Terra Rosa E-Magazine Issue 14

Terra Rosa e-magazine, No.
14 (July 2014) 1
Terra Rosa
Terra Rosa

E-Magazine
Open information for massage therapists & bodyworkers
No. 14, July 2014
Terra Rosa e-magazine, No. 14 (July 2014) 2
Terra Rosa E-Magazine, No. 14, July 2014
3 The Great Debate about Stretching
Chris Frederick

8 Cervical Injuries & Treatment Strate-
gies George Kousaleos

13 Dont Underestimate the Thorax
Jo Key

15 Fascia Distortion Model
Frank Rmer

18 Fascial Fitness and Pilates
Kerrie Murphy

23 Fascia and Back Pain
Andreas Schilder

24 Functional Fascial Taping
and
Research Ron Alexander

30 Cover Feature: Donna Eddy

31 PNF Stretching

34 Barefoot vs. Shod Running

38 Working at the End of Range
Art Riggs

41 Throwing and Elastic Storage
James Earls

45 Research Highlights

49 6 Questions to Donna Eddy

50 6 Questions to Chris Frederick

Inside this Issue
Disclaimer: All material provided in this e-magazine should
be used as a guide only. This information should not be took or used
as a substitute for professional or medical advice. The publisher of
this e-magazine disclaims any responsibility and liability for loss or
damage that may result from articles in this publication.
Published and made freely available by: Terra Rosa
www.terrarosa.com.au
www.massage-research.com
Introduction

The great controversy about stretching, particularly in
therapy and athletics, started about 15 years ago
(Shrier, 1999). Previously, it was assumed that
stretching improved overall functional and athletic per-
formance, increased specific flexibility and reduced
injuries. A majority of clinicians and therapists
as well as trainers and coaches from all disciplines were
convinced about the importance of stretching as a nec-
essary part of their protocols for successful outcomes.

An article titled The Stretching Debate featured invited
commentary on research, that was largely negative, on
the benefits of stretching (Chaitow, 2003). Many of
these opinions, most of them by recognized manual
therapists, were emotionally charged and reflected the
conflicts between what therapists believed worked for
them and what the researchers were saying was really
happening in stretching. Since then, adamant pro and
anti stretch camps have formed within professions
practicing varietal therapies including fitness and
sports coaches. This acrimonious climate has been
taken advantage of in the media, adding more fuel to
the fire (Reynolds, 2013). Consequently, the author of
this article feels that it is extremely important to bring
awareness to these facts and hopefully present a bal-
anced, concise attempt to further explain and bring
more light to the debate of stretching.

Negative outcomes in research

Injuries

In August 2002, an article appeared in The British
Medical Journal that created a great deal of interest
and controversy. The paper in question was a system-
atic review of research that evaluated the benefits (or
lack of benefits) associated with stretching procedures
in relation to protection from injury and post exercise
soreness (Herbert & Gabriel). Conclusions taken di-
rectly from the study were Stretching before or after
exercising does not confer protection from muscle sore-
ness. Stretching before exercising does not seem to
confer a practically useful reduction in the risk of in-
jury, but the generality of this finding needs test-
ing. (Herbert & Gabriel, 2002).

Six years after that study, another similar systematic
review seemed to confirm the conclusions of the for-
mer. Namely, There is moderate to strong evidence
that routine application of static stretching does not
reduce overall injury rates. But there was an addi-
tional finding in that study that cast doubt on the con-
cluding statement being taken at its word as a reliable
and valid guide for using stretching in preventative
therapy and training: There is preliminary evidence,
however, that static stretching may reduce muscu-
lotendinous injuries (Small, 2008).

Strength, power and speed

There are many studies that demonstrate overall de-
creased parameters for strength such that many train-
ers and coaches do not allow stretching before weight
training and other strength focused activities (Babault,
2010; Sekir, 2010, Manoel, 2008).

With regards to both power and speed, a study about
the effects of stretching on sprinting is a good represen-
tation of what other studies have found. A repeated
The Great Debate
About Stretching
By Chris Frederick, PT, KMI
...conflicts between what
therapists believed worked for
them and what the research-
ers were saying was really
happening in stretching.
measures design was used, which consisted of the same
group of 25 healthy, recreational runners completing a
40 yard sprint trial immediately following each of four
different stretching conditions aimed at the iliopsoas
muscle and lasting one minute each. In the no stretch
condition, subjects improved significantly from pre- to
post-sprint times. However there were no statistically
significant differences in pre- and post-stretch sprint
times among the static, ballistic and dynamic stretch-
ing conditions. The study concluded that sprint per-
formance may show greatest improvement without
stretching and through the use of a generalized war-
mup with walking as the activity. Obviously, these find-
ings have clinically meaningful implications for run-
ners who include iliopsoas muscle stretching as a com-
ponent of their warm-up before running. For the re-
cord, similar negative results have been observed with
various kinds of jumping (Behm, 2007).

The studies discussed above are several examples of
negative outcomes with some studies even suggesting
in their conclusions that stretching not be performed as
a therapeutic or training guideline. Taking a look at
positive outcomes in stretch research may help to form
a balanced opinion and approach using science to in-
form our practice.

Positive outcomes in research

In one study, authors found three positive results from
stretching: (i) there was steady-state force enhance-
ment following stretch in voluntarily contracted mus-
cles; (ii) some force enhancement persisted following
relaxation of the muscle and (iii) force enhancement,
for some stretch conditions, exceeded the maximum
isometric force at optimal muscle length (Lee &
Herzog, 2002). This study counterpoints other studies
concluding that stretching weakens force production in
muscle and suggests further study to see how stretch-
ing may actually enhance muscle force production.

A recent systematic review on multiple studies indi-
cated the following positive outcomes from stretching:
Increased ROM.
ROM increases bilaterally from unilateral stretch.
Static and dynamic warm-ups are equally effective
at increasing ROM prior to exercise.
Pre-contraction stretching (e.g. PNF) lowers excit-
ability of muscle.
A pre-stretch contraction has been associated with
greater acute gains in ROM compared to static
stretching in many studies.
Debate on Stretching
In contrast to static stretching, dynamic stretching
is not associated with strength or performance defi-
cits.
Dynamic stretching improved dynamometer-
measured power as well as jumping and running
performance.
Static stretching performed before or after warm-
up does not decrease strength.
Four repetitions of 15-second holds of static
stretching did not affect vertical jump.

Getting perspective on studies about stretching

There are many examples of a number of ubiquitous
problems that is seen in research on stretching. One
view is that one of the big problems in this and in many
studies is that the word stretching is not adequately
defined. Even after reviewing individual studies, the
majority are only moderately specific about the type of
stretching studied, e.g. most often static stretching.
In the conclusions, it gets much worse as the general
term stretching is used without qualifying it with a
descriptor term, e.g. static (Thacker et al., 2004). The
problem occurs when only the conclusions and not the
details of studies like this are read (as is often the case),
and the wrong impression is promoted. That is, all
stretching is this or that when it should more accu-
rately state, for example, static stretching that utilizes
the specific parameters used in this study is this or
that. This author believes this problem is one major
source of misinformation about stretching in the news,
other media and in professional journals that is preva-
lent.

It should be noted that much of the negative outcomes
of studies on stretching over the past ten years has
come from static stretch research (McHugh & Cos-
grave, 2010). It should also be noted that the majority
of stretch studies have attempted to isolate the stretch
to one accessible muscle, most often the hamstrings
(Slavko, 2013). Static and the hamstrings are obvi-
ously only two of a multitude of variables that can be
studied and controlled in stretching research. Unfortu-
nately, those are the two most common variables seen
in research of stretching human tissue. Many other
clinically relevant variables that can be applied in
stretch therapy remain largely unstudied (Page, 2012).
For example, the author has never seen a study that
attempts to compare or differentiate any type of
stretching applied to tonic versus phasic muscles.
Therefore much of the negative press about stretching
and the concomitant advice that has recently arisen
from fitness and therapeutic sources appear to be lim-
ited at best and potentially harmful at worst. Much of
this advice is seen as being derived from narrow, evi-
denced-based studies and not from systematic reviews
comparing multiple methods or approaches to clinical
assisted stretching much less self-stretching.

What may be an even bigger problem with using out-
comes of research studies to guide clinical practice is
disturbing evidence that has recently come to light. As
reported in a Wall Street Journal article, most results,
including those that appear in top-flight peer-reviewed
journals, cant be reproduced (Naik, 2011). Bruce Al-
berts, editor of Science magazine was quoted in that
same article: It's a very serious and disturbing issue
because it obviously misleads people who implicitly
trust findings published in a respected peer-reviewed
journal. As a result, he had that journal devote a large
chunk of one of its issues to the problem of scientific
replication (Jasny, 2011). The point to be made here is
that the results of scientific studies can be viewed with
respected suspicion just as much as anecdotal report
from a trusted colleague or mentor. One is not better or
necessarily more accurate and certainly not more trust-
worthy than the other, if one is to believe the multiple
sources that have recently exposed the fallibility of the
scientific method.

There are many examples of
a number of ubiquitous prob-
lems that is seen in research
on stretching.
With this being the case, if a clinician wants to use evi-
denced-based protocols in stretching, it is advised to
follow the recommendations of study outcomes only to
the specific degree they were derived. That is, it should
not be assumed by the therapist that the outcomes are
also valid, using one example, for muscles and/or other
tissues not studied in research. Unfortunately, incor-
rect and potentially harmful assumptions and generali-
zations (and therefore incorrect advice) about stretch-
ing still abound in all fields.

Ian Schrier, MD, PhD a well-known researcher on
stretching, concluded the following key points in his
2007 article Does Stretching Prevent Injuries?

Stretching immediately before exercise is different
from stretching at other times.
Stretching immediately before exercise does not
appear to prevent injury.
Regular stretching that is not done immediately
before exercise may prevent injury.

Obviously, the debate about stretching is far from over
and the author enthusiastically encourages the reader
to join in on this discussion.

We agree with a 2012 clinical commentary that dis-
cussed current concepts of muscle stretching interven-
tions and summarized the evidence related to stretch-
ing as used in both exercise and rehabilitation (Page).
Noting both negative and positive outcomes from
stretching as we just did, the article stated that several
authors observed individual responses to stretching.
For example, the effectiveness of type of stretching
seems to be related to age and sex: men and older
adults under 65 years responded better to contract-
relax stretching, while women and older adults over 65
benefit more from static stretching. Another one: 60-
second holds of static stretches were associated with
greater improvements in hamstring flexibility in older
adults compared to shorter duration holds. Growing
studies like this suggest that stretching programs may
need to be individualized for best outcomes. It has been
this authors observation in practice that this is indeed
the case and that standard protocols in stretching and
flexibility training are mediocre at best and harmful at
worst.

Practical, reliable professional experience from ones
personal practice integrated with input from experi-
enced colleagues or mentors, when needed, which is
then informed by evidence in research is, in the au-
thors opinion, the best strategy for optimal client out-
comes. It is important to note that while science is
moving steadily forward in research of connective tis-
sues and is producing findings that can be clinically
very supportive of stretching used in different kinds of
manual therapies, practical parameters for a broad
range of clinical application sadly lag far behind. The
many possibilities of multiple types of stretching com-
bined with the application of multifarious parameters
have yet to be studied. Some or even many of these may
well yield positive outcomes. Practice-based evidence
(along with credible backing from fascia research) has
certainly produced many positive outcomes with
stretching. We need both reliable and valid clinical an-
ecdotes as well as good research for best outcomes with
our clients.

Note: This article is an extract from Chris & Ann Fre-
dericks latest book Fascial Stretch Therapy
(Handspring Books, 2014). Fascial Stretch Therapy
(FST) shows how assessment, treatment and training
are used in a variety of common circumstances encoun-
tered in manual therapy and athletic training. The book
describes and shows the therapist or trainer how to
integrate FST in their current practice, business or
workplace to enhance what they already do and pro-
vide. Available at: www.terrarosa.com.au

References
Babault, N, et al. (2010) Acute effects of 15 min static or contract-
relax stretching modalities on plantar flexors neuromuscular proper-
ties. J Sci Med Sport 13(2). Pp. 247252.

Behm, D.G., Kibele, A. (2007) Effects of differing intensities of static
stretching on jump performance. Eur J Appl Physiol 101(5). pp. 587
94.

Chaitow, Leon et al. (2003) The stretching debate. Journal of Body-
work and Movement Therapies 7(2). pp. 8096.

Herbert, R. Gabriel, M. (2002) Effects of stretching before and after
exercising on muscle soreness and risk of injury: systematic review.
British Medical Journal 325. pp. 468472.

