Original subtitles

Next to the fingers, the forearm is probably the most versatile tool we have

at our disposal.

It's extremely easy to use. Actually, it's much easier than using the fists,

the knuckles, or even the fingers.

And it's an easy way for you to take care of your body and also feels very

supportive for the person you're working on.

I'm going to start with the legs to show you some of the ways you can use the

forearm.

In areas that are bony, like the front of the tibia, you can use the fleshy

part of your forearm.

And I don't have to have my arm up in the air. I can very often just rest my

hand wherever it's comfortable and then do a snow plowing stroke up the leg.

In the area where there's bones, you're not going to want to rotate your arm

because your ulna would be pressing against that and it would be too

sensitive.

You don't have to always go in a straight line. You can use your hand

right here as a pivot point and work at angles to sort of pull this

tibialis anterior away from the tibia here.

My biomechanics are not going to be perfect here because I'm trying to keep

my body out of the way. So I'm actually reaching across the midline, which is a

little strain on my back.

But it'll be easier to show you what's going on here with my forearm. So with a

large muscle group such as the quadriceps, you may want to rotate your

arms slightly so that you have the use of that ulna to sink in a little

deeper.

that your client is reacting to the pressure and it's a little too much, you

may not need to move out to a more superficial level.

You may just need to rotate your arm a little bit to have a softer surface or

slow down.

Notice that my wrist is relaxed. There's a very different feel to this stroke if

you tense your wrist. That tension is going to go all the way up your forearm

and it'll have a very different feel for those muscles. So let your hand just

swing relaxed.

A couple other points on using the forearm.

You want to make sure that you're using it near the elbow.

As you move farther and farther away from the elbow, it requires more and

more muscular force to hold everything. I don't know if you can tell with my

shoulder here, but I'm having to use my shoulder again to supply force.

So the closer I am to the elbow and the lever arm of the humerus, I'll have a

lot easier time of it.

Sometimes people, if they feel like they're working a little too hard and

they're not quite strong enough, all you need to do is take your other hand and

brace your elbow, and that'll provide support for you.

I'm going to move Dina's knee up to show a way of working on the IT band with the

forearm.

Again, this nice, soft, fleshy surface of your underarm is probably the best

way to do this. You can provide more and more stretch the more that you bend her

knee over.

And just do a raking stroke, snow plowing.

This is something you want to be a little careful of if somebody has some

low back issues. You can be rotating the spine a little too much. And we'll talk

about working on the IT band in the side-lying position later. But this is

an excellent way if you want to take a couple quick strokes down the IT band to

work this.

Another disadvantage working this way is that you are compressing this femur into

the acetabulum here. So we'll talk about a couple other ways of working on that.

Yes, indeed, we will actually show working on the back right now. I know

we've been doing a lot on the legs, so let's use the forearm on working on the

back. The important thing on the forearm and the back is that you want to have

your elbow toward the spine.

If I use my right hand here, I wouldn't have any specificity close to the spine

to be careful about where I'm actually applying pressure.

So let me finish this stroke and show you what it would look like if I used

the right hand.

So if I use the right hand, you can see I really can't get close to these

erector muscles and try to push them one way or another. I can basically just do

a nice broad stroke up that way. This is fine, but if you want to get specific,

you're going to need to use your arms so that your elbow is near the spine in

what I call the spinal groove, the area between the transverse processes and the

spinous processes of the spine.

Depending on how broad...

More narrow you want your stroke to be, you can raise your arm. The more you

move up toward the elbow, the more specific you can be.

Regardless, if you're taking a very long stroke, you're going to want to swing

your arm around so that you're not sliding over the prominences of the

scapula here.

And then you can follow all the way up and finish off on the trapezius here and

the levator scapula.

Remember, don't get too hooked into doing a long, continuous stroke. It's

fine sometimes, but if you feel particular tension in one area, come off

and do repeat strokes.

Sometimes just waiting.

Just waiting for that to soften, sort of jostle the body a little bit.

Feel if these ribs are giving on the way up.

Start thinking about the bony articulations here rather than just the

superficial muscle.

Coming down on the other side, I can pretty much duplicate the strokes I was

showing with the fist by using the forearm.

If I want to get more and more sharp, I just raise my hand and pretty soon I'm

going to be working with the elbow, which we will be showing next.

Another advantage of working unilaterally is you can take your other

hand and push down the shoulder and get some strokes right along levator scapula

and the trapezius here.

So we're putting those on a stretch, actually.

And, of course, the same area that we talked about with the fist, you can also

use your forearm on the scapula and on the rotator cuff.

After we finish the elbow, we'll have all the tools at our disposal and as

soon as you're working some way and your weight isn't right or you want to use a

little more direct force or a little less direct, then you'll have anything

from your fingers all the way up to your elbows to use.

I will be talking about the side-lying position later in this tape, but

I think it works best to have Dina in this position now to show one other

great way to work with the forearm.

And that is in the side-lying position, I can do a wonderfully broad stroke all

the way down the IT band. I can distract this leg so that her femur almost drops

right out of the pelvis. And this is a great position to work with the forearm.

Notice again that I'm working up near the elbow. I'm not getting down to the

wrist where I would be straining.

And just...

stroke down, and just gets a lengthening stroke the whole way here.

I can certainly start raking across the gluteals and change my stroke if I'm

feeling some tension here and change directions here.

The crest of the ilium is another area that is often neglected, and it feels

great to use a forearm here.

You have a nice, soft part of your forearm. You would not be using the bony

part of your ulna here.

So all I would do is move over. I'm going to try to keep my body out of the

way so my mechanics are not perfect and just work along the crest here.

You'd be taking care to not use your elbow in this area because the sharpness

of the elbow would not feel good on that bony surface of the crest.

But a nice broad forearm is perfect for this area.

As easy as the forearm is to use, the last of our tools, the elbow, is

probably the easiest.

Basically, I'm going to keep this pretty short and pretty quick because we'll

have ample examples of the proper use of the elbow when we start talking about

specific ways to work on the body.

I'm probably going to retrace some of my steps on the back that we used with the

forearm and just show you with the elbow the basic difference.

