascial Research Congress
 

If you read that and found it difficult to really understand you are not alone! The key phrase is that fascia is "the soft tissue component of the connective tissue system". It forms ligaments, tendons and wraps around the brain, nerves, bones muscle fibres and bundles of muscle fibres. All of these fasciae were previously labelled as different structures (e.g. epimysium, perimysium, endomysium), yet the mind-boggling truth is that all of these things are really one fascia and are all interconnected through a silk-like spiders web. Imagine for one moment if your entire body was to be dissolved leaving only the fascia behind......you would in fact still have a complete 3D representation of you.

Tom Myer's fascial slings on the front and back body (Myers 2001)

Tom Myer's fascial slings on the front and back body (Myers 2001)

Our new understanding of fascia is challenging many long held beliefs about how the body works. For example, Tom Myer's has developed the idea of 'myofasical trains, chains and slings' in his work. He suggests that our previously held belief that 'muscles just operate over a single joint' are too simplistic - instead because muscles are connected in various ways to fascia that cross several joints and can span from head to toe, we are therefore in effect dealing with a series of much larger 'cardinal slings' that cover the entire body. This means that pain or dysfunction experienced in one part of the body, may have its origins in a totally different, apparently unrelated part of the body.

Fascial restrictions do not show up on CAT scans, MRI's or x-rays, and many people suffer with unresolved physical or emotional pain due to blockages or trauma in their fascia. Fascial tension is common and most of us will have restricted fascial tissue somewhere in our bodies. In order to function properly fascia likes to move, something which is an issue in a society of desk-based jobs, excessive driving and sitting, and it also likes to be hydrated, so that means drinking plenty of water! When fascia is not hydrated it loses its ability to glide freely and becomes stuck.

In fascial work a fluid touch is required, coupled with the ability to remain quietly still while the fascial tissue 'releases'. Areas of fascial tension may need to be held for 5-8 mins, with a sustained but gentle pressure, so that the fascia has time to elongate naturally and return to its normal resting length. Sometimes the 'release' is felt by both the client and the therapist, and has been described as anything from 'melting, like a wave' through to 'a sense of teasing matted, almost felted wool to loosen and create space within (my) tissues'.

There are a number of different forms of fascial release:

  • Myofascial Release which focuses on the fascia around and within muscles, and also the superficial fascia just below the skin
  • Rolfing or Structural Integration developed by the great Ida Rolf in the late 1960's when she was seeking to establish proper vertical alignment of the body. SI work seeks to change the alignment of the whole of the body, easing pain and dysfunction caused by fascial restrictions. Practitioners will work with clients over 10 sessions through the whole of the body from feet to head. Other similar approaches include Kinesis myofascial integration as developed by Tom Myers and Hellerwork. although all are based heavily on Rolf's work and retain many of her original ideas and concepts.
  • Craniosacrial Therapy which focus on gentle movement to the sacral bones in the skull
  • Viseral Manipulation which focuses on the fascia around organs such as the lungs
     

It is worth remembering that it is impossible to touch the body without touching the fascia, and therefore, it makes sense to integrate a variety of fascial techniques into any bodywork session. Doing fascial work requires a sensitive touch, a willingness to follow intuition, a deep sense of connection to the body and the development of a 'listening touch'. Whether direct techniques or indirect techniques or a combination of the two are used, the results can be very powerful, and conditions such as sciatica, carpal tunnel syndrome, RSI, sporting injuries, rotator cuff issues, fibromyalgia, pelvic and menstrual problems, IBS and headaches can all be treated successfully.


References

Chaitow, L. (2014) Somatic dysfunction and fascia's gliding potential. Journal of Bodywork and Movement Therapies 18 (1), 1-3

Fairweather, R. and Mari, M. S. (2016) 'Dedicated followers of facia', pp 85-113. Handspring Publishing, Edinburgh.

Myers, T. (2001) Anatomy Trains, 1st edn. Churchill Livingstone: Edinburgh

The power of hot stone massage

 
 

The use of heat as a therapeutic modality has been around for centuries. You will have certainly used a hot water bottle to sooth your belly when you had stomach ache. We often naturally turn to heat when we are in pain: e.g. hot baths, hot water bottles, wheat cushions, compresses and jacuzzis.

This much can be said for certain about hot stones: they are deeply relaxing, and they enable the massage therapist to work much deeper, improving the outcome for the client. Heat can be used as inexpensive self-care at home (no stones required!). When applied before trigger point work, acupressure and stretching the results can be truly amazing.

Heat can be used very effectively in all cases of chronic pain. If you want to know more about chronic pain please read my previous blog post on the topic. The positive effects of using heat are:

  • Heat makes us feel nurtured, relaxed, cared for and positive
  • Heat helps the body to relax, enabling the therapist to work more deeply
  • Heat has a direct effect on tight tissues, reducing muscle tightness and pain
  • Heat increases circulation, thus improving the healing time of soft tissues
  • Heat helps to increase the pliability of fascia

Research has shown that heat can be an overwhelmingly positive modality for people who suffer from lower back pain, arthritis, neck pain, wrist pain, Temporomandibular joint (TMJ) pain, Fibromyalgia, digestive problems, menstrual pain and insomnia. Further more, heat can help to free up the fascia and improve 'range of motion' of joints, for example, when suffering from frozen shoulder. I use hot stones everyday in my massage work and have found them to be a tremendously powerful modality bringing clients relief from pain, better range of motion, relaxation and a sense of wellbeing. If you have never tried them, why not give them a go and experience for yourself the power of hot stones!


References

Fairweather, R. and Mari, M. S. (2016) 'The warm up act: the power of hot and cold in advanced clinical massage', in Massage Fusion. The Jing method for the treatment of chronic pain, pp 73-84. Handspring Publishing, Edinburgh.

Chronic Pain and Massage

Chronic pain is pain that persists long beyond the usual healing time for an injury. Chronic pain can manifest in a multitude of ways including sciatica, pain from herniated discs, whiplash disorder, RSI, carpal tunnel syndrome, tennis and golfer's elbow, frozen shoulder, restricted range of motion in the shoulder joint, sporting overuse injuries such as Achilles tendinitis, rhuematoid and osteoarthritis, TMJ pain, heads/migraines, fibromyalgia, IBS and chronic fatigue syndrome. Chronic pain can also manifest as mysterious pain which is persistent and debilitating but has no diagnosis, despite extensive medical tests. 

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