Jasny, B.R. (2011) Again, and Again, and Again Science. Available
at: http://www.sciencemag.org/content/334/6060/1225. [Accessed:
19 December 2013]

Lee, H-D, Herzog, W. (2002) Force enhancement following muscle
stretch of electrically stimulated and voluntarily activated human
adductor pollicis. Journal of Physiology. 545.1. pp. 321330.

Manoel, M.E. et al. (2008) Acute effects of static, dynamic, and pro-
prioceptive neuromuscular facilitation stretching on muscle power in
women. J Strength Cond Res. 22(5). pp.15281534.
Practical, reliable profes-
sional experience from ones
personal practice integrated
with input from experienced
colleagues or mentors, when
needed, which is then in-
formed by evidence in re-
search is the best strategy for
optimal client outcomes.
McHugh MP, Cosgrave C.H. (2010) To stretch or not to stretch: the
role of stretching in injury prevention and performance. Scandina-
vian Journal of Medicine & Science in Sports. 20(2). pp. 169181.

Naik, G. (2011) Scientists' Elusive Goal: Reproducing Study Results.
Wall Street Journal [Online]. Available at: http://online.wsj.com/
article/SB10001424052970203764804577059841672541590.html
[Accessed: 19 December 2013].

Page, P. (2012) Current concepts in muscle stretching for exercise
and rehabilitation. Int J Sports Phys Ther. 2012. 7(1), pp. 109119.

Reynolds, G. (2013) Do we need to stretch? [Online] N.Y. Times.
Available at http://well.blogs.nytimes.com/2013/04/26/ask-well-do-
we-need-tostretch/?comments#permid=36 [Accessed 4 November
2013].

Shrier, I. (1999) Stretching before exercise does not reduce the risk of
local muscle injury: a critical review of the clinical and basic science
literature. Clin J Sport Med. 9(4). pp. 221227.

Schrier, I. (2007) Does Stretching Help Prevent Injuries? In:
MacAuley, D., Best, T.M. Evidence-based Sports Medicine, 2nd ed.,
p. 36-53.

Slavko, R., Wust, D., Schwitter, T., Schmidtbleicher, D. Static
Stretching of the Hamstring Muscle for Injury Prevention in Football
Codes: a Systematic Review. Asian J Sports Med. March 2013: 4(1): 1
9.

Small, K. et al. (2008) A systematic review into the efficacy of static
stretching as part of a warm-up for the prevention of exercise-related
injury. Res Sports Med. 16(3). pp. 21331.

Sekir, U. et al. (2010) Acute effects of static and dynamic stretching
on leg flexor and extensor isokinetic strength in elite women athletes.
Scandinavian Journal of Medicine & Science in Sports. 20(2). pp. 268
281.

Thacker, S. B. et al. (2004) The Impact of Stretching on Sports Injury
Risk: A Systematic Review of the Literature. Med. Sci. Sports Exerc.
36(3). pp. 371378.
Chris Frederick has been a
physical therapist/
physiotherapist since 1989,
focusing on manual therapy
particularly with integration of
Fascial Stretch Therapy and
Kinesis Myofascial Integration
along with personalized
movement prescription to re-
store function. He has an ex-
tensive background in dance,
both as a professional dancer
of classical ballet, as well as
being a practitioner in the spe-
cialty of dance physical ther-
apy/physiotherapy. Chris is also well versed in the an-
cient movement and healing arts of tai chi and qigong.
He is a coauthor with Thomas Myers of the chapter on
stretching in the seminal book Fascia: The tensional
network of the human body.
Chris and his wife Ann Frederick are both certified by
Thomas Myers in Kinesis Myofascial Integration and
are the authors of the popular book Stretch to Win,
and the new book Fascial Release Therapy. They are
Directors of the Stretch to Win Institute at
www.stretchtowin.com, where they offer certification
training workshops in Fascial Stretch Therapy.
Read 6 Questions to Chris on Page 50.


Now Available at
Swan neck. Bull neck. No neck. Pencil
neck. Rubber neck. Theyre running neck and
neck. She stuck her neck out. Youre a pain in
the neck.
The neck is often used to demonstrate physical charac-
teristics or the human condition. The neck is one of the
most important and distinguishable regions of the hu-
man body. It has multiple responsibilities, including
support for the head and face, and coordination of
movement between the cranium and thorax. It houses
the cervical portion of the spinal cord, seven delicate
vertebras, major arteries and veins, lymphatic vessels,
lymph nodes, a myriad of muscles, and connective tis-
sue that wraps, envelopes, and interconnects all of the
above.
As massage therapists quickly learn, pain in the neck
affects thousands of people each day. Indeed, neck and
back pain are probably the two most common com-
plaints by those who suffer soft-tissue injuries and seek
massage therapy as a primary treatment. These pains
are commonly caused by automobile accidents, athletic
injuries, overuse, or postural distortions. This article
will look at the anatomy of the neck, and treatment
strategies that include relaxation techniques, clinical
procedures, and exercise options for some of the most
common client complaints.
The Anatomy
The deepest structure of the neck is comprised of seven
cervical vertebrae. The atlas, or C1, is where the head
attaches to the neck. It is different from the other six, in
that it lacks a vertebral body. The atlas has 2 arches,
anterior and posterior, that allows it to sit atop the axis,
or C2. The axis allows for the atlas and head to rotate
on its unique structure, known as the odontoid process.
The odontoid process sits upright, allowing the fora-
men of the atlas to surround this tooth-like process.
The other five vertebrae (C3-7) have a more traditional
formation with vertebral bodies, transverse processes,
and spinous processes. All of the cervical vertebrae
support and protect the spinal cord within the vertebral
foramen, an opening that is posterior to the vertebral
bodies. Between each vertebra is an intervertebral disk,
which consists of a dense outer annulus fibrosus, and a
soft, jelly-like nucleus pulposus. Because the interverte-
bral disks act like shock absorbers, there are many inju-
ries that affect the condition of the disk. Some com-
pression injuries tear the annulus fibrosus, while more
serious injuries force the jelly-like nucleus into the ver-
tebral foramen. These injuries can endanger the spinal
cord or individual spinal roots or spinal nerves.
Cervical Injuries &
Treatment Strategies
By George P. Kousaleos, LMT
The muscles of the neck can be divided into three re-
gions posterior, lateral, and anterior. The deepest
muscles in the posterior region include the erector spi-
nae, which are comprised of lateral and medial compo-
nents. The longissimus and splenius portions form the
superficial and deep muscles respectively. The longis-
simus are responsible for erect posture and the splenii
are responsible for rotation. There are also spinalis
muscles which attach spinous processes of the upper
thoracic and lower cervical vertebrae to the spinous
processes of the upper cervical vertebrae. The semispi-
nalis capitis is one of the strongest muscles of the neck,
attaching from thoracic and cervical transverse proc-
esses to the occipital bone of the skull. Some of the im-
portant shorter muscles of the posterior neck include
the rectus capitis posterior major and minor, which
attach the atlas (minor) and the atlas (major) to the
occipital bone. Other important muscles of the poste-
rior neck include trapezius and levator scapulae, which
are often considered as head and shoulder muscles, as
they attach to the clavicle and scapula, respectively,
from the occiput.
The most important lateral muscles of the neck include
the sternocleidomastoid (SCM) and the scalene group
(anterior, medius, and posterior). These muscles either
turn the head (SCM) or tilt the head to the side
(scalenes). The scalenes are also muscles of quiet inspi-
ration as they lift the first two pairs of ribs at the supe-
rior part of the thorax. Between the anterior and medial
scalene is the scalene opening, which allows for passage
of the brachial plexus and the subclavian artery.
The anterior muscles of the neck are also called prever-
tebral muscles. Most anatomy books include the scale-
nes in this group, but for our treatment strategies we
will view them as lateral muscles. The prevertebral
muscles also include the longus capitis, longus colli,
and the rectus capitis anterior. These muscles combine
to bend the neck and head forward (bilaterally) or tilt
the head and neck to the side (unilaterally).
The final important soft tissues of the neck consist of
three investing layers of cervical fascia and the epi-
mysium of each muscle. These fascial tissues are dense
and fibrous and surround the full outer layer of neck
musculature, a deeper layer surrounding intrinsic mus-
culature, and the deepest layer, which surrounds the
vertebral column. The epimysium of each muscle will
often be the site for adhesions and thickening following
injury. These layers of fascia are richly innervated with
sensory neurons and are often the primary site of
strained or injured soft tissues.
Common Neck Injuries
Neck sprain or strain is the most common cervical in-
jury that massage therapists treat. These injuries are
often caused by impact or contact with another person,
object, or surface. Neck sprain or strain is most fre-
quently associated to sports accidents, but can easily
occur in falls or automobile accidents. Neck sprain usu-
ally refers to ligament damage and neck strain refers to
muscle damage. The common symptoms of neck
sprain/strain are:
Pain in the neck that increases with movement
Muscle stiffness and decreased range of motion
Delayed pain in neck (24 to 48 hours) following
accident
Headache associated to neck pain
Tingling or numbness in arms or hands
Massage therapy treatments can be safely administered
once a physician has evaluated the injury and ruled out
more serious damage to the vertebra and intervertebral
disks.
Whiplash occurs when there is forceful impact from
behind, causing the neck and head to violently move
forward and back in an abrupt motion. While many
whiplash injuries are caused from rear-end automobile
accidents, there are also lateral whiplash injuries that
occur from violent side impact. The common symp-
Cervical Injuries & Treatment Strategies
Muscles of the neck (image from Grays Anatomy).
toms are:
Neck pain and stiffness
Headaches
Pain in the shoulders or upper back
Difficulty concentrating
Blurred vision or ringing in the ears
Irritability and fatigue
Like neck sprain/strain, a physician should evaluate
the whiplash injury. Based on the severity of the symp-
toms, MRI or CAT Scans may be useful in determining
the severity of the injury. Once structural damage has
been ruled out, any massage therapy treatment can be
enhanced with the use of ice (for acute stage), or con-
trast (for chronic stage) therapies.
Overuse and Postural Distortions
Overuse injuries to the neck are often caused by daily
activities that are repetitive in nature, or create undue
strain for extended periods of time. These can include
carrying heavy backpacks or purses, work-related re-
petitive motion with the arms and shoulders, or sitting
at a desk in a strained position that holds the head and
neck forward of the body. The common symptoms are:
Neck pain and stiffness
Pain that radiates from neck to shoulder
Tenderness at the base of the skull
Chronic, dull pain throughout the neck and upper
back
Tension headaches
Massage therapy treatments are even more beneficial if
the client can change the repetitive pattern that may
have caused the injury. Carrying a lighter backpack or
purse in a more balanced position, or changing the
workstation to allow for better body mechanics is nec-
essary for an optimal outcome. While forward head
position is common in the computer age, postural dis-
tortions of the neck may also be caused by distortions
in the back, pelvis, or legs. Chronic tightness of the fas-
cia and muscles of the upper neck is one of the primary
causes of tension headaches.
Treatment Strategies
Every discipline of massage therapy can have a positive
effect on diminishing neck pain. From Swedish to Shi-
atsu - from neuromuscular to myofascial - from sports
massage to structural integration, a treatment plan that
incorporates the following criteria should improve the
soft tissue dysfunction found in common neck injuries.
The criteria are:
Treat the whole body all soft tissue is connected
through the multiple layers of fascia that surround
and support the body.
Spend considerable time warming the soft tissues
of the neck before applying deeper pressure.
Balance the treatment of the neck by working with
posterior, lateral, and anterior regions of the neck.
Address any corresponding issues in the paraspinal
tissues of the thoracic and lumbar regions.
Test range of motion of the neck before and after
treatment.
Teach safe stretches for the neck and back and en-
courage the client to practice alignment exercises
that improves posture.
Massage therapy is most effective when delivered in
a progressive series of sessions that gradually works
deeper with less sensitivity.
Go slow, improving the parasympathetic reflexes of
the autonomic nervous system.
Treat the whole body
The best session strategy is one that incorporates a
thorough treatment of legs, pelvis, back, abdomen,
chest, and arms, as well as the neck, head, and face.
Some massage therapists prefer to start the session
with treatment for the extremities and trunk before
moving into the neck, shoulders, and skull. Others pre-
fer to start with more general work on the neck, then
move to other regions of the body, followed by deeper
work for the neck, shoulders, and skull. If time is lim-
ited and a full-body treatment isnt possible, at least
work on the paraspinal, chest, and shoulder tissues that
attach below the neck, and the cranial tissues that at-
tach from the skull.
Warm the tissues
Tight, contracted, or shortened tissues do not allow for
full circulatory response of blood, lymph, or interstitial
fluid. Warming the tissues prior to specific work assists
in the bodys ability to nourish and cleanse the affected
area. This increases the solubility of the ground sub-
stance, or matrix, of the dense fibrous connective tis-
sues, which starts the process of diminishing adhesions
and reducing spasm.
Balance the neck treatment
No matter where the neck injury is, plan a balanced
treatment to works will posterior, lateral, and anterior
tissues. The older the injury is, the more likely that
compensation has built from the opposite side. Work
with the client in prone, supine, and side-lying posi-
tions to achieve maximum benefit on each area.
Address paraspinal tissues
Because the neck is a part of the spinal column, spend
quality time during the session reducing hypertonicity
that is common in the superficial and deep muscles of
the back. If obvious kyphosis or lordosis is apparent
utilize corresponding methods that improve the align-
ment and support of the chest and pelvis. Remember
that the thoracolumbar aponeurosis is the densest tis-
sue in the back and can restrict the release of tissues in
the mid and lower back.
Test range of motion
Testing the range of motion of the neck prior to treat-
ment will give the therapist and the client a starting
point to measure the effectiveness of the treatment.
Use forward flexion and hyperextension, lateral flexion
to both sides, and rotation in either direction. Have the
client attempt each movement with light to moderate
effort, as neck pain can increase during movement.
Test the same range of motion following the session,
again with minimal pressure. Hopefully, the client will
have increased their range of motion and will have de-
creased any painful sensation caused by movement.
Teach stretches
Along with the cervical range of movement used prior
to the treatment, it is also beneficial to instruct the cli-
ent to stretch the full spinal column through a series of
flexibility exercises. Like the neck, the back and trunk
should steadily become more pliable. The most com-
mon series of stretches include forward flexion (from
standing or sitting), side bending (from standing or
kneeling), moderate hyperextension (from prone posi-
tion), and spinal twists (from standing or supine posi-
tion). Important aspects to consider when teaching
flexibility exercises includes teaching the client to use
light to moderate effort, to use a full and even breath-
ing cycle, and to use slow and thoughtful movements.
Progressive series
Whether treating neck injuries, or injuries to any part
of the body, the best results often happen with a pro-
gressive series of sessions that engage increasingly
deeper layers of soft tissue. Many clients who are ex-
periencing neck pain can initially handle only light
pressure. Progressive sessions also allow the client to
practice self-help exercises or other home treatments
(ice or contrast) that will expedite recovery. Still other
clients have either time or financial restraints that limit
the amount of massage therapy that is affordable or
practical. For all of these reasons, establishing a pro-
gressive series of 3 to 6 treatments will support the re-
covery from most common neck injuries.
Go slow
Many disciplines of massage therapy teach, To go
deeper, go slower. Since most neck injuries include
strain or spasm of both extrinsic and intrinsic layers of
fascia and muscles, the need to manipulate multiple
layers of tissue is apparent. Whether it is the first treat-
ment session or the sixth of a progressive series, it is
important to remember that by applying pressure too
quickly sympathetic responses can easily be stimulated.
Most people in pain experience higher levels of fear and
anxiety. Controlling the application of pressure through
slower stroke speed is critical to successful outcomes.