Forearm would be nice and flat and relaxed.

Elbow, you just bring it up and you can use, depending on how you rotate, you

can use as much bony surface as you can. You want to keep away from getting on

the uphill side of your elbow where the ulnar nerve is. You can irritate your

elbow there. So do most of your pressure down below the elbow and just work your

stroke slowly, sink in, grab that tissue, pull the tissue rather than

sliding over it.

Some people are going to have very, very bony backs without a lot of musculature,

and you feel like you're sliding over that. When that happens, all I do is

take my other hand right here, put the elbow in the crook of the thumb, and

then that's going to keep me from sliding.

Remember when you're working down the back that the floating ribs down here

are not going to take nearly as much pressure as the upper ribs.

And this might be a reason to sometimes use the elbow because you're going to

have less surface area than you are with the forearm and you're not going to be

disrupting large patterns of ribs here.

You can work very, very precisely.

Another example of where the elbow is very, very effective.

is when you need very focused work in one small area.

A lot of people are very tight in fibers at the ischial tuberosity where the

hamstrings attach.

So all I'm going to do is keep my hand here so my elbow won't be sliding over

the tissue which can roll here just distal to the ischial tuberosity.

And then just pretend I'm grabbing these tendons, waiting for them to soften.

That feeling of softening tissue, including tendons, is what we're really

working for in deep tissue work.

And that's why you work slowly, so that you can feel this tissue softening.

Sometimes you can wait for a minute or so before you feel this tissue finally

letting go. And what I find is that if the tissue doesn't let go, Very often

it's that I'm pushing too hard rather than not pushing hard enough.

The body's reacting against that pressure.

Another way to save the thumbs, the elbow is a great tool on the bottom of

the feet. You can get very, very precise with your elbow, and you can really feel

what's going on with your elbow. I'm sure that my elbow is more sensitive by

a factor of two or three times than my fingers were when I first started doing

massage. All I need to do is hold this foot so I can manipulate it.

Come in with my elbow.

and start stretching that plantar fascia.

This feels very, very good. It's a broader surface than your thumbs.

Sometimes people that are ticklish with thumbs and finger work on their feet

will be able to take the elbow. You can even move to the forearm if you want a

little broader stroke.

This should do it for the elbow for now. We're going to have lots of uses for it

later. It's actually very, very easy, and I find that most students really

have a pretty good grasp of this.

Now that you know how to properly use your fingers, knuckles, fists, forearms,

elbows, and you have proper biomechanics, and you have the idea

about sinking into tissue and grabbing tissue, I want to talk about several

different kinds of strokes with a little more precision than what I've been

talking about earlier.

Earlier, I need to really focus on how you're properly using your body.

Now, I want to talk about accomplishing something.

A stroke without intention can be an empty gesture.

And I want you to really remember that because I've had a lot of massages in my

life that have been done with great flourish,

and they haven't accomplished much.

And you can tell that people are focusing on the strokes rather than what

they're trying to accomplish with the body.

So I'm going to give a few different kinds of strokes here that will have

precision in what your goals are so that your work becomes much more effective.

The first type of stroke I'd like to demonstrate is the...

Basic lengthening stroke. We're going to talk about different kinds of

lengthening strokes later on, but the first one is the basic stroke most

people learn in their first massage class, which is an Esalen stroke.

It comes by many names, but basically you're going along the muscle fiber

direction.

You can switch to any tool you want to use now.

You can use the forearm now.

If I wanted to, I could use a fist.

All of the time, I'm going in the direction of the muscle belly fibers.

I'm not going to cross over the knee yet.

It's too sensitive an area to really accomplish much in there. You need much

more precise work.

If I wanted to work with my knuckles right along the Achilles tendon, I could

work in the same direction like this.

Moving up to the hamstring.

Same idea.

I often like to use broad surfaces like the forearm on the hamstring.

Fist here, there's a tendency for those muscles to roll around the bone and you

just don't have the stability.

So I use the forearm a lot of the time here.

Notice that I'm taking my bottom hand and I can turn the leg, I can stabilize

the leg, and I can distract the leg. We'll talk more about distracting joints

later on.

The erectors, again, are the area that so many people are tied in, so the same

thing. Basically, I'm going to run up the spine with the erectors here.

I can do repeat strokes.

I've demonstrated the use of the forearm in this area already.

So let's demonstrate the knuckles to show how to save those thumbs.

Triceps all the way down to the hands.

Anything on the arm? This time you'll notice I'm not working toward the heart.

A lot of classes really, at least in the early going, talk about the importance

of always moving toward the heart. I believe there's a lot of times if you

move nice and slowly that the cue that you're giving this arm to relax and drop

out of the glenoid fossa there so that the shoulder isn't jammed there far

overrides any possible benefit of moving toward the heart.

By the same token, I can come this way and work on the forearm, anchoring here,

and give the cue for this elbow to relax and distract,

not be so compressed.

These are your basic lengthening strokes.

One of the things that we need to work with as massage therapists is to

decompress joints rather than just stretching muscles.

So I often try to think about working across joint lines so that I can give a

cue to the body to relax a constricted joint.

The hamstrings here will be a perfect example of how I can work to decompress

the hip joint. A lot of people, if they're doing impact sports,

landing with basketball, running, things like this, the hip joint gets compressed

and every step you take it's pushed in.

So I often like to, I'm going to work across Dina's body so you can see what's

happening. My mechanics aren't great because I'm leaning a little too far

forward. But what I can do is I can distract Dina's leg. So basically I'm

pulling her femur a little lower in the acetabulum here and then working in a

stroke. to lengthen this muscle in that same direction that I'm lengthening

here.

So I'm working in the same direction that I want to give her the cue to open

up that muscle. And there I felt her femur just drop, just a little bit, a

nice subtle relaxation in the joint there.

The lower hamstring and knee also works to show the same principle but working

with a slightly different stroke so that you can get an idea how you combine

these different principles.

If I want to decompress a knee, I certainly could do the same thing by

working on the gastroc and pushing down this way while anchoring away in the

opposite direction up here.

