Sep 26, 2011

Bodywork or Massage?

A few weeks back, I was sitting with a dear friend of mine in one of our favorite haunts in NE Portland. Following a late afternoon romp in Laurelhurst Park, avoiding duck poop as we tossed a nerf ball back and forth, we were enjoying a brew and a plate of nachos. Perhaps we were discussing possible ideas for a logo for her new business, or our endeavor to train for and run a 1/2 marathon, when out of the blue Lauren, my friend, said, "I think I'm starting to know what you mean when you say 'bodywork'."

Ah, yes bodywork. After going to school for 'massage therapy' and becoming a 'licensed massage therapist', my friends and family don't quite follow when I describe what I do as bodywork, not massage.

The term bodywork can be understood in two ways: it is an umbrella term, encompassing all forms of manual therapy, including massage. It is also the term I use to distinguish and differentiate myself from the word massage. A contradiction this would seem? Allow me to elaborate.
 
In broad terms, bodywork is an umbrella term for all kinds of manual therapies. Manual therapy is the use of skillful touch to deliver treatment, describes Deane Juhan, in Job's Body: A Handbook for Bodywork. Thus, as different as these practices are from one another, Swedish (relaxation) massage, Shiatsu, Feldenkrais, Rolfing & Structural Integration, Visceral Manipulation, Trager, Craniosacral and Aston Technique can all be labeled under the umbrella term of bodywork (and these are just a few of the many hundreds of manual therapies and modalities that may fall under bodywork). I even consider private instruction in Pilates and Yoga as forms of therapeutic bodywork.

And yet, bodywork is also a very specific term, more specific and very different from what massage, unfortunately, has come to imply.

Going back to Juhan's description of bodywork, he writes that it conveys the 'idea of the body being touched in a deliberate fashion for specific results,' meaning there is a process of intention for both the the client and the therapist. The client is not passive, like a slab of meat on table, the therapist is not impassive, like a lump of stone. A session of bodywork is the meeting point between the needs of the client and the methods and the discretion of the therapist. 

Bodywork is a practice that one builds upon over time. Meanwhile, massage is what is innate to our human selves and we use it on ourselves or to comfort others when we hurt physically, emotionally, spiritually. A person benefits enormously when they receive respectful, safe touch from any other human being. But bodywork is not innate to us, it is a combination of knowledge, skill and study that are developed over time and practice. Bodywork is about intention.

An example of what I mean is that a person may come in with a knee that becomes painful during running. I could massage the area around the knee, the quads, the IT band, the hamstrings and perhaps the sensory input will assuage the pain for a while and relieve muscle spasm. But the knee will more than likely continue to cause pain when that person runs again.   

In contrast, with bodywork I assess the factors that may be causing the knee pain, often which are not at the knee, but come from the hip and/or the foot, and use methods to recreate balance there. When the foot and the hip are in balance, the knee will naturally and quite happily come into balance. And is more likely to stay in balance, as the factors causing it to be imbalanced have been addressed.



Thanks for reading!

Sep 3, 2011

Adding Assetts: Advanced Hip and Pelvis

Last week I learned some new powerful and refined techniques for assessing and treating troublesome hips. Advanced Rolfing instructor and head of the certification program Advanced Myofascial Techniques, Til Luchau, demonstrated techniques to release tension in the soft tissue around the hips, as well as releasing the joints within the hip and pelvis.

Along with adding a couple dozen techniques to my repertoire, I also learned how to quickly assess and find restrictions in the hips and pelvis, allowing for more focused work where it is needed most. Even in the short time since implementing this new know-how into my work, I've enjoyed seeing my clients walk out of sessions feeling better and moving more freely.

The hip bone, also called the innominate, meaning 'nameless' in Latin, is actually 3 bones that fuse embryologically: the iliam, ischium and pubis. The two innominates join at the pubic symphsysis joint in the front and the sacrum in the back.
Some brief Anatomy:

The hip/pelvis system is marvelous and complex. It is where our upper body meets our lower body and its unique wide, bowl shape allows for our distinctly human upright nature. The hip socket is shallow and dish-shaped, allowing the femur that articulates with it great flexibility to move freely in many directions. Freedom of motion is important and a key aspect of the hips, but also has an inverse relationship to stability. Therefore strength in the soft tissues, the ligaments, tendons, muscles and enveloping fascia, is required to create stability in this vital structure, which must negotiate the functions of mobility for our legs to carry us where we want to go while also giving support to our heavy upper body. Altogether, about 20 muscles work in a harmonized symphony to create or prevent movement in our hips as we move and stabilize ourselves throughout the day, according to J. Earls and T. Myers in Fascial Release for Structural Balance (2010).

Where the hips are in space, whether we are standing, sitting or in motion, also determines the alignment of the spine and upper body. The base of the spine, the sacrum, articulates with the two hip bones creating the sacroiliac joint (SI joint). The sacrum is also the platform for the first lumbar vertebra (L5). If the hips are tilted to one side, often due to tightness around the hip socket, then the sacrum is also tilted and the spine must compensate for it by curving and counter-curving. The pelvis also tilts front to back. A little tilt is good, and creates relaxed curvature of the spine. But too much (sway back) or not enough will put tension on the body as it tries to maintain an upright posture. It's good to keep your hips relaxed, mobile and balanced, because their condition affects your whole body!



Techniques and Applications:

While at this Hip/Pelvis workshop, one of my favorite techniques I learned is actually a ligamentous release (ligaments are the dense connective tissue the link bone to bone). The sacrotuberous ligament attaches the bottom half of the sacrum, which is the fused base of the spine, to the back and bottom of the hip bone. This ligament anchors the sacrum. Working to release this ligament can help relieve tension further up in the low back, along with tension in the musculature of the hips, such as the gluteus maximus.

This technique, along with the others I learned last week, are helpful in balancing and mobilizing the hips, including in treating sciatic pain, which is a common condition, causing pain, usually on one side, starting in the glutes and down the back or side of the leg, and sometimes into the low back area.



Thanks for reading!