About the Author
George P. Kousaleos, LMT, is
the founder of the CORE Insti-
tute in Tallahassee, FL. He has
practiced and taught Struc-
tural Integration, Myofascial
Therapy and Sports Bodywork
for the past 30 years. George
has served as a member of the
Florida Board of Massage Therapy and was Co-Director
of the International Sports Massage Team for the 2004
Athens Olympics. He will teach CORE Myofascial Ther-
apy for the first time in Sydney in September 2014.

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This 3-day seminar will examine the basic styles of perform-
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the autonomic nervous system will highlight a comprehensive
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George Kousaleos, LMT is the founder and director of the Core Institute, a school of massage
therapy and structural bodywork in Tallahassee, FL. He is a graduate of Harvard University,
and has been a leader in the massage therapy field over his 30-year career. He helped bring
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A paper by Tsang et al. (2013) offers great kinematic
data on functional movement of the upper spine and
confirms the clinical approach of many experienced
therapists successful in the treatment of neck pain.
The authors concluded that the motion of the thoracic
spine, in particular the upper thoracic spine, contrib-
utes to neck mobility, and that the upper thoracic spine
should be included during clinical examination of neck
dysfunction.
I never treat the neck without addressing the thoracic
spine Why so? No part of the body functions in isola-
tion. As the pelvis is to the lumbar spine, the upper
thorax similarly acts as an adaptable platform of sup-
port for the head and neck. When our postural align-
ment changes, the natural movement kinematics of the
whole spine and in particular those in the upper spine
change. This further creates altered loading patterns
(tension and compression) of the joints and soft tis-
sues. In time, stiffness and pain will predictably ensue.
This pretty much underlies all neck pain syndromes.
Many of us adopt a habitual slumped posture sitting at
work and during many leisure activities most of
which also invariably involve use of the arms down in
front of the body. The shoulder girdle and head and
neck hang forward off the thorax. We start to lose the
sense of and ability to come back up to neutral. And in
time the cervico-thoracic spine and upper thorax be-
comes stiff. The cervical joints above become the
victim and cant assume a neutral position or move
properly. Many exercises prescribed for neck pain
simply bother it more. The secret is to address the
criminal to get mobility into the upper thorax and
through the cervico-thoracic junction. To this end The
Fundamental Shoulder Patterns are a good start.
(See: www.keyapproach.com.au/blog ).
Its important to realise that it isnt simply a stiff tho-
rax which biomechanically effects cervical function.
Changed posture-movement of the thorax also directly
affects the kinematic patterns and loading patterns of
the shoulder girdle. Appropriately treat the thorax and
youll also make better gains with your shoulder pa-
tients
Secondly, thoracic joint dysfunction per se has a
marked influence not only on the adjacent soft tissues
but also upon autonomic function - the autonomic sup-
ply to the head and neck is T1-5 and that to the upper
limb T2-10. The literature is increasingly showing sym-
Dont Underestimate the Thorax
By Josephine Key
pathetic involvement in many central and peripheral
pain syndromes.
Thirdly, the changed myo-mechanics and altered load-
ing patterns also affect the fascial system which func-
tionally connects the thorax to the head neck and upper
limb. This tissue is richly innervated and forms a con-
tinuous whole body signalling system and structural
web arranged in various layers.
If you are not addressing the thorax you will achieve
limited results in the treatment of not only head and
neck pain, but also shoulder and upper limb pain syn-
dromes not to mention low back and pelvic pain.

Normal kinematics of the neck: The interplay
between the cervical and thoracic spines
By Sharon Tsang, Grace Szeto, Raymond Lee. Pub-
lished in Manual Therapy 2013 Oct;18(5):431-7.
The movement coordination between the cervical and
thoracic spine was examined in 34 asymptomatic par-
ticipants (24 female and 10 male). The authors used
3D motion sensors attached to the skin overlying the
head, T1, T6, and T12 spinous processes to measure the
angular displacement of the cervical, upper thoracic,
and lower thoracic spine during active neck move-
ments. The study found that both the cervical and tho-
racic spines contribute to active neck motion, the great-
est contribution being from the cervical region in all
movement directions. The inter-regional movement
coordination between the cervical spine and upper tho-
racic spine in all three planes of movement was found
to be high.