Or if I want to stretch the hamstrings in the opposite direction, I just grab

her tibia here, get a nice soft hold here, and then

Distract this joint here and move up this way.

You can do this anywhere on the body. You can distract the shoulder joint by

gently pulling the humerus away.

You can distract the ankle. You can distract the wrist. Any of these are

great ways to give the person a cue to have a looser joint.

You can do the same thing on the quadratus lumborum here. I can take my

hand and get a little bit of a hold of her quadriceps here and her femur and

pull this down. I can even move her legs over a little bit to pull this hip joint

away from the ribs here and stretch the quadratus.

I could work with knuckles.

I could work with fingers.

I personally like to work with fingers here.

You're not going to use too broad a surface because you have the floating

ribs and the kidneys here. You want to have your force in a fairly small

surface area.

Dina's foot and ankle complex illustrates another important point.

that is not often covered in massage classes.

We often try to extend a joint and make for greater range of motion, but some

joints are unable to shorten properly.

If you look very closely right around here, when I have Dina dorsiflex her

foot, you'll notice a little bit of jerkiness. It's almost like it's

catching as it's shortening. So, Dina, if you flex your ankle up.

Okay, little it's not a very smooth movement there. So all I'm going to do

is is instead of spending all of my time trying to just lengthen this foot,

Dina's a swimmer, and her foot often is very extended, so she has great range of

motion on plantar flexion here. Her dorsiflexion is a little bit limited,

and she's not used to moving her foot that way, so I just sort of look like

when the dog is screeching to a halt on the rug that it just sort of buckles,

and that's the sort of feeling that I have right here. So all I'm going to do

is work in the direction that I want her ankle to work more smoothly.

And this works very well with a knuckle or fingers.

And all I do is I feel little cross fibers in the retinaculum here.

We'll talk at length about the ankle and the strategies and troubleshooting

injuries tapes about how to get better function in the ankle and better balance

in the foot.

But right now, I'm just illustrating the point that you can also help a joint

shorten and a muscle shorten here. So all I'm going to do is move her foot.

through her range of motion and expedite that movement by sliding over and

grabbing any of the fibrous adhesions or other things that are impeding this

movement. Sometimes two or three strokes here can make a big, big difference on

how easily a joint will move and your clients will really notice this.

I always try to have a purpose in everything I do rather than just

squeezing tissue or making long strokes on the foot. I'm always thinking of

joint function. So Dina, give this a try here and see if that works a little more

smoothly for you.

So I don't know if you can notice that on the camera, but it certainly does

seem to me that there's a much smoother movement here.

One of the things that, of course, could be impeding this would be the tight

soleus or gastroc, which would mean that I would shorten this and at the same

time stretch the posterior compartment here to increase her range of motion.

Dina's wrist is another example of enabling a joint to shorten.

Her action is actually pretty smooth here, but a lot of people that are doing

things like working at a keyboard where their wrist is in a flexed position a

fair amount of time, you really want to make ease in moving it up this way. If

it's really tight and things are bunching in this area, that's where you

start running into overuse injuries and carpal tunnel and all of these. So I'll

just demonstrate very briefly some of the principles that I just demonstrated

with the foot.

All I would do is move Dina's hand through its range of motion, inflection,

and then just work wherever I feel some tension here. I could also do some cross

-fiber strokes if I wanted to.

People immediately notice the difference when you work in this way.

I'm feeling more fascial bunching here than actual muscles not sliding.

I'm going to combine two strokes in this next section to differentiate between

the two and make them a subcategory of the lengthening strokes.

What I want to talk about are anchor and stretch strokes and strokes to

facilitate lengthening. So if I work in the neck area here,

all I need to do is move in the direction that I am turning her

head.

in order to facilitate this muscle learning to lengthen in that direction.

If you notice, we're moving into a more active stage. Instead of just letting

the body lie there, we're starting to move it through range of motion. We'll

be talking about putting muscles in different degrees of stretch.

So I can anchor anywhere I feel a tight muscle and then move the body in

such a way that that muscle has to lengthen and then I facilitate that

lengthening. by grabbing the muscle and stretching it.

The other side of this coin would be what I call the anchor and stretch,

which would be when you feel tightness in a particular area, you anchor on that

tightness and then stretch the muscle away from there.

So I'm working on the posterior scalenes right now. We'll go into a lot more

detail in the neck later on, but this is the principle we're talking about.

I use the image of a rubber band that's got a knot in it. If you're stretching

something such as a yoga stretch or whatever means you're using, if you take

a nice broad stretch, the flexible components of that tight muscle will

stretch where the knot's going to stay where it is. So this is a good one to

anchor on, hold right at,

the point of fibrousness, and then stretch from there. This is not a stroke

where you're moving in different directions and sliding over. You're

grabbing that fibrous area.

You might move partway. When you feel it resisting, you might stop, wait, sink,

let that soften, and then move a little bit farther.

You can do this for virtually any muscle group that crosses a joint, and

particularly the long muscles. I could even do something like...

Grab the pectoralis major here, anchor, and then pull this arm away.

Interior shoulder girdle in stretch.

This drawing of the shoulder girdle, and particularly the pectoralis major

muscle, shows the advantages of abducting the arm to put a stretch on

muscles.

As long as we have the arm up here, let's talk about the teres major and

minor. They adduct the arm along with other issues of rotation, but all I need

to do is, if I'm going to do an anchor and stretch, is put this arm down here,

anchor in this area, and then right from that area stretch.

Going to the other side of that coin, if we're going to facilitate that stretch,

all we need to do is get below, have the arm

in a fairly shortened position for those muscles, and then move the arm up and

facilitate that.

Let's move to the lower body to look at a couple other examples.

The front of the lower leg is another perfect example of how to work a

facilitating stretch here.

So what I'm doing, I'm working just as we did before in the direction of the

muscle, but I am facilitating this muscle lengthening by pulling the foot

down into plantar flexion here.

A lot of people, when they lie on the table and you see their foot right up

like this, this is what they need to be able to let this foot move down here.