Comments by Til Luchau on the paper by Ta-
sang et al. (2013)
It takes a lot of careful work to measure big-picture
correlations by piecing together the small-picture de-
tails, and this study has endeavoured to do just that.
Even though, as Einstein said, "Not everything that
counts can be counted, and not everything that can be
counted counts, there is an odd kind of satisfaction
when we get a quantified validation of something we
knew already. Did you know that the spine moves when
the neck does? Of course you did, but to see it laid out
in nice charts done under carefully standardized ex-
perimental conditions reassures us that we really do
know what we know. There are a few gems here, for
instance, that the lumbars respond more to cervical
side bending than to other neck movements. And it
would be interesting to see if symptoms correlated to
variations in the neck/spine movement coupling,
rather than focus solely on asymptotic examples as this
study did. Still, kudos to the authors for their diligent
work.
Kinematic Chain
The understanding of the body language
Every day, countless patients try to show and describe
their complaints to doctors and therapists. Most of the
time their attempts fail as a result of miscommunica-
tion or misunderstanding. Doctors prefer an MRI diag-
nosis, osteopaths find the dysfunction in other parts of
the body, PTs work most of their time at the right place
but, unfortunately, too often with the wrong tech-
niques. This misunderstanding now has an end in the
Fascial Distorsion Model. Through the joining of body
language and verbal description of the patients pain,
FDM therapists are able to establish an appropriate
diagnosis and therapy.
The founder and developer of the FDM model was
Stephen Typaldos, DO - an American emergency room
physician. He noticed that his patients always used the
same body language to show their problems and devel-
oped the Fascial Distorsion Model in which the clinical
signs and the body language of the patients were com-
bined to form a diagnosis and a appropriate therapy.
The first distortion discovered by Dr. Typaldos was a
triggerband in 1991. Six different distortions are now
known and treated. Unfortunately, Stephen Typaldos
died in 2006. The FDM is beginning to spread into the
professional healthcare communities and trained prac-
titioners can now help to improve and develop this dis-
covery. Dr. Typaldos discovered 6 different disorders
within the fascia of the musculoskeletal system.
1. Triggerband
2. Continuum Distorsion
3. Herniated Triggerpoint
4. Cylinder Distorsion
5. Folding Distorsion
6. Tectonic Fixation
The patient may have one or all six disorders. One of
these disorders, the so-called triggerband, is here ex-
emplified. In a trauma, there may be a rotation or split-
ting of the fascial layer resulting in pain and restricted
movement. Fascia in the body is always oriented to ac-
curately transfer or transmit forces along appropriate
planes. If a force is introduced into the system that can-
not be physiologically contained, such as a transverse
(across the grain) force, a splitting of the fascia may
occur. Patients report a drawing, burning pain which
they illustrate by moving their fingers along the path of
their pain. In the clinic, we see a movement restriction
due to the shortening of the trigger strip, a loss of
strength and a reduction of stability and coordination.
Treatment is done with the therapists thumb following
the course of the lesion accurately and with deep pres-
sure to re-establish the normal orientation of the fibres
(twisting/untwisting). After closing the fascia it is as
good as before the trauma. A third possibility for the
emergence of a triggerband is the calcification of the
fascia along a stress line. It is assumed that the load is
suspended and the patient requires a more stable fas-
cia. To ensure this, the body reinforces the connective
tissue with calcium. With the same triggerband therapy
as before, the stored calcium is released again from the
fascia. Often a repeated treatment is necessary until the
patient is pain-free.
Fascial Distortion Model
By Frank Rmer
Figure 1. Treatment of a Continuum Distortion of the ellbow
FDM
In the Fascial Distortion Model, the concept of
Chronic Pain patient gets a whole new meaning. Pre-
viously, these patients were considered incurable. The
FDM provides a different perspective on persistent
chronic pain. In chronic pain, there is an incorrect
bonding of the split triggerband via cross links, which
leads to excessive restriction of the tissue and dys-
functional movement. These pathological cross-links
connect structures together which do not belong to-
gether leading to even more pain and an even greater
restriction of movement. Through a targeted treat-
ment using triggerband technique, the adhesions are
dissolved and the lesion is brought back to an acute
state where the body can then heal correctly. This
results initially in bruising and increased pain as the
triggerband is returned to the acute state so the body
can re-establish the normal linking necessary for cor-
rect physiological functioning. In the second and
third treatments, the triggerband is treated with the
same technique thus completing the correct realign-
ment of the cross links of the fascial structure. After
the treatment, the patient is asked to move and assess
whether there is still some remaining pain on move-
ment or whether they are now pain free. The out-
standing results of the FDM technique, along with
ongoing clinical research into fascial treatments, give
therapists a strong foundation on which to build. Old
theories, such as muscular contraction causing
chronic decreased ranges of motion in the shoulder,
are rapidly changing in light of the FDM techniques
which can restore full pain free ranges of motion in
two treatments. After learning and understanding the
model, therapists will be able to immediately achieve
greater clinical success based on the ability to cor-
rectly assess the patients problems utilizing the
FDM's body language assessment and description
techniques and then treating with the appropriate
FDM therapy. The FDM is a revolution in the entire
medical field. Let us work to rethink and improve
existing models to identify new disorders and, above
all, to find the right therapy for each patient. In the
field of fascial research, we will gain in the next few
years many new therapies that should not be ignored.
An Example of FDM treatment for a supina-
tion trauma
Previously it was thought that the best treatment for a
supination trauma was immobilization, at least par-
tially using a plaster cast for up to four to eight weeks.
The assumption was/is that such traumas came from
an injury to the ligaments that could be healed by
keeping the limb immobilized. Surgery is mostly
The six typical fascial dysfunctions
Triggerbands
When a triggerband is put under undue stress
that leads to a rotation, splitting or calcification of
the fascia the patient describes a searing pain and
points with several fingers along a line. This dis-
tortion can be treated by applying heavy pressure
to the affected structure to de-rotate, to close or to
decalcify it.
Continuum Distortions
Ooften the result of a injury in the transitional
area between the fascia tissue and the bone. The
body loses its ability to respond correctly to exter-
nal forces in the transitional area. Patients will
point with one finger at the point(s) of pain. By
applying heavy pressure to this point we encour-
age the transitional area to be able to accept rea-
sonable external forces again.
Folding Distortions
Compression or traction forces together with a
rotation can cause pain deep within a joint and
produce folding distortions. This results in not
just a restriction of movement but also a feeling of
instability. This can be corrected by traction and
compression manipulation.
Herniated Triggerpoints
Injuries where tissues that normally lay under-
neath the fascia have bulged through the fascia
and have become stuck there. The patient de-
scribes a dull as well as a tense pain. By means of
heavy pressure eon the HTP the tissue can be
pressed into its original position.
Cylinder Distortions
Tangled coils of cylinder fascia. The ability of the
fascia to uncoil and recoil is restricted and maybe
even lost. The body language of the patient with a
cylinder distortion is extremely varied. Mostly
they will run a flat hand over the affected area.
The injury is also treated is by using a flat hand
and applying pressure to the area.
Tectonic Fixations
A physiological alteration where the fascial sur-
face has lost its ability to glide naturally. This is
painless. Patients often complain of a complete
restriction of movement. The treatment of large
joints that have indications of tectonic fixations
is very strenuous for the therapist and patient.
avoided.
With FDM we have a different approach to the patients
complaints on pain. The most common complaints af-
ter a supination trauma are stabbings pains in the lat-
eral malleolus as well as lateral twinging pains in the
lower leg running down to the foot. If the complaints
disappear after a few weeks there is still often an unsta-
ble feeling in the ankle joint. Translated into
FDM distortion this means that the patient has a fold-
ing distortion on the lateral malleolus contin-
uum distortion, the lateral lower leg triggerbands, as
well as in the ankle joint. When beginning the FDM
treatment the aim is that the patient has a normal gait
after being treated. To begin with the patient should
indicate where the painful areas are. This is followed by
a triggerband technique to correct the twisted fascia of
the lower leg. After the second treatment the patient
should be able to hop on the affected leg with feeling
any pain. Often though, there is feeling of instability.
This is rectified after the third round of treatment by
means of a folding technique on the upper part of the
ankle joint. If the patient has no further complaints
then the FDM treatment is finished and the patient can
play sport again. When everything goes well, correcting
a supination trauma should take three days.
See examples of FDM treatment in a video: http://
youtu.be/aL2I2dcO7bI
FDM
Figure 2. Cylinder Distortion of the lower arm
Figure 3. Treatment of a refolding distortion of the shoulder
The New Year began for me in a dusty community hall
in Marrickville, NSW, alongside other body workers
from many disciplines. We were there to be inspired
and to learn from a leading researcher in fascia from
the University of Ulm in Germany, Dr Robert Schleip,
who led us on a journey of the latest discoveries of the
bodys fascial web. His wife, Divo Muller, joined him
and presented the practical application of these find-
ings through movement.
With industrial fans blowing on the back of our necks
in the mid-summer heat, we began madly scribbling
down notes about the discoveries Robert and his col-
leagues had to share, hungry for all the latest findings
about the largest sensory organ of the body, fascia.
In between Roberts lectures on recent scientific find-
ings, Divo would have us up on our feet demonstrating
the science through motions and with great detail. This
exploration took us out on the streets, jumping and
skipping towards the playground where we reclaimed
our youth, climbing and swinging in and around the
equipment. Not quite with grace and vigour, but I am
sure with practice this too could spring back!
Back to the dusty floors in the hall, and to watch Divo
move and ripple like a fish, and swing and bounce with
ease, was a delight to see! Then it was our turn to ex-
plore. It was great fun and you could really sense the
fascia moving and rippling under the skin. This was a
new and novel experience for me and one to visualise
and revisit in Pilates classes for breath, flow and ease.
After 4 full days of work with Robert and Divo, I walked
away with a greater appreciation of the function and
purpose of the living sensory organ. This insight also
highlighted how well Pilates trains the body harmoni-
ously. With this new knowledge, I can only draw even
more greatness out of the body of work Pilates has to
offer and share it with my clients.
I was so excited about the world of fascia; I want to
share my experience and the highlights of the Fascial
Fitness Workshop.
Come inside and explore the wide matrix of the fascial
web and its relationship with Pilates and movement.
Fascial Fitness
with Robert Schleip and Divo Mller
Sydney, January 2014
By Kerrie Murphy
Come and explore the wide matrix of the fascial web and its
relationship with Pilates and movement
Fascia - or fascial net, fascial body suit, connective
tissue, is situated beneath the skin and runs in multi
directions throughout the body. It comprises of several
layers, the superficial layer which is just below the der-
mis, deep connective tissue membrane which sur-
rounds muscles and bones, and the visceral fascia that
suspends organ are within their cavities.
It consists of fibrous collagen and soft living tissue, in-
cluding ligaments, tendons and joint capsules. Healthy
fascia is elastic and resilient. When it is properly condi-
tioned, it helps improve movement performance and
assists, to a large extent, with injury prevention.
Our fascial body suit adapts to the changes of load that
are placed on the body. It stretches and shifts in the
direction that we move. Through movement of the fas-
cia, it remodels the collagen network, which in turn
moulds to the body and gives the body suit tone.
The Pilates technique has always understood the im-
portant role well-trained fascia has when developing a
well-balanced body. However, up until now, in the
world of sports training, there has been a great empha-
sis placed on muscle strength, cardiovascular fitness
and neuromuscular and coordination training.
Modern insight into the field of fascia research has dra-
matically developed and is now able to apply specific
training to the body and incorporate the principles pre-
sented more specifically to sports training.
Fascial Fitness & Pilates
Age, sex, body type, hormones, mental state and trauma
to name a few, affect the condition and response of fas-
cia. Therefore by understanding the qualities of fascia
and how it responds to movement, strategies can be put
in place to assess and program more specifically to each
individual client.
Not only is this information great in targeting and ad-
dressing specific areas of the body and general popula-
tion, but it is also wonderful for the Pilates industry
where scientific based evidence is now more attainable
and supports what we do so well for the health of fascia
and it relationship to the whole mind body conditioning.
The four principles of fascial fitness
1. Rebound elasticity - the catapult mechanism
Exercise has always been known to produce more
youthful collagen, however it has now been proven that
the type of exercise applied also influences the changes
in elastic storage capacities.
It has been shown that humans have the same kinetic
storage capacity to that of kangaroos. The tendons and
fascia are tensioned like elastic rubber bands. The re-
lease of this stored energy is what produces large jumps
and leaps. This springiness and rhythmic movement is
also created when walking and running.
2. Fascial stretch - stretching the longest possible myo-
fascial chains
Due to the varying density and multidirectional fibres of
fascia, each type responds to different types of stretch.
Slow passive stretching in varied angles and actively
loaded dynamic stretching through to end range is re-
quired for easy shear ability. Not only is the direction
and load specific, but it has been shown that increase of
collagen fibres is dependent on exercise volume and that
few repetitions are necessary to achieve optimum re-
sults.
3. Fascial release - self treatment on rollers and barrels
Stretching, or local compression, increases fluid which
enters from surrounding tissues and from the local vas-
cular network. This activity increases lubrication in the
areas that are often difficult to reach.
Moving slowly in different directions is an effective way
to rehydrate the tissues which are then given the chance
to soak up nourishing fluids.
The benefits include increases metabolism, increases
circulation, decreases fatigue and soreness, and mini-
mises DOMS.
4. Proprioceptive refinement - sensory
Fascia is the largest sensory organ in the body. It has a
rich supply of sensory nerves, proprioceptive receptors,
multimodal receptors and nociceptive nerves.
When there is an increase of proprioception there is a
decrease in myofascial pain. This has been proven with
non-specific lower back pain. The thoracolumbar fascia
is drenched in nerve endings and often the problem.
Stress and emotional tension cause changes in back
pain, more so through the fascia than in the muscles. So
if the proprioception of the lumbar spine is improved
through retraining the elastic lumbar, it helps the me-
tabolism of the fascia, stimulates and assists in its heal-
ing while the pain receptors of this area are decreased.
Exercises that draw attention to detail bring awareness
to neglected areas of the body. The quality of motions
should include slow-motion, very quick micro move-
ments, and large micro movements involving the whole
body and while avoiding any jerky actions.
Pilates application
1. Rebound Elasticity: Spring like movements that load
fascial tissue over multidirectional pathways improve
elasticity qualities.
Foot work: double/single legs with angle variations.
Jump board footwork and jumps. Encourage light
soft landings, rebounding like a bouncing ball.
Be creative with the upper body through light
bounces. For example, springing off the wall with
the hands.

2. Fascial Stretch: 3D stretches and rocking motions.
Fascia loves to be pulled and stretched in all directions.
Consider the long chains of Thomas Myer in order to
explore long chains. Front line, back line, lateral line,
and spiral line.
Upstretch, elephant with rotation in torso and legs.
Side splits with saw.
Hanging back, swan, rocking.
Side over of the high barrel/box.
The twist.

3. Fascial release: The fascial release helps dissolve fas-
cial adhesions and nourishes bunched up tissues.
This in turn creates a more flexible body and a sense
of feeling good.
Barrels and rollers are shaped to help get into those
places that are hard to reach.
Release - ITB, quads, hamstrings and movements
through forward bending, extension, lateral flexion
and spiralling motions of the spine.
These actions are similar to squeezing out a sponge,
releasing inflammation and waste products, only to
be replaced by healthy water.

4. Proprioception: Increased body awareness has direct
impact and positive effect on muscular pain.
Breathing and centering exercises, with considered
pace, direction, spatial orientation and the use of
imagery, can bring proprioceptive attention.
Balance work - standing lunge, step ups, wobble
board, foot corrector and exercise ball variations.
Be mindful to use the eyes to lead the body into
space. This micro movement of the eyes improves
spatial orientation and the neural pathways from the
eye stimulate greater body awareness.

Patience and consistent training of the fascia (up to
twice a week) are necessary when it comes to collagen
renewal. Unlike muscles, fascia changes more
slowly. Schleip compared it to filling an aquarium, one
small droplet of water at a time. Slowly the fascia
grows, but the results are long lasting.
Often however, muscles increase faster and the fascia is
overloaded causing strain and tension, and loss of abil-
ity to stretch, bounce and move within the body. This
highlights the importance of how much load and when
to apply that load to the body being worked on, in order
to achieve a positive outcome.
Mr. Pilates was well and truly on track in acknowledging
the importance of addressing the body as a whole, in-
cluding the working of the fascial web. Ongoing research
into the human body never ceases to amaze me in show-
ing just how closely the mind and body work together.
With this gained knowledge we now have the ability to
work with a clearer intention and strategy for each per-
son that we see in the Pilates studio for better health
and wellbeing.
The co-ordination of the mind and body is important
...not only to accomplish the maximum result with
minimum expenditure of the mental and physical en-
ergy, but also to live as long as possible in normal
health and enjoy the benefits of a useful and happy
life (Joseph Pilates, Your Health, Presentation Dynam-
ics Inc. 1998, p.41).
About the Author
Kerrie Murphy is the director and principal teacher at
Infinity Pilates Studio in St Kilda East,
www.infinitypilates.com. Kerrie is an ex modern dancer
and ballet teacher, Kerries been practising and teaching
Pilates. Applying her extensive experience in the field,
she trains everyone from elite athletes to dancers to
people in rehabilitation.

Available at

This series focuses on the new approach to the treat-
ment of the joints that Jean-Pierre Barral and Alain
Croibier have developed over the years.

More than 40 years of clinical practice have led to this
innovative, holistic approach on the: muscles, liga-
ments, capsule & labrum synovial fluid inside the cap-
sule, arteries & veins, nerves, connections with the
organs.

The KneeA Neurological Joint
The Hip
The Lower Leg & Foot
The Cervical Spine
The Thoracic Spine
The Lumbar Spine & Pelvis
The Elbow, Wrist & Hand
The Shoulder

The two producers of this DVD, Peter Schwind and
Christoph Sommer, have brought their experience
gained during a long period of study with Barral and
Croibier into this DVD: the purpose of this production
is to make these unique, very precise and effective
ways of working with the human being more easily
accessable and open to a larger public.

Peter Schwind and Christoph Sommer have been able
to observe, over and over again within a 25-year long
period, that therapists and medical doctors who
practice various methods find the teachings of Barral
a real complement and enrichment to their work.
Jean Pierre Barrals
New Articular Approach
Back pain is a worldwide problem causing time lost
from work, disability and economic cost. Over 75% of
humans suffer from back pain at least once in their life-
time and the yearly prevalence of the working popula-
tion is 8%, where the lower back represents the most
mentioned region. Disorders of osseous structures, disc
herniations or nerve root compressions that can be
seen on imaging are traditionally assumed to be the
only causes of low back pain (LBP). But recently, other
sources of LBP, like muscles and fascia, are being more
and more appreciated in basic as well as in clinical sci-
ence. Moreover, immunohistochemical studies showed
that thethoracolumbar fascia is innervated by nocicep-
tive free nerve endings [1,4] and that the dorsal horn
neurons receive input from the lumbar fascia [2]. From
a clinical point of view, we asked the question: Is it pos-
sible to distinguish disorders of the fascia with pain of
muscular origin by measuring different parameters,
such as pain intensity, pain distribution, pressure pain
threshold or pain quality?
We performed ultrasound-guided bolus injections of
hypertonic saline into the posterior layer of the thora-
columbar fascia, the erector spinae muscle and the
overlying subcutaneous tissue at lumbar level of twelve
healthy volunteers [3].
We observed that the human thoracolumbar fascia was
more sensitive to chemical stimulations by hypertonic
saline than the underlying muscle and overlying subcu-
tis, according to pain intensity. Control injections of
identical volumes of isotonic saline induced only weak
and short-lived pain sensation, indicating that disten-
tion induced by the bolus injections played a negligible
role in pain induction in deep tissues.
Regarding pain distribution, pain was confined to the
ipsilateral side regardless of tissue type. These distribu-
tion patterns were measured by marking the painful
areas on a scheme showing the back, the abdominal,
and leg region, of a drawn standardized body. The
painful area after fascia injection exceeded those after
intramuscular or subcutaneous injection by far and was
in the typical locations of lumbago. It was also similar
to that seen in pseudoradicular LBP patients, and even
consistent with pain distribution patterns given by pa-
tients with lumbar facet joint syndrome.
Given that affective pain qualities are the ones most
commonly mentioned by LBP patients, it was remark-
able that only the hypertonic saline injections into the
fascia, but not those into muscles or subcutis, yielded
substantial affective pain ratings, like agonizing,
cruel, exhausting, heavy, severe and torturing.
However, hyperalgesia to blunt pressure, a frequent
sensory sign in both localized acute and widespread
chronic LBP, was only induced by injections into the
muscle, not fascia or subcutis.
A potential dysfunction of the thoracolumbar fas-
cia thus might lead to a high pain intensity, large pain
distribution patterns and substantially high affective
pain qualities. Being theoretical, low back pain pa-
tients, suffering from spreading strong pain with high
affective qualities might exhibit a structural change
within the fascial tissue, while the muscle could be of
minor interest. This could have positive impact on
clinical characterization of patients and their treat-
ment.
References

[1] Corey SM, Vizzard MA, Badger GJ, & Langevin HM (2011). Sen-
sory innervation of the nonspecialized connective tissues in the low
back of the rat. Cells, tissues, organs, 194 (6), 521-30
PMID: 21411968
[2] Hoheisel U, Taguchi T, Treede RD, & Mense S (2011). Nociceptive
input from the rat thoracolumbar fascia to lumbar dorsal horn neu-
rones. Eur J Pain, 15 (8), 810-5 PMID: 21330175
[3] Schilder A, Hoheisel U, Magerl W, Benrath J, Klein T, & Treede
RD (2014). Sensory findings after stimulation of the thoracolumbar
fascia with hypertonic saline suggest its contribution to low back
pain. Pain, 155 (2), 222-31 PMID:24076047
[4] Tesarz J, Hoheisel U, Wiedenhfer B, & Mense S (2011). Sensory
innervation of the thoracolumbar fascia in rats and humans. Neuro-
science, 194, 302-8 PMID: 21839150
This article is originally published in BodyinMind.org Repro-
duced with permission.
About Andreas Schilder
Andreas Schilder is a doctoral student in
the department of neurophysiology at the
Medical Faculty Mannheim of the Heidel-
berg University (Germany). He obtained
his Master degree in animal physiology in
2011 and studied Bioscience abroad at
the Southern Illinois University Carbon-
dale back in 2008. The current interest of
Andreas is the contribution of deep soft tissues to back pain
and its general characteristics.
Fascia and Back Pain
What does a chemical stimulation tell us about it?
By Andreas Schilder
Can you explain how the research project on
Functional Fascial Taping (FFT) came about?
I have always been interested in being involved in a
research project as have always been interested in how
and why things work. Someone said to me years ago
that you study to do clinical work and then you con-
tinue to learn through doing this work, however, its
also important to further your understanding through
post graduate courses, reading and discussing ideas
with peers. Taking part in a research project is a proc-
ess that allowed me to combine my practical experience
and theoretical knowledge and to ask questions about
FFT. Research provides the opportunity to test these
ideas under controlled conditions. This scientifically
adds validity to what you do, whilst increasing your
own depth of understanding. Then you have the ability
to implement the results into your clinical practice and
share this knowledge. This process leads to further
clinical observation and questions, and the cycle con-
tinues. This constant process of enquiry and testing is
what I really enjoy about research.
I had discussed the possibility of conducting a research
project on FFT with Dr Jill Cook, Head of the Muscu-
loskeletal Research Unit, at Deakin University. As a
result of our discussions Dr Cook referred the following
patient to me as a test case to determine if FFT could
assist a long standing chronic non-specific low back
pain patient.
The following provides a brief clinical overview of this
patient, for a more detailed explanation follow the link
http://www.scribd.com/doc/232954803/Ron-
Alexander-FFT-on-Low-Back-Pain. The patient had a
history of back pain for 14 years. She had 2 laminecto-
mies for disc decompression. These procedures were 18
months apart, both were unsuccessful and she contin-
ued to have pain for the next 2 years. Three months
prior to the commencement of the FFT treatment, a
trunk flexion test showed trunk flexion to be 15. The
patient was given three treatments over a one week
period and was able to achieve full flexion. The tape
was worn for a further 5 weeks and she was weaned off
the tape during this period. The patient made a full re-
covery, experiencing full range of movement and the
total absence of pain.
Her final progress was followed up at 3 years with no
pain and full range. This successful case study indi-
cated to Dr Cook that a RCT (randomized control trial)
on FFT was warranted in order to determine if this re-
sult could be replicated with a larger sample size. It had
taken me many years of trial and error to get to this
point. Dr Cook sourced a Deakin University PhD
Physiotherapy student, Shu-Mei Chen who was on
scholarship from Kaohsiung Medical University Hospi-
tal, Taiwan to conduct the trial. I then submitted the
case study for review by the Scientific Committee for
the first Fascia Research Congress (FRC) at Harvard
Ron Alexander on
Functional Fascial Taping

and Research
and it was accepted as a poster* presentation
(Alexander, 2008a), available at: http://
www.scribd.com/doc/232954803/Ron-Alexander-FFT
-on-Low-Back-Pain. Presenting this at the Congress
was a great experience as it gives the presenters of
posters the ability to talk about studies to delegates and
other presenters.

Case studies have a role to play in clinical practice and
research. Case studies provide the reader with the abil-
ity to gain a broader understanding of clinical assess-
ments, treatments and outcomes, and thereby create
informed discussion amongst peers. Although the case
studies are in themselves not strong evidence for the
efficacy of a treatment they can form the basis of re-
search topics and RCTs to test the validity of a treat-
ment scientifically.
You presented two posters at the first FRC in
Boston. What was the topic of the second
poster?
The second poster* focused on the results of two real
time ultra-sound (RTU) investigations that we con-
ducted into the effect of tension/load from tape
(Alexander, 2008b) http://www.scribd.com/
doc/232955487/Functional-Fascial-Taping-real-time-
ultrasound-investigation . The first RTU was filmed at
the Australian Institute of Sport. The procedure in-
volved applying the tape to the quadriceps. We ob-
served the region before and after the application of
tape with active knee flexion and extension (FE), to
ascertain change. Interestingly we also filmed the ap-
plication of the tape, without knee movement, in order
to observe the presence of load being applied. The tape
direction was longitudinal to the thigh and was
width of the standard 38mm wide, which makes it
tighter. This comes about because force over area
equals pressure and in this case the pressure is tension.
So if we decrease the width of rigid tape, we increase
the force and therefore more tension is possible. When
the tape was applied the subcutaneous tissue including
the superficial fascia moved in the direction of the tape.
The deep fascia and the muscles below at 3cm deep,
moved in the opposite direction. The effect was more
than likely deeper, however, the RTU was not cali-
brated to view the thigh at any greater depth than 3cm.
On this occasion we were in fact able to blame the
equipment. The tissues and the Retinacula Cutis are
held in a new position and muscle activation post-
application was completely different from pre-
application. See the RTU Box for footage. Many
therapists who have viewed the RTU are of the opinion
that we are potentially viewing Myofascial Release in-
side the body, for the first time.
The other RTU was conducted in Perth with a very
skilled Musculoskeletal Physiotherapist Felicity Ker-
mode who lectures on RTU in various countries. We
investigated the Abdominal region using the apex of
Transverse Abdominis (TrA) as a reference point to
observe if movement was possible from tape. For a
more detailed explanation See RTU Box. We applied
tape to the Contra Lateral side of the body on the Tho-
racolumbar Fascia (TLF). The tape direction was from
Lateral to Medial using the FFT gathering technique.
We thought we may see an effect because the TLF is
connected to the TrA. The result was really interesting
because the TrA moved in the direction of the tape,
however what we didnt expect and what happened was
that the whole abdominal cavity moved, the RTU meas-
ured 0.94cm displacement and was in the direction of
the tape. The subject remained seated for a period of
time and the tissues were held with sustained load in
this new position. This observation may lead to new
developments in Visceral Manipulation.
Have there been any other RTU investigations
conducted in relation to FFT?
We have conducted many more RTU observations and
each time the Subcutaneous Tissue (SCT) moves in the
direction of the tape. So we can say with confidence
FFT & Research
Figure 1. Taping the foot.
Figure 2. Taping the hip.
that the SCT and the Superficial Fascia Tissue Layer
(SFTL) move in the direction of the tape and it has a
controlling or stabilizing effect to those layers.
We have observed the same movement of tissues in a
distant region. For example we have applied tape to the
proximal forearm, whilst observing with the transducer
at the wrist and we observed the SCT and the SFTL
move in the direction of the tape and the deep struc-
tures moved in the opposite direction and this change
was on the opposite side of the body to where we were
applying the tape. One possible explanation for this, if
we think of the Biotensegrity principle where living
tissue and cells are constructed by discontinuous com-
pression columns supported and balanced by tension
elements resulting in continuous tension (Fuller 1961,
Ingber 1998, Levin 2002) then FFT may be offering a
strong load by tightening components of the mechani-
cal scaffolding of the body. It may alter the skin and/or
remodel the internal architecture of the connective tis-
sue (Ingber 2008, Langevin 2010). These tissues are
heavily innervated with mechanoreceptors and poten-
tially change the neural input by stimulating large-
diameter afferent fibres and then modulate nociceptor
input.
Another part of our study on FFT also included an RTU
investigation on 23 asymptomatic subjects, this was
filmed with Deluca J, Senior Musculoskeletal Sonogra-
pher at Latrobe University Medical Centre. We investi-
gated motion analysis, from standing position, moving
into truck flexion to 65. The transducer was kept in
FFT & Research
Real Time Ultrasound (RTU) of Taping Effect
The procedure involved applying the tape to the quadriceps.
All 3 movie files are 5 second shots and repeated. The hip is
right of screen in all shots. The tape width is width of the
standard 38mm wide. The transducer is longitudinal muscle
fibre direction, in a Mid Saggital line to the Quadriceps
Muscle. The small dots on the left of screen are the RTU
measuring cms deep. 3cms deep is shown and a depth of
approximately 2mm, we can observe the Subcutaneous tis-
sue layer and the Superficial Fascia layer. Approximately
3mm the Deep Fascia. Greater than 4mm deep, the Muscles.
One piece of tape applied, the standard tape application is 3
layers which are tighter each application.

1) Before Flexion and Extension, No Tape. Watch at http://
youtu.be/qTjGItE7gb0
The first is shot is pre-tape observation under normal condi-
tions with active knee flexion and extension. Observe the
amount of movement in the Superficial Fascia layer and the
muscle tissues relationship to each other.