So all I need to do is stretch this muscle by plantar flexing the foot and

at the same time grab this tibialis anterior and fascia and all of this

around here and move it in the same direction.

If I wanted something a little more intense in my fingers or if my fingers

weren't strong enough, I could then move to my knuckles.

Or if that felt a little too intense for her, then I could move to my forearm and

use the fleshy part of my forearm.

Just from this little bit of work, I think you can sort of see that her foot

is slightly farther down on this side already.

And then the antithesis of that stroke would be the anchor and stretch.

So all I need to do is shorten this wherever I felt tension along here. And

sometimes it can go all the way up to the knee.

I'll just anchor on that area.

And this is where I picture the knot on the rubber band.

I hold that and then pull the foot down so that all of that stretch

is focused right where my knuckle is here.

The feet are incredibly important.

They're how we contact the earth. And a lot of people have strain patterns

there. We're going to go into great detail on how to leave your client

balanced on the ground and in more contact with the ground so that their

weight isn't all on the outside of their foot or on the inside of their foot.

We'll talk about that later. But this is another area. If you feel some

fibrousness in here in the ankle retina, just anchor and stretch away.

Forearm feels also very nice here.

Dean, if you could roll over, I'll show on the back of the leg the other side of

the body and how these principles would work.

So by the same token, if her feet were unable to dorsiflex easily, I might want

to take my knee here to expedite the stretch.

and then do a raking stroke, pulling toward my body.

I'm going to flex her foot into dorsiflexion, and then lengthen the

muscle this way.

I can shorten again, and then stretch into lengthening with my forearm.

The hamstrings and the knee are another perfect example of showing the two sides

of the anchor and stretch and the working in the direction of the stretch.

If I want to expedite the lengthening of the hamstrings at the lower end here and

have them work in the same direction, I could start them in a shortened position

and then as I'm moving in that direction, I'm expediting that

stretch.

I'm basically giving some neurological input in here. I also can get more

sophisticated if I feel that there's strain pulling her hamstrings toward the

outside with her IT band. I can just take a little bit different angle and

push in at a little bit of a diagonal here, shorten, and then work with that

so that her knee tracks in a straighter line.

If I want to do anchor and stretch, all I need to do is shorten,

the hamstrings by lifting the knee.

I then can anchor right here, hold this up, and then extend the joint.

So all of that stretch, rather than being dissipated over the whole

hamstring complex, is focused right where I'm holding this. So if you feel a

knot somewhere, if you feel some scar tissue, then you can just get right on

that and all of your energy is going to be focused right on that area.

The junction between the gluteals and the back is another perfect example of

anchoring and stretching, particularly with someone with an anteriorly tilted

pelvis that is giving them a fairly good lordosis and you want to get some length

here, all you would do is pull the gluteals under into a posterior tilt,

hold that, and then move up this way.

One other thing you could do with Dina's suit here, it's going to be a little bit

problematic, but I hope you can imagine, is I could then anchor her back up this

way. I could pull this way with my hand and then work down this way in the

opposite direction.

The calf is another good example of a different principle on working with

muscles than just lengthening, shortening, cross-fiber, and some of the

other things we have been talking about.

Particularly for long muscles in the appendages, the calf muscles, the

hamstrings, the quadriceps, there's a tendency for muscles to just adhere down

to the bone so that instead of being able to lengthen and roll like... like

they should, they are stuck almost and glued down to the bone. Dina's are

actually quite good, so she doesn't need a lot of work here, but it'll be good to

illustrate this.

So what I want to do is I want to visualize that this gastroc complex

in the whole calf, including the soleus, is able to revolve around this tibia

rather than being stuck to it.

And so what I'm going to do is either from above or below, probably right

around the knee joint or at the ankle joint, I'm going to stabilize the tibia.

I don't want her whole leg rolling.

I'm trying to get this muscle to roll on the leg.

So I can anywhere along here, I can just grab wherever I feel that it's not

moving, and sometimes you come right to the end range and just wait for

sometimes 10, 20, 30 seconds, and then you'll feel that muscle start rolling

around the bone.

So you can move it along the longitudinal axis of the bone.

You can also move it up and down. This works very well for the quadriceps,

which I'm not going to show.

But there you don't need to stabilize the leg. You grab the muscle and you

lift a little bit and you move it up and down so that it's able to contract and

lengthen on this bone without being glued there.

The last component of this would be to grab as far as you can around the

muscle.

and just lift it off the bone. And take it to the end range. This isn't

something that you just sort of keep lifting like this. Take it to the end

range where you feel all that soft tissue fighting you and then just hold

it there and continue to lift and just visualize lifting this muscle off the

bone.

the rhomboid muscles.

Notice the uniform fiber direction.

The distance between the scapula and the spine will dictate whether you will use

cross-fiber strokes or strokes that move in the direction of the muscle if you

want to add length to the muscles to free the scapula from the spine.

The next stroke I'd like to talk about is a cross-fiber stroke.

Sports massage probably uses this stroke a lot more than deep tissue, but it's a

very viable tool for you to use in your work. If somebody requires a whole lot

of cross-fiber work, very often I do refer them out to a sports massage

specialist, though.

If we picture the rhomboids, they're coming from the spine along here and

connecting to the medial scapula. So when they contract, they pull the

scapula this way.

If we're going to work on a cross-fiber, method on these.

Basically what I try to do is if this pin could represent a rhomboid is you

want to roll over and roll that fiber and just keep rolling over it to soften

up adhesions and little cross fibers that build up.

Sometimes people wonder whether they should be doing cross fiber work or

working in the direction of the rhomboids which would be working like

this. And the thing that I try to differentiate is if a muscle is fibrous

but long, somebody that's got their scapula pulled very wide, that maybe has

a tight chest, a little bit of a sunken chest, I don't want to add any length to

these fibers by working in their direction. So what I try to do is I try

to break up this fibrous issue by sliding over, softening the fibers,

which will cut inflammation.

but I'm not giving a cue to that muscle to lengthen. So that's why I use cross

fiber rather than a longitudinal stroke working along.

Another area close by that sometimes can be very, very fibrous, especially for

swimmers.

the rotator cuff muscles the infraspinatus right below the spine here

can be very very ropey and what I try to do is I just sink through those outer

layers of skin and I get right on that infraspinatus and I just try to roll it

back and forth.

The rotator cuff muscles.

Notice the complexity of the rotator cuff muscles and also that the teres

major is the only internal rotator of the humerus.

How you position the humerus will make a large effect on the amount of stretch

you will be placing upon the rotator cuff muscles when you're working.

The infraspinatus muscle.

The infraspinatus is one of the most important external rotators of the

humerus. Also notice the wide variation in the direction of its muscle fibers.

how hard you're working. And sometimes you do have to explain to people that

the next day if you're really working hard and you're breaking up some of this

tissue, they may be a little bit tender.

Let's go down to the gluteal area to talk about the piriformis muscle.

The piriformis and deep rotators of the femur.

Although it is not crucial that you know the specific names of the rotators, it

is very crucial for you to be able to determine which of those muscles are

tight.

Also notice the sciatic nerve descending below the piriformis muscle.

It is extremely important to not put direct pressure upon this nerve.

We'll go in a lot more detail on the piriformis later on when we're talking

about specific techniques.

But the same principle would work. The gluteals are coming down this way. The

piriformis is working this way. I just sink right through the gluteals, take a

diagonal so I can feel that piriformis.

It feels almost like a pencil underneath my hand here now, and I just roll over

it, and I just try to roll it back and forth and soften it.

I stay in there. Most of my work has been to sink down to that level. Once

I'm there, I can just stay right on that piriformis.

It's really not that important whether you're on the piriformis or one of the

other rotators. You go to where the tension is, you stay there, and you wait

for the melt.

These are cross fiber strokes.

The erector spinae muscles are another example of freeing muscles from

entrapment.

With many people, they're very, very hard and ropey. And instead of being

able to move, Dina's are actually pretty good here. I can actually move them from

side to side. But a lot of people just feel like they're glued down on the

deeper muscles here.

And they're hard as can be, and no matter how hard you work on them, they

don't seem to free up. So I want to show the difference between a cross-fiber

stroke, which we showed you earlier,

freeing the erector spinae from that gluing to a deeper level.

So if I'm working on cross fiber, I'm going to be sliding over these erectors

like this. And that's certainly a beneficial thing to do. I can be

softening a little connective tissue buildup and things like that, and that's

fine. People somewhat...

find that this becomes a little bit irritating as you keep sliding over

this, and I haven't found great results at softening it. So to free the erectors

from that area down below, from which I call entrapment, what I'm going to do is

with my fingers at an angle so that I'm not going to slide over those erectors,

I'm going to sink right along their medial border here, and I'm just going

to try

to free them from the tissue down below. So I'm picturing that I'm on the side of

a guitar string or something and I'm moving it this way.

I can go back and forth but I find what really works best is to come to you feel

the resistance when that muscle is not sliding anymore and then just ease up a

little bit and wait.

If your fingers start getting tired all you need to do is cover less area and

put one hand over the other and move it this way.

Now you might feel some people that their erectors are way too close to

their spine, and you want to move this way. On the other side, you'll feel some

people that the erectors are pulled way over toward the outside, and so you

would want to get on the lateral border and free them this way. In fact, it's

rare that you're going to work on the wrong side. The more freedom you can get

in both directions, the better these muscles are going to work.

The quadriceps muscles.

Notice the different attachment points and angles of pull of the quadriceps

muscles. It is important to create balance between these muscles so that

torsion on the knee can be eliminated.

Just to give one more example of what we did to the calves, I'm going to show

this with Dina's quadriceps.

Runners, athletes always like this. I can grab her IT band and make this part

of this or I can really isolate the...

the quadriceps group, whichever you feel like working with.

But you just get a big, broad hold here.

You lift the muscle off the bone and then move it so that it's able to slide

across that bone. And I can feel those fibers right down next to the bone

coming to their end range. And then when I get that, then I sort of hold, maybe

do some rotation and get this moving.

I can also do some rolling here and try to keep...

Femur from rolling so that I'm actually rolling the muscle off the bone

Sternocleidomastoid

muscles Notice the two attachments at both the sternum and the clavicle and

the broad attachment to the mastoid process

Learning how to separate the sternocleidomastoid from the deeper

scalene muscles is also an important skill to have.

The sternocleidomastoid muscle is a very important muscle.

Tightness in this muscle can have trigger point referral patterns that

cause headaches and a lot of people that breathe with their...

neck muscles rather than building the pressure up from down below by breathing

abdominally. The sternocleidomastoid muscle can be very, very tight along

with the scalenes. So this is another example of trying to show how you can

free a muscle from entrapment. This sternocleidomastoid should be able to

slide from that tissue down below. And a lot of times you'll feel with people

that it's just glued down.

This isn't something that you free up in one session, but with multiple...

repeat sessions, you can get a lot of freedom with this sternocleidomastoid.

So what you want to do with this, if it's put on too much of a stretch,

you're not going to be able to grab it. You want it to be in a shortened

position. So you want to rotate your client's head away from the SCM that

you're working on.

This will shorten and soften the muscle and also make it more accessible for you

to grab.

And with nice soft fingers, adjust the neck rotation so that you can gently

grasp that SEM and lift it free from any deep tissue that it seems to be adhered

to.

This might take a minute or two when you're actually working. And when we're

working on the neck, you'll get a better shot of this. But I just want to give

this as an example of freeing muscles from entrapment. Once you have it out

there and you have a pretty good grip on it, you then can start moving it in a

lengthwise manner.

Trying to free it up. Just visualize these little cross fibers down below

that have had that glued.

And you can start going back and forth with that. This may look rather intense,

but it usually feels very, very good to the person you're working on.

Now I'm rotating her head a little bit to get a little bit more stretch there.

Tensor fasciae latae and iliotibial band.

Notice that in addition to the tensor fasciae latae, the gluteus maximus can

put strain upon the iliotibial band.