2) Presence of tape being applied with tension (load). Watch
at: http://youtu.be/59bSjlSjQKY
The application of one piece tape with tension, without knee
movement, in order to observe the presence of load being
applied. The deep fascia and the muscles below are moving
in the opposite direction at 3cms deep.
3) With tape on the body with active Flexion and Extension.
http://youtu.be/fbP_7boT_EU
The tissues are held in new position, with load. The muscle
activation post application is completely different from pre-
application. We can observe virtually immobilisation of the
Subcutaneous tissue layer and Superficial Fascia layer. Ob-
serve change taking place at the Deep Fascia, Retinacula
Cutis and the muscle activity is different from the first RTU.
Real Time Ultra-Sound Investigation of the left Ab-
dominal region.
Watch at http://youtu.be/Epqh_obihjs
The shot is 7.5cm deep, 1 cm markers are shown left of
screen. We can observe the skin and the Subcutaneous Tis-
sue layer. First muscle External Oblique followed by Inter-
nal Oblique, Transverse Abdominis (TrA) and then the Ab-
dominal cavity.

The apex of the TrA is used as a reference point. A little
black digital marker can be seen near the center of screen.
This is a part of the RTU machines measuring tool. At the
right of screen you can see +DIST 0.02cm displayed. It
should be 0.00, so we need to subtract 0.02 of at the end.
The digital maker is going to be moved manually, to follow
any potential movement of the apex of the TrA. We applied
tape to the Contra Lateral side of the body. The tape were
applied to the Thoracolumbar Fascia from Lateral to Medial
using the FFT gathering technique, with 4 pieces of rigid
tape. The white areas shown in the body are the Connective
Tissues and the Fascia being highlighted. The TrA moves to
the right of screen and then is measured. What we observe
is that the entire Abdominal region moves in the direction of
the tape. The RTU displays 0.96cm however taking off the
0.02, it shows 0.94cm in the direction of the tape. There is
no skin or subcutaneous tissue movement which possibly is
because a standoff is not used (standoff allows the skin to
move) and more than likely the transducer is blocking the
tissue.
You may need to watch a couple of times to make out the
RTU digital maker and Connective Tissue movement.
constant contact with the skin as the participant per-
formed flexion. In all cases apart from one, the SCT
and the SFTL moved independently from the deeper
structures and then at some point in range they moved
together. The case that did not follow this pattern had
the complete opposite reaction in that the tissue layers
worked together and then at a point in flexion they
worked independently. In an attempt to find out why
this occurred we questioned the subject and found out
that she was doing regular Pilates, which may have
given her better core recruitment and naturally want-
ing to bend from the hips, however, when asked to
bend from the low back she demonstrated a similar
pattern of the tissues sliding independently of each
other first and then together. The concept of tissues
sliding on one another has been around for some time
for muscles, tendons and mechanical interfaces. This
concept was later applied to the superficial tissues and
other structures from the great work by Plastic Surgeon
Dr Guimberteau JC and his famous DVD Strolling un-
der the skin, which provides an exquisite demonstra-
tion of morphing fascial tissues in patients, un-going
surgical procedures and returning back to the original
configuration when the tissue is released.
Why apply FFT when everything goes back to
the way it was?
By decreasing pain and assisting function, we return a
patient to normal movement patterns. This is a key ele-
ment in the treatment plan because FFT is holding the
body in a pain free state for an extended period of time
determined by us. Potentially the tape provides pro-
prioceptive muscle activation and creates a decrease in
fear avoidance behaviour, as patients are encouraged
move into a previously painful position without pain.
This state allows patients to perform simple or complex
activities depending on the presenting history. Some-
times just having the patient go about normal activity
can be enough for them to achieve recovery. However
this depends on the duration, nature and severity of
symptoms and quite often additional rehabilitation
advice is required. This allows the therapist to more
accurately address the signs and symptoms of the mus-
culoskeletal condition.
The tape is applied in the direction of optimal ease,
which is variable and this is determined from the FFT
Assessment procedure. However clinically for years I
have observed that sometimes when you apply FFT, the
tape direction that relieves pain can sometimes be in
the direction or the opposite direction of move-
ment that you are trying to increase. Tape is applied
with almost maximum tension by the use of a gathering
technique to take the skin and tissue slack up, in the
direction you are trying to increase (See Figure 1).
Wouldnt this logically decrease range of motion?
However in over 95% of cases what we see is that it ac-
tually increases range of motion (ROM). There are
some specifics to this application in some regions and I
know that this sounds counterintuitive, nevertheless we
see this take place in most regions in the body and I
find this extremely interesting. I have observed this
result thousands of times, firstly with the dancers at the
Australian Ballet, then later with athletes and patients.
I have taught this technique to thousands of therapists
who have observed the same outcome. I have thought
for many years that superficial structures could be
working independently of the structures below as well
as potentially changing neural input. This thinking is
supported by a cadaver dissection of the SCT and the
SFTL conducted by Gil Hedley. This was the first time a
dissection of this type had ever been conducted and
recorded. Hedley removed the entire skin layer. He
then sliced through the Reticular Cutis to remove the
SCT and the SFTL from the Deep Fascia. Hedley also
moved the layers on each other to demonstrate the
amount of available movement. Put simply in practical
terms, you can distract your skin and underlying tissue
with strong sustained load, whilst moving your arm. As
therapists we do this all the time when performing
myofascial release with active motion.

We conducted another experiment to determine how
far the skin and underlying tissue can move in the low
back. This was another part of Chens PhD. In this ex-
periment we applied tape in a lateral direction 4cm
above and 4cm laterally away from the posterior supe-
FFT Research
Figure 3. Taping the knee.
rior iliac spine (PSIS). We then used the PSIS as refer-
ence point and graphed the body over the hip. The re-
sult was that both the skin and underlying tissue had
the ability to move up to 2.4cm. This test was under-
taken on asyptomatic subjects, we have not as yet
tested subjects with super hypermobile tissue, such as
Ehlers-Danlos syndrome. The results would also vary
in different areas such as over the tibia.

When applying FFT the assessment procedure and tape
application, one end of the tape is placed directly on the
pain site, therefore load is going away from this point.
Taping this way is unique to FFT. The tape is applied
with a strong loading force. The start point could be
called point A, the other end of the tape where a resul-
tant reactive force would be created, called point B.
Both these ends pull the skin and underlying tissue to-
wards the centre of the tape, point C. In the centre
there would be a balance between these two forces (See
Figures 2 & 3). According to the tensegrity principle,
external force on the skin can transfer to the underlying
tissue and cause multi-laminal sliding movement under
the skin, and that could convert into an internal force
to evoke different levels and types of mechanoreceptor
firing (Chen 2012
#
). The load from both ends pulling
into the centre is consistent with Newtons 3
rd
law,
where every action has an equal and opposite reaction.
Its nice when the physical laws of motion appear to
support many years of clinical observation. This con-
cept potentially will lead to new insights into Mecha-
notransduction and Mechanotherapies.

Pain can come from numerous sources in the body and
the effect of applying rigid strapping tape on the body
is multidimensional. The principle and application of
FFT is different to other rigid taping techniques (RTT)
that have been shown to be effective in decreasing pain.
My observations of the effect of FFT on the body does
not take away from current theories regarding RTT. It
is looking at taping from a different perspective.

How can I get involved with a research project?
There are various levels of research, if you are looking
at robust RCTs, then it is a process that requires a cer-
tain level of academic expertise and a different skill set,
whereby you will need to work cooperatively with rele-
vant departments within universities. RCTs are nor-
mally conducted at PhD level, although there are ex-
ceptions to this. A clinicians involvement can take on
many forms and levels, and can lead to higher qualifi-
cations if that is part of your goal. In my case, I took on
the role of co-investigator for three of the trials. You
will need to contact the relevant department of univer-
sities to discuss your proposal. If they are interested,
the professor who will oversee the project, should have
a list of students who may be interested in undertaking
the research.

The depth of understanding that comes from being in-
volved with a rigorous scientific trial, is helped by read-
ing scientific literature and undertaking clinical work.
If your study supports what you are investigating and
you have a great team then they should have the ability
to produce a good publication that will be published in
a respected journal with a wide readership. This in turn
supports our industry.
Have you got any tips?
RCTs do take a while. The processes involved are re-
search design, systematic review, ethics application,
clinical trial, data collection, publication and thesis.
Its good to remember that the research team will be
focused on the method and the processes involved in
the project. The subject or technique in the study, is
only one part of the project. The best research is done
in collaboration and the ability to compromise is im-
portant, which can be challenging at times. Also the
amount of detail required in robust trials is incredible
resulting in a very lengthy process, patience is required
and the ability to not lose sight of the bigger picture of
getting a study completed and published. It might also
come as a surprise that no one does research in todays
world without a publication in mind.
It may also be worth keeping in mind that the investi-
gation may not be exactly the scope that you had in-
tended. I have found that sometimes people try to ei-
ther support something too hard or want to look at too
many variables and this stops the study from ever get-
ting off the ground. It may be better to do a more lim-
ited study and then do a follow up study at a later date.
FFT & Research
Figure 4. Taping the lower back.
Having a study published in an international scientific
journal gives credibility which can make it easier the
second time around for your team. My last tip is to be-
lieve in yourself, the technique and your team as these
elements will see you through when the going gets
tough. The knowledge that I have personally gained
through the research process has been invaluable.
Lastly, good luck and remember, nothing ventured
nothing gained!

References
*Posters. Fascia Research Congress Boston, MA, October 4-5, 2007.
The Conference Center, Harvard Medical School.
www.fasciacongress.org. Full colour version online download at
www.fft.net.au
Chen SM, Alexander R, Lo SK, Cook J. 2012 Efficacy of Functional
Fascial Taping on Pain and Function in Patients with Non-
Specific Low Back Pain: A Randomised Double Blind Placebo
Controlled Trial. Clinical Rehabilitation Vol 26, No. 10. 924-933.
#
Chen SM. 2012. FFT Thesis. Neurophysiology of the Cutaneous
Mechanoreceptors. Deakin University, Supervised by Jill Cook.
Alexander R. 2008a. Functional Fascial Taping for Lower back pain:
A Case Report. Journal of Bodywork and Movement Therapies.
Volume 12, July 2008, Pages 263-264.
Alexander R. 2008b. Functional Fascial Taping Real Time Ultra-
sound Investigation. Journal of Bodywork and Movement Thera-
pies. Volume 11, April 2008, Pages 390 391.
Fuller B. 1961. Tensegrity. Portfolio Artnews Annu, 4, 112-127.
Levin S. The tensegrity-truss as a model for spine mechanics:
Biotensegrity Journal of Mechanics in Medicine and Biology.
2002 vol. 2, #3&4, 375-388.
Ingber D. 1998. The architecture of life. Scientific America.
Ingber D. 2008. Tensegrity-based mechanosensing from macro to
micro. Prog Biophys Mol Biol. 97:163-179.
Langevin HM, Storch KN, Snapp RR, et al. 2010. Tissue stretch in-
duces nuclear remodeling in connective tissue fibroblasts. Histo-
chem Cell Biol; 133: 405415.

Functional Fascial Taping with Ron Alexander
Evidence-Based Pain Relief
This workshop teaches a fast and simple way for clinicians to reduce pain, improve function,
encourage normal movement patterns and rehabilitation of musculoskeletal pathologies in a
pain-free environment.
FFT has been shown to have a significant effect on Non-Specific Low Back Pain in a random-
ised double-blind PhD study. FFT is a non-invasive, immediate, functional and an objective way
to decrease musculoskeletal pain.
Presenter: Ron Alexander
STT [Musculoskeletal], FFT Founder and
Teacher
Melbourne 11 October 2014
One-Day Refresher for past participants
Brisbane 18-19 October 2014
Sydney 25-26 October 2014

Register Now at:
A great way to encourage treatments
hold longer
FFT & Research
Donna Eddy is an acupuncturist, massage therapist and
movement specialist. She is also certified in Pilates,
fitness instructing and workplace training.
Donna developed the Posture Plus program inspired
from her clinical work, ongoing personal therapy, and
her devotion to reduce aches and pains, and boost the
wellbeing of her personal training clients. It appeared
to her that many of her regular fitness training clients
were potential future patients as they had many prob-
lems with pain, dysfunctional movement and activity
necessitating a different approach. Donna wanted to
give her clients a life choice, a system that enabled ex-
ercise and movement to become integral to everyday
life.
The Posture Plus class program which is a blend of
many movement and rehabilitation practices including
but not limited to: Posture & Flexibility (stretch ther-
apy), Pilates floor method, Gymnastics, and Basic
strength training
The Posture Plus workshops and DVDs enable you to
learn how to look after yourself. Donna has two tips to
live pain free and enjoy movement:
1. Intention & Attention
Being attentive in class (that is any class that you at-
tend) or whilst following our DVDs. You are there to
learn and play with your body.
What are you doing in the exercise/ position?
Why are you doing it?
Do you need to practice this regularly or daily?
Listen to the cues as they come. If you are present to
the movement and present in each moment (not drift-
ing off running checklists through your head or dwell-
ing on the last phone call you had or the calls you need
to make) actually be connected to the moment, your
body, the teacher, this position.... you will get more out
of the session and more out of your body.
2. What can you do to challenge yourself more?
We are all time poor. So how do you get the most out of
what you are doing? Set the intention to do as much as
you can, and then a little more with each and every
movement you make. If you apply point one, you will
know where you are and where you have come from, so
you will know how much is the ideal amount to chal-
lenge yourself and extend your potential.
In the Posture Plus program , Donna uses Chi balls to
enhance the practice. Used as a prop to align postures
to release tension and used as an isolation/ activation
tool to perform exercises and drills to the best benefit.
If you want a taste of Posture Plus, take advantage of
the DVDs available from Terra Rosa website. If you
want a Posture Plus workshop session for you or your
team; clients; gym members contact
donna@postureplus.com.au
Read also 6 Questions to Donna on page 49.
Cover Feature:
Donna Eddy
And Posture Plus
PNF or proprioceptive neuromuscular facilitation
stretching, is a popular techniques used in conjunction
with manual therapy. PNF can be regarded as a set of
stretching techniques to enhance range of motion. PNF
uses the bodys proprioceptive system to facilitate or
inhibit muscle contraction. To increase the ROM of
target muscles, PNF involves a shortening contraction
of the target or opposing muscle. The techniques were
credited to physiologist Charles Sherrington, who in
the mid 1900s, defined the concept of neuromuscular
facilitation and inhibition. Following on, Herman Ka-
bat, a neurophysiologist, developed clinical PNF
stretching techniques in the 1950s.
There are various forms of PNF stretches, mainly Con-
tract Relax or CR, Agonist Contract or AC and Contract
Relax Agonist Contract or CRAC. In CR the target mus-
cle(s) is placed into a position of stretch, then a static
contraction of the target muscle. This is followed by a
gentle stretching, where the muscle is moved into a
greater position of stretch. In AC (which is the basis of
Active Isolated Stretching) the target muscle is placed
into a position of stretch to its end-range, then concen-
trically contracts the opposing (antagonist) muscle,
followed by moving the joint to a new position in the
range of motion. CRAC stretching is similar to CR ex-
cept that following the contraction of the target muscle,
a shortening contraction of the opposite muscle is used
to place the target muscle into a new stretch position.
PNF stretching has been well-proven to improve and
provide a greater range of motion (ROM) as compared
to static or other type of stretching (Sharman et al.,
2006). Despite its success, controversies remain on the
mechanism of actions. Neurological reflex muscle re-
laxation following isometric muscle contraction is the
main basis of mechanism suggested for PNF stretches.
However such mechanisms are not substantiated by
research. Eyal Lederman in his book Therapeutic
Stretching said that Post Isometric Relaxation is an
erroneous premise. While Ian Shrier in Evidence Based
Sports Medicine wrote that Reciprocal Inhibition is a
myth that continues to be promoted in textbooks and
the medical literature. Lets look at the two common
mechanisms proposed for PNF stretching and examine
what the antagonists said.
Autogenic Inhibition
The common explanation of the basis of CR stretching
is autogenic inhibition or reduction in excitability of a
contracting or stretched muscle due to the Golgi ten-
don organ (GTO) reflex. As part of the bodys self-
regulatory mechanisms, GTOs protect muscle and ten-
don from overstretching. If the muscle belly contracts
too forcefully, the GTO sends a signal to the nervous
system that triggers the GTO reflex to inhibit the mus-
cle from contracting. In other words, muscles relaxed
after voluntary muscle contraction. It is also referred to
as post isometric relaxation (PIR) (Hindle et al., 2012).
Lederman in his book wrote: Under normal circum-
stances, when a person is fully relaxed there is no mo-
tor tone in the muscles, i.e. there is no demonstrable
activity on the EMG trace. Similarly, when a person is
stretched passively the muscle is motorically silent. If
muscle activity is observed, it is usually when the
stretching reaches the end of ROM at the onset of dis-
comfort and pain. This increase in motor activity is
likely to be an evasive response to pain. It means that
during the early phase of stretching, the muscle is re-
laxed and therefore further inhibition i snot possible
cannot relax a relaxed muscle, whereas, at the end-
ranges, motor activity is likely to increase; an outcome
which would defeat the purpose (muscle relaxation).
PNF Stretching
What does research say about
its mechanisms
PNF stretching is well-known
to improve ROM, however
controversies remain on its
mechanism of actions.
Studies showed that following contraction of a
stretched muscle, inhibition of the stretch reflex re-
sponse is transient and only lasts less than a second.
Researchers questioned whether such short period of
inhibition can result in a clinically meaningful muscle
relaxation (Chalmers, 2004). In addition, the hypothe-
sis is that muscle activity should be minimum, but
studies using electromyography (EMG) have shown
that muscle activity is actually increasing after PNF
(not relaxed) (Wilkinson, 1992).
Chalmers in his review wrote: Studies examined sug-
gested that decreases in the response amplitude of the
Hoffmann and muscle stretch reflexes following a con-
traction of a stretched muscle are not due to the activa-
tion of Golgi tendon organs, as commonly purported,
but instead may be due to presynaptic inhibition of the
muscle spindle sensory signal.
Reciprocal Inhibition
AC techniques were based upon the basis that stretch-
ing of the antagonist muscle creates reciprocal inhibi-
tion of the agonist muscle. As explained by Susan Salvo
(2007) in Massage Therapy: Principles & Practices:
When the central nervous system sends a message to
the agonist muscle (muscle causing movement) to con-
tract, the tension in the antagonist muscle (muscle op-
posing movement) is inhibited by impulses from motor
neurons, and thus must simultaneously relax. This neu-
ral phenomenon is called reciprocal inhibition.
However, when the initial hypothesis was proposed,
muscle activity was not measured. When EMG was
recorded in the late 1970s, the reciprocal inhibition
theory was mostly disproved. As described in the pre-
vious section, data from laboratory do not support the
theory that contraction of a stretched muscle prior to
further stretch, or contraction of opposing muscles dur-
ing muscle stretch, produces relaxation of the stretched
muscle. Muscles are electrically silent during normal
stretches until near the end ROM. PNF stretch actually
increases the electrical activity of the muscle during the
stretch (during antagonist contraction, the muscle sup-
posed to be relax), even though the range of motion is
increased (Chalmers, 2004). While the effect of RI can
be observed, it is brief and mostly happening under
normal voluntary contractions.
Studies also showed that PNF has a cross-over effect,
during a unilateral leg PNF stretching, the ROM in the
unstretched leg also increases. The electrical activity in
the unstretched leg was also active when the stretched
leg was contracting against resistance. ROM gain fol-
lowing a CR stretch is the same whether the target
stretching muscle is contracted, or an uninvolved mus-
cle is contracted (Markos, 1979).