The next specific type of stroke I'd like to talk about is a stroke that

separates muscle compartments. We, in some ways, could say that this is

similar to the last stroke we did, which is separating muscle compartments from

deeper layers where they've been glued, but very often muscles that are supposed

to be running alongside each other will then get glued to each other so that

there isn't a real sharp demarcation. One of the areas that this is most

evident in is with the IT band.

or the fascia lata, and it can get glued to both the quadriceps group here or to

the hamstrings group here. And what you'll often notice when you feel with

people is that it can slide one way much easier than another.

Dina's slides much more easy toward the hamstring than it does away from the

hamstring. So she's a little bit bound right along the hamstring here. And this

might cause a lot of torsion and tension on her knee.

All I'm going to do is try to differentiate these muscles from each

other so that they can slide in different directions.

Again, we will go in much more detail in the tape talking about how to work on

the knee for specific techniques here. So this is one that I often use just my

fingers.

And what I'll do is I'll just get on the top border of the IT band here, and

here's the quadriceps, here's vastus lateralis here, and I'll just...

slide right down there. Anytime I feel some adhesions, some tension there, I'm

just going to sink in, possibly roll this quadriceps away, see if maybe

there's too much tension. If I roll it toward it so that I can get a little bit

better grip on here and soften this and work my way down very, very slowly. This

is going to be work that requires very, very patient work because it's going to

be very tender.

Since Dina is more bound toward her hamstrings, I'll probably have better

luck by grabbing this IT band, pulling it away, and then trying to find the

hamstring area that is bound to it. So I'm rotating her leg internally, finding

areas here with the hamstring, and there's some fibrous area right here.

And right in there.

And I'm just going to wait for that tissue to melt. Notice how slowly I'm

working.

I could use my knuckles here.

because I'm pretty used to doing this, but you're not going to get quite a

sharp hold there.

So it's up to you how you feel with the strength of your fingers to do that. If

your fingers aren't quite strong enough, then use your knuckles. You'll also find

it's much easier to have your hand resting on the table when you do this,

rather than trying to lift it up.

The gastrocnemius muscles.

Notice that these are actually two different muscles with different

attachment points.

Depending upon the strain placed on the lower leg, one muscle may be

considerably tighter than the other and create torsional strain upon the

Achilles tendon.

Hamstring muscles.

Many beginning massage classes talk about relaxing the hamstrings as if they

were just one muscle.

Notice the wide variation in angle and how tightness on either the lateral or

medial hamstrings can place strain upon the knee.

On the gastroc area, you could even differentiate the lateral head from the

medial head. There's a nice septum that runs up the back of the leg here with

the gastroc basically being a two-headed muscle. So sometimes...

If one side is much tighter than the other and it's pulling in an inordinate

angle or something like that with too much stress, all you need to do is just

separate these muscles.

And you can almost see with Dina's hamstrings here, we've talked about how

they're sort of bound to the IT band here, you can almost see her lateral

hamstring being pulled over toward the IT band. So not only is it pulling the

IT band back, but this hamstring is pulled too far laterally so that it's

not pulling straight on the leg here. So all I need to do on this one, I think

I'm going to shorten the hamstrings a little bit so I can sink in, so I just

lift the leg a little bit, almost like we did with the anchor and stretch,

actually moving down here too much. I can a little bit, but I'm just going to

work my way up all the way along this lateral hamstring here.

Anytime I feel any fibrousness, I may want to shorten a little bit more to

sink in here.

Let's discuss the importance of body positioning in your strategies for

working on your clients.

I think in early massage training, we often look at a massage as a chess game

with two moves. The client is either beginning on their stomach or beginning

on their back, and you have one move to turn them over.

As we get into problem solving, it becomes very important to have an

understanding of anatomy and kinesiology

make a stretch on the muscle you're working on. Let's look at the biceps and

the elbow as an example of this.

If you have a client coming in that's been lifting weights for 15 years, and

this is about as straight as his arm can get, then you can do all the work you

can in a neutral position for him, which would be about like this, of softening

the muscle, of working with adhesions, but in all probability, when he stands

up and gets off the table, his arm is still going to be bent about this angle.

because you've not given any signal to this muscle to lengthen. So the

importance of understanding how to move bodies can help your work immeasurably

in the results you'll have, because the main issue that we have talked about in

this series has been the importance of stretching muscles rather than just

squeezing muscles.

So do take the time to cultivate these skills of learning how to move bodies

and have an understanding of kinesiology and anatomy so that you can work with

the neurological component of muscles rather than just squeezing and softening

muscles. You can give very, very important cues to your clients to have

longer, more supple, and more freer movement if you start stretching their

muscles when you're working on them.

The rhomboid muscles.

The rotation of the scapula will dictate whether you are stretching the lower or

the upper fibers of the rhomboids. A clockwise rotation can stretch the upper

fibers, while a counterclockwise rotation can stretch the lower fibers.

We've talked earlier about how the rhomboids attach to the spine and then

come along the medial border of the scapula here.

If we look at the upper fibers, Versus the lower fibers, we notice that when

the scapula is in a neutral position, the lower fibers are longer here.

If I want to work on the upper fibers, I want to bring this scapula as far

rotated this direction as possible so that these muscles can lengthen and

redefine themselves.

If I call my client into doing some active work along with this, All I need

to do is facilitate that lengthening and call for her to reach down with her arm,

and that's going to rotate this scapula.

So somebody that's very, very tight in the upper scapula, you would continue to

work on them this way. They may have a lot of length here, and you don't need

to redefine that.

However, somebody that's got their scapula pulled this way with very short

fibers, you're going to want to stretch those. And working in this position is

not going to do that because the scapula is rotated in this direction.

So all you would need to do would be to take the arm up, and that rotates the

scapula this way so that you can then work

on those lower fibers and lengthen those.

reset those neurological factors that are determining muscle length. You might

even have your client reach up above their head while you're working.

It may seem strange to be asking for movement from your client, but as you're

moving into deep tissue work, people expect this, and you'll find that its

increased effectiveness will more than make up for the upset that you may be

thinking you're giving this person when you think they're totally relaxed.

Along the same lines, a lot of people come in with their shoulders up toward

their ears.

So all you need to do is be sure that you've got this shoulder down as far as

you can. If you want to call for active movements, that's great, but you just be

sure that you put a stretch on this muscle.

You don't have to call for active movement, but that is the way to make it

the most effective. The main thing is to consider how do you want this body

placed so that that muscle is on a maximum stretch.

So as we were talking about earlier, the issue of whether you have a one or a two

joint muscle and how it crosses a joint is a real important factor to consider

when you're planning your strategy.

The gastroc-soleus combination here is a perfect way to demonstrate this. As we

said, I really want to try to get a stretch to most muscles. Most muscles

problems are caused by shortness rather than just tightness.

Most classes, when they demonstrate working on the back of the calf and on

the soleus and the gastrocnemius, indicate that you want to have a bolster

here so that the foot is not compressed against the table. The problem with this

is that the bend in the knee places the gastroc in a shortened position, so it

is difficult to stretch.

The soleus isn't affected by knee flexion, but you can see that it is

difficult to stretch it also because of the limitations of ankle plantar flexion

as it rests on the table.

One of the ways that I will try to get around this problem to put the gastroc

on a stretch is that we can move the leg right off the table.

I can then move in with my knee and put a stretch on the gastroc. So now I can

use any stroke I want.

I can do a raking stroke with my forearm.

I can do more precise work with knuckles.

Again, you might work in very different speeds from what I'm doing here.

I just want to show you some of the tools that we would be using. The fist

is another fine way to work on the gastroc here.

Of course I can work on the soleus, but with the gastroc in a stretch here, it's

going to be hard and it's going to be hard for me to work on the soleus. So

for me to work on the soleus and put it in a stretch, all I need to do is bend

the knee, which softens the gastroc, and then I can stretch the soleus by putting

some weight and flexing the ankle.

and then work on the soleus any way I want to.

One of the other things you consider when you first begin your massage and

you're evaluating where tension is, if you notice that the calves are very

tight, you don't have to do all the work when the client is face down.

What you can do is sort of mark that in your memory that when you turn the

client over into supine position, it's another great way to get a stretch

behind the legs. So, Dina, if I can have you turn over here, I'll demonstrate how

you would work there.

So now, as Dina's lying in the supine position, her knee is fully extended. I

can vary the amount of stretch.

to the posterior compartment here by how I Flex her foot and I can use my

shoulder so that I have both hands free I can now work on the gastroc clear up

near the knee I Could even cross the knee joint and work on the lower

hamstrings this way and I can work all the way down the leg this way Basically,

my hands are just milking tissue Grabbing tissue rather than sliding over

it and stretching it leaving her with a message that when she walks off this

table, her gastrocs are actually going to be longer.

The hamstrings present another example of putting a muscle on a stretch and the

benefit of body positioning.

95% of the work that I see done on hamstrings, the client is in the prone

position, and so the best stretch that you're going to get is into neutral

position. And basically, with the hamstrings, most of the problems of

tightness with muscle pulls come when they're in a stretched and extended

position. So to lengthen the hamstrings, you may do some warm-up work with the

client in prone position, but I really like to do a lot of work with Dino lying

in the supine position where I can put different...

parts of the hamstring into a stretch.

So the first thing I would do would be I would bend the knee, take care of my

back, and I'd put her foot right on my shoulder so that I can focus on the

lower hamstrings.

What I can do with the knee flexed here, her hamstrings are in a shortened

position. I then anchor them in this shortened position wherever I feel

tension. I can use my thumbs on this because it's much easier to just anchor

here. It doesn't require a whole lot of pressure or force on the thumbs.

And then all I need to do is just lean back, and I can generate almost all of

my force right where my thumbs are to free up tissue that's tight here.

This is very effective work. A lot of runners and bicyclists just love this

work.

Go all the way to extension now.

Her hamstring is put on a bit of a stretch.

already so we're getting a very good stretch through the whole length of the

hamstring and I can work anywhere along here wherever I feel tension.

I could take a nice broad stroke as well.

Up near the origin in the ischial tuberosity the hamstring is a totally

separate issue here. If I can anchor here even though her knee is flexed and

the lower hamstring is in a shortened position I am stretching the upper

hamstring now and all I need to do is just

force her knee into hip flexion here and anchor or move down over this hamstring

and I can put a great stretch on it here. You can also work on hip rotation.

If you feel that her hip wants to move out rather than moving in, you just

counter that and work in a little bit different angle.

You can work very specifically with your knuckle at the tendinous insertion.

Notice that on this, rather than staying close, And muscling this, I'm going to

get up, step back, and lean in, and then move this way.

If you want to work with rotational issues of the hamstrings and the IT

band, then all you can have Dina do is just grab her knee. She can provide the

force, and I can work with rotation with this hand as I come down and again

generate my force at the upper hamstring.

This is also a nice place to do the fist.

Notice that my wrist is in a neutral position, my hand is relaxed.

The forearm holds a lot of tension for a lot of people.

I think it's one of the most underworked parts of massage.

But again, we want to stretch this rather than just squeezing tissue in a

neutral position.

So what I do is I take the arm over to the edge of the table, and then I flex

the wrist, which is going to get the wrist extensors into a lengthened

position, and I can do any stroke I want. I can do very precise work with

knuckles, with fingers.

I can come up here to where a lot of people have problems with tennis elbow

and do some very specific work here. I can rotate so that these muscles are

able to move along the bone here.

I could even do some nice forearm work. I can do the anchor and stretch at any

specific areas by flexing her wrist down here.

Or I can move in the direction of the stretch by moving it this way.

You do have to be cautious not to...

hyper-extend the elbow here. Just be sure that you're watching the elbow as

you have it over near the end. To work on the wrist flexors, all I need to do

is rotate the arm, can hold the hand here, and I can move it in any direction

I want, but I'll anchor and then move away from the stretch here.

The anterior shoulder girdle.

We've seen this picture earlier in demonstrating the importance of

stretching the pectoralis major, but also notice how subscapularis, teres

major, latissimus dorsi, and even the triceps can be stretched and affected by

the abduction and rotation of the arm.

The triceps are another perfect example of putting a muscle in a stretch.

Most massage therapists work with the triceps with the arm down at the side.

The problem with that is it's not into a lengthened position.

If you move the arm up and abduct it way above the head, then I can get a

stretch. I can really access the origin of the triceps here and work any way I

want.

Fist feels quite good on the triceps here.

Up by the elbow, if I want to accentuate the stretch, all I need to do is flex

the elbow, and this is going to stretch.

the lower fibers of the triceps here.

This is also a nice way to work on the pectoralis major and minor. Particularly

the pec major, if you do a lot of work with the arm adducted down to the side

and internally rotated, it's not going to be in a stretched position.

But taking the arm, moving it out, this lengthens the

pectoralis major.

And I can even move it all the way up here.

The pectoralis major is an internal rotator, so you can also rotate the

humerus to affect the amount of stretch.

Here I'm augmenting a movement into internal rotation by working in the

direction of rotation.

You work with whichever side feels good for you.

Learn to work ambidextrously.

So you can see that I'm actually distracting the shoulder joint as I'm

working here, and I can work with rotation of the arm also to get very

fine tuning.

Working on the abductors.

is the perfect segue into the side-lying position.

I find that the adductors are extremely underworked in most massage classes, not

because they don't need it, but because people are a little awkward on how to

work on the inside of the legs.

So the side-lying is the perfect position to work on the inside of the

legs and to affect all sorts of other positioning of the body to get a release

and a stretch of muscles.

Let's take a look back.

at the adductors and how most people work on them in the supine position.

What most people do is pull the leg up, rotate this out. Of course, you'd be

having draping in here to cover the genital area.

But the problem with this is that you're moving toward the genital area here.

The adductors are grabbing.

because they don't want this leg to go down any farther near the end of their

stretch area.

So sometimes you can get around this by putting your leg here as a brace or a

pillow or something.

But it's just all in all is not the best way to work on the adductors.

So one of the things that we have to do as massage therapists is get over our

idea that we only have two moves in a massage.

working in the prone position and then switching to supine or the opposite.

The adductor muscles.

Notice that the adductor muscles contact the inside of the femur almost its whole

length. Be specific which muscles you're working on when trying to lengthen the

adductor compartment.

I'm going to put a bolster on her top leg, which will keep her spine from

rotating.

And now the adductors are perfectly in view here.

She's not spread eagle. She's going to feel a lot more secure about this. And

you can make all sorts of changes in body positioning to work on these

muscles. Now, we're going to work on the adductors much more specifically in

later tapes, but I want to just show some of the principles that you could

do.

You could extend the hip back to stretch the front muscles here, including the

quadriceps. You can move it forward to get a little bit of a hamstring stretch.

And then you can also vary how much stretch you want on the lower adductors

and the gracilis and other muscles like that.

So you can accomplish much more than in the supine position.

And you can work with anything that you want to. Here I'm stretching the

hamstrings. I'm stretching gracilis.

And I can just take a nice, soft fist and work up this way.

If I want to, I can take a broader stroke with my forearm.

If I want to do real specific work, Just like we work next to the spine, I can

take my fingers and do some muscle compartment separation work.

This is very, very important for people with knee problems to differentiate

these muscles on the inside of the leg.

If I want to work up closer to the pelvis, I can start up here and move

down. That way I'm giving the picture of dropping this femur right out of the

pelvis here.

I do want to mention the resistance that students have to moving people into the

side-lying position.

Every time I teach this in class, students are extremely excited. They

feel how effective it is, and they get back in their practice, and they start

finding resistance to moving people on the side. They've had it drilled into

them that the only time you do side-lying work is with pregnant women.

So you will have to do some work here to break your patterns.

And once you do, you'll find that your clients love this work.

I can do the same thing in sideline, moving up the body here, working at the

trochanter. I can work along the IT band.

I can work with hip extension.

I can work with hip flexion.

And we'll do all of this in much more detail later. I can put the rotators on

the stretch by bringing the knee forward.

I can do separation work along the IT band here.

Switching to knuckles if I want.

And this is also great work to work on the quadratus lumborum area.

The quadratus lumborum. It is important to work both the superior and inferior

attachments of the quadratus lumborum to relax the muscle.

A lot of people are very, very compressed in this area. Their ribs are

pulled down, their pelvis is pulled up, and they're very short in the

midsection.

There's really not many ways you can stretch that out in a neutral position

of lying prone.

But all you need to do is take the leg, bring it down, and this whole area

will open up this way.

You can actually take your forearm and put a stretch by holding the ribs up

above and pushing down with the pelvis.

You can move directly to the quadratus.

And we'll talk about this in detail in the strategies tapes.

And work on the quadratus in a stretched position.

You can grab this tight area, the latissimus dorsi, the serratus

posterior, serratus anterior, and you can work about...

freeing them up so the ribs can move up when they're taking a breath.

Now notice this area, if I have Dina move her arm up above her head, how this

area opens up there.

So this is another perfect example of how body positioning can affect a

stretch.

I can even grab her lateral scapula here and just peel it around back here.

I can just open this up with my thumbs and stretch all

this whole area here.

I can get into subscapularis, teres group, all of

this. I can just open this up.

The subscapularis muscle.

The subscapularis muscle is an internal rotator of the arm and can be accessed

by either the medial or the lateral scapula.

I can even stretch the rhomboids and other areas to move this way by having

her stretch her arm down this way.

And then I can work this way.

I realize this is a lot of material to be covering here, but I want to show the

importance of working in the side-lying position.

And this is just a small portion of the strokes you can do. And your clients

will love this.

It's another great way for people that have their shoulders up near their ears

again to just have them reach down here. You can see how much length is created

here.

I can do any one of many, many strokes here.

I can move in the opposite direction, sort of the anchor and stretch.

I can work in the same direction of the stretch, facilitating it this way.

And I can even work... on cervical rotation by turning the head and

stretching this way.

This was sort of a whirlwind tour of the side lying position, but I did want to

show you the importance of this and we'll go into much more detail when we

start talking about specific strategies in later tapes about how to work with

different body parts.