Summary
Various mechanisms other than the spinal processing
of proprioceptive information have been proposed. The
contemporary view proposes that PNF stretching influ-
ences the point at which stretch is perceived or toler-
ated (Magnusson et al, 1996). The mechanisms under-
pinning the change in stretch perception or tolerance
are not yet known, although pain modulation has been
suggested. Other possible mechanisms include:
Distraction that increase stretch tolerance
Analgesia following sustained isometric contraction,
thus increased stretch tolerance
Changes in viscolesticity of the muscles induced by
PNF
A recent study by Konrad et al. (2014) from Austria
evaluated a six-week stretching program (including
static, ballistic, or PNF stretching) on the various pa-
rameters of the gastrocnemius muscle and the achilles
tendon. Several functional (Range of Motion, maxi-
mum voluntary contraction , etc.) and structural
(fascicle length, tendon and muscle stiffness, etc.) pa-
rameters were evaluated. The results showed PNF in-
creases ROM and decreases tendon stiffness. All
stretching intervention increased ROM. However only
in PNF stretching structural changes (decrease of ten-
don stiffness) were observed. However the decrease in
tendon stiffness could not solely explain the change in
ROM. Thus, Konrad and Tipp (2014) concluded that
the increased ROM due to stretching could not be ex-
plained by the structural changes in the muscle-tendon
unit, and was most likely due to increased stretch toler-
ance possibly due to adaptations of nociceptive nerve
endings .
Although there are still controversies behind the
mechanisms underlying PNF, there is no doubt on its
PNF Stretching
Research results do not sup-
port the theory that contrac-
tion of a stretched muscle
prior to further stretch, pro-
duces relaxation of the
stretched muscle. PNF stretch
actually increases the electri-
cal activity of the muscle dur-
ing the stretch
efficacy. Sharman et al. (2006) recommended the fol-
lowing:
PNF techniques that are more effective utilise a short-
ening contraction of the opposing muscle to place the
target muscle on stretch, followed by a static contrac-
tion of the target muscle. The inclusion of a shortening
contraction of the opposing muscle appears to have the
greatest impact on enhancing ROM. When including a
static contraction of the target muscle, this needs to be
held for approximately 3 seconds at no more than 20%
of a maximum voluntary contraction. The greatest
changes in ROM generally occur after the first repeti-
tion and in order to achieve more lasting changes in
ROM, PNF stretching needs to be performed once or
twice per week.
References
Chalmers, G. "Strength training: Reexamination of the possible role
of golgi tendon organ and muscle spindle reflexes in proprioceptive
neuromuscular facilitation muscle stretching." Sports Biomechanics
3.1 (2004): 159-183.
Hindle, K., et al. "Proprioceptive neuromuscular facilitation (PNF):
Its mechanisms and effects on range of motion and muscular func-
tion." Journal of human kinetics 31 (2012): 105-113.
Konrad, A., M. Gad, and M. Tilp. "Effect of PNF stretching training
on the properties of human muscle and tendon struc-
tures." Scandinavian journal of medicine & science in sports (2014).
Konrad, A, and Markus T. "Increased range of motion after static
stretching is not due to changes in muscle and tendon struc-
tures." Clinical Biomechanics (2014).
Lederman, E. Therapeutic Stretching in Physical Therapy: Towards a
Functional Approach. Elsevier Health Sciences, 2013.
Magnusson, S. P., et al. "Mechanical and physiological responses to
stretching with and without preisometric contraction in human skele-
tal muscle." Archives of physical medicine and rehabilitation 77.4
(1996): 373-378.
Markos, P. D. "Ipsilateral and contralateral effects of proprioceptive
neuromuscular facilitation techniques on hip motion and electromy-
ographic activity." Physical therapy 59.11 (1979): 1366-1373.
Osternig, L.R., et al. "Muscle activation during proprioceptive neuro-
muscular facilitation (PNF) stretching techniques." American Jour-
nal of Physical Medicine & Rehabilitation 66.5 (1987): 298-307.
Sharman, M., et al. "Proprioceptive neuromuscular facilitation
stretching." Sports medicine 36.11 (2006): 929-939.
Shrier I. Does stretching help prevent injuries? In: MacAuley D,
Best T, editors. Evidence-based sports medicine. London: BMJ Pub-
lishing Group, 2007.
Wilkinson, Andrew. "Stretching the truth. A review of the literature
on muscle stretching." Australian Journal of Physiotherapy 38.4
(1992): 283-287.
Increased ROM from PNF
stretching was likely due to in-
creased stretch tolerance pos-
sibly due to adaptations of no-
ciceptive nerve endings .
PNF Stretching
There has been a great interest in barefoot running.
Several athletes running in barefoot were epitomized,
Abebe Bikila from Ethiopia ran barefoot and won a
marathon gold medal in the 1960 Summer Olympics.
(In the 1964 Olympics he won again, but wearing
shoes). British runner Bruce Tulloh won the gold
medal in the 1962 European Games running barefoot
in a 5,000 metre race. In 1985 Zola Budd broke world
record in 5000 m run with barefoot. The Tarahumara
people in Mexico are renowned for their long-distance
running run barefoot.
The book Born to Run by Cris McDougall published
in 2009 sparked worldwide interest in barefoot run-
ning. It was claimed that based on theory of evolution,
long-distance running ability was crucial for human
survival. Human has been running for hundreds of
thousands of years to chase prey or to outrun preda-
tors. This is followed by Daniel Liebermann, professor
of human evolutionary biology at Harvard, who pub-
lished an article Foot strike patterns and collision
forces in habitually barefoot versus shod runners in
the prestigious journal Nature. (see http://
www.barefootrunning.fas.harvard.edu/)
Shoes companies also start to make barefoot or
minimalist shoes and many claims have been made
about the advantages of barefoot over shod running.
Sales of minimalist shoes increased 300 percent in
2012, compared with a 19 percent increase in tradi-
tional running shoe sales in that same year. Theres an
enormous publicity on barefoot running, and many
claims made about its positive effects and superiority
over running shoes. Benno Nigg and Henrik Enders
from the Human Performance Laboratory at the Uni-
versity of Calgary investigated and published a critical
review in the journal Footwear Science last year. They
critically examined the claims based on available re-
search evidence. Nigg also presented this work at the
Connective Tissues in Sports Medicine Congress in
2013 at the University of Ulm in Germany. This article
is based on Benno Niggs lecture and paper.
Barefoot running land on forefoot (toe) while
people running on shoes (shod) landed on the
rear (heel).
Lieberman et al. (2010) wrote: habitually barefoot en-
durance runners often land on the fore-foot (fore-foot
strike) before bringing down the heel, but they some-
times land with a flat foot (mid-foot strike) or, less of-
ten, on the heel (rear-foot strike). In contrast, habitu-
ally shod runners mostly rear-foot strike, facilitated by
the elevated and cushioned heel of the modern running
shoe.
An unpublished thesis by Herzog (1978) examined the
landing strategy for barefoot running either on asphalt
or grass based on 180 trials. Herzog found that running
on asphalt, 23% landed on heel while 77% landed on
forefoot. Meanwhile on grass, 54% landed on the heel,
while 46% on forefoot. This implied ground condition
heavily influenced landing pattern of the foot.
In a recent study by Hatala et al. (2013) observed 23
subjects that are habitually barefoot in Northern
Barefoot vs.
Shod Running
A matter of preference?
Kenya. Subjects ran at self-selected endurance running
and sprinting speeds. The data showed that 72% landed
on the heel, 24% on midfoot and 4% on forefoot. The
results indicate that not all habitually barefoot people
prefer running with a forefoot strike.
The statement that barefoot running is associated with
forefoot landing is thus not well supported by evidence.
The studies suggest that landing strategy depends on
many environmental and personal conditions, such as
the surface condition, footwear, the subject, speed (e.g.
sprinter dont land on heel), training, etc.
Forces on barefoot running is smaller than
shod
Liebermann et al. (2010) suggested that barefoot fore-
foot strikers generated lower impact forces compared
with shod rearfoot strikers. This is based on studies of
ground vertical force, which measures the (vertical)
force back against the foot when the foot strikes on the
ground during running. Nigg argued that higher im-
pact forces are not associated with higher risk of inju-
ries. In a review by Zadpoor and Nikooyan (2011) , the
authors found no significant difference between the
ground reaction force impact peaks for people develop-
ing a stress fracture compared to controls.
Nigg also suggested that we should look at the internal
forces for heel and toe landing. Based on his analysis,
in toe-landing, the force is mostly on the achilles ten-
don, meanwhile for heel-landing mostly forces is on the
tibialis anterior. The change between toe and heel land-
ing created a shift of internal forces, the structure that
are loaded are different, where the internal joint forces
are similar.
Barefoot running has less injuries
This claim advocated by Robbins and Hanna (1987)
based on anecdotal evidence from their work in Haiti
that people that come to the clinic are the people who
wear shoes. It was believed that toe landing create
smaller impact forces. Likewise, Nigg argued that peo-
ple that had shoes that can afford to go to the doctor.
Robbins and Hanna (1987) proposed that running
shoes with supportive structures and absorbent cush-
ioning suppressed sensory feedback and therefore in-
creased the likelihood of lower extremity injuries. Thus,
they recommended barefoot running as a possible solu-
tion to running-related injuries. It is also reasoned that
toe landing creates smaller impact forces of landing.
However there is no experimental or even theoretical
evidence on this claim.
Nigg noted that running injuries have not changed over
the years despite the massive development of the run-
ning-shoe industry.
Bahlsen (1989) evaluated different landing impact
forces on relative injury frequency and found no signifi-
cant differences in injuries for low, medium, and high
impact forces. However people with firm landing (high
loading rates) significantly have fewer injuries. There is
no experimental evidence that barefoot running has
less injuries. A review by Murphy et al. (2014) con-
cluded that barefoot running is not a substantiated
preventative running measure to reduce injury rates in
runners.
Reports in 2010 seen a large increase in injuries caused
by running barefoot or with minimalist shoes
(Fitzgerald, 2010). A recent study from Griffith Univer-
sity Australia showed that transition to minimalist foot-
wear appears to increase the likelihood of experiencing
an injury, specifically increasing pain at the shin and
calf (Murphy et al., 2013). The authors speculated that
the runners who switched to full-minimalist shoes may
have been forced to change their running form. Simi-
larly a crowd-sourced data showed that the risk to suf-
fer a running related injury was significantly increased
during the period of changing from shod to minimalist
running (Daumer et al., 2014). Prof. Lieberman said
that If you switch to minimal shoes or go barefoot you
need to (a) do so gradually so your body can adapt, and
(b) you need to learn proper running form. Recently
Vibram, the minimalist shoes company, agreed to pay
Barefoot Running
Barefoot minimalist shoes. Photo courtesy of Donna
Eddy.
$3.75 million in refunds to purchasers after a class ac-
tion lawsuit accused the company of making claims
without scientific backup that the Five Fingers shoes
could decrease foot injuries and strengthen foot mus-
cles.
Barefoot running requires less energy
This aspect can be looked at based on energy consump-
tion on a global (respiration) and local (oxygenation of
muscle tissues). Barefoot is believed to consume less
oxygen as logically an increase in mass (due to shoes)
should increase volume of oxygen (O2) demand. Fre-
derick et al. (1984) gave a rule of thumb that 100g of
additional mass will results in additional 1% of energy
demand. However a recent study by Franz et al. (2012)
did not find this relationship to be universal. Increase
in shoe mass up to 300g, did not result in any change
in O2 consumption. The additional mass added to the
foot by the shoe does not seem to have a negative effect
on the performance until at a threshold mass of about
200 to 250 g. The reason is not fully understood yet, it
could be a threshold of mass effects, or different shoe
characteristics, etc.
Franz et al. (2012) further studied the effect of mass on
3 types of runners (1) barefoot, (2) with shoes that
weigh 150g, (3) barefoot with added 150g weight. The
subjects were midfoot landing that run 25 km/week
with 8 km/week on barefoot. The results show no dif-
ference between barefoot (1) and shoes (2). Further-
more there is a 3-4% less oxygen use for shoes (2) com-
pared to barefoot (3). Possible factors include stride
length or frequency, shoe damping effect from inserts,
comfort or preference.
The results of these studies are inconclusive and thus it
is suggested that additional information may be found
through the investigation of local energy aspects during
running. There is also no significant difference between
running barefoot or with running shoes in muscle ac-
tivity. Nigg and his colleagues studied the soft tissue
vibrations, caused by the landing of the foot on the
ground which results in waves that travel up the body
from the feet to the head. The vibrations of soft tissue
compartments due to impact are usually damped. The
magnitude of soft tissue vibration damping can serve as
an indicator for the amount of work a muscle needs to
expend for impact related vibration damping. A study
by Enders et al. (2013) looked at participants who ran
at 3.5 m/s on a treadmill in shoes and barefoot using a
rearfoot and a forefoot strike for each footwear condi-
tion. The preferred strike patterns for the subjects were
a rearfoot strike and a forefoot strike for shod and bare-
foot running. The results showed that neither shod and
barefoot nor rearfoot and forefoot strike resulted in a
consistent change of the damping coefficient. Only pre-
ferred movement pattern showed significantly lower
damping coefficients compared to the non-preferred
strike pattern. It is suggested that a runners individual
movement preference might be a much more important
and influential aspect when considering soft tissue vi-
brations.
Energy Storage in Running
Alexander (1987) suggested that runners bounce along
their tendons and ligaments. It was suggested that run-
ning shoes take away the natural musculature spring of
the foot and lower legs. Running involves a mass-
spring mechanism an exchange of potential and ki-
netic energy in the tendons and ligaments. Tendons
and ligaments are elastic tissues that can store energy,
where they are stretched and then release energy as
they recoil. The main springs are the Achilles tendon
and the longitudinal arch of the foot. Achilles tendon
can store 35 Joule per step for running and, the arch of
the foot can store 17 Joule. The mechanical energy per
step is 100 Joule, and it was suggested that the arch
and Achilles tendon can return 52% of the energy cap-
tured in each step, when we run.
A study Perl et al. (2012) concluded that minimally
shod runners are modestly but significantly more eco-
nomical than traditionally shod runners regardless of
Barefoot Running
strike type. The likely cause of this difference is more
elastic energy storage and release in the lower extrem-
ity during minimal-shoe running.
However there is still a great uncertainty on how much
of the energy is returned. Nigg argued that if we were to
use the Achilles tendon, we would hop like a kangaroo
not run. He also argued that if we were to use 17% of
the energy form the arch, then most sprinters will have
a high-arch. Similarly athletes would not use orthothics
that do not allow the foot to deform. . There is also a
high variation of stiffness in the Achilles tendon, from a
factor of 100 to 1000. Currently the theory and data on
storage and return of energy in running is not well un-
derstood yet.
Conclusions
In conclusion, Nigg said that it's not the right question
to ask or to compare ,which is better barefoot running
or wearing running shoes. The most important factors
in mitigating risk of foot injuries and raising running
performance, are individual preference and comfort.
The bottom line is if it doesn't feel good on your feet,
don't run with it.
References
Alexander R. McN. (1987). The spring in your step. New Sci-
entist 1588, 42-44, 30 April 1987.
Bahlsen, A., (1989). The etiology of running injuries, a longi-
tudinal, prospective study. PhD University of Calgary.
Daumer, Martin, et al. (2014) Overload injuries in barefoot/
minimal footwear running: evidence from crowd sourcing.
PeerJ PrePrints No. e250v1.
Enders, H., von Tscharner, V., & Nigg, B. M. (2013). The ef-
fects of preferred and non-preferred running strike patterns
on tissue vibration properties. Journal of Science and Medi-
cine in Sport, 17(2), 218-222.
Fitzgerald, M. (2010). The barefoot running injury epidemic.
Competitor
Franz, J. R., Wierzbinski, C. M., & Kram, R. (2012). Metabolic
cost of running barefoot versus shod: is lighter better. Med
Sci Sports Exerc, 44(8), 1519-25.
Frederick, E.C., Daniels, J.T., Hayes, J.W.(1984) Current
Topics in Sports Medicine, pp. 616-625
Gruber AH, Umberger BR, Braun B, Hamill J. "Economy and
rate of carbohydrate oxidation during running with rearfoot
and forefoot strike patterns." Journal of Applied Physiology.
2013 Jul;115(2):194-201.
Hatala, K. G., Dingwall, H. L., Wunderlich, R. E., & Rich-
mond, B. G. (2013). Variation in foot strike patterns during
running among habitually barefoot populations. PloS one, 8
(1), e52548.
Herzog, W. (1978) Thesis Dissertation, ETH, Zurch.
Lieberman, D. E., et al. (2010). Foot strike patterns and colli-
sion forces in habitually barefoot versus shod runners. Na-
ture, 463(7280), 531-535.
Nigg, B., & Enders, H. (2013). Barefoot runningsome critical
considerations. Footwear Science, 5(1), 1-7.
Lorenz, Daniel S. Pontillo, Marisa. "Is There Evidence to Sup-
port a Forefoot Strike Pattern in Barefoot Runners? A Re-
view." Sports Health. November/December 2012 vol. 4 no. 6
480-484
Murphy, K., Curry, E. J., & Matzkin, E. G. (2013). Barefoot
running: does it prevent injuries?. Sports Medicine, 43(11),
1131-1138.
Perl, D. P., Daoud, A. I., & Lieberman, D. E. (2012). Effects of
footwear and strike type on running economy. Med Sci Sports
Exerc, 44(7), 1335-43. Ryan, Michael, et al. "Examining in-
jury risk and pain perception in runners using minimalist
footwear." British journal of sports medicine (2013): bjsports-
2012.
Robbins, S. E., & Hanna, A. M. (1987). Running-related in-
jury prevention through barefoot adaptations. Medicine and
Science in Sports and Exercise, 19(2), 148-156.
Zadpoor, A.A. & Nikooyan, A.A. (2011). The relationship be-
tween lower-extremity stress fractures and the ground reac-
tion force: A systematic review. Clinical Biomechanics, 26 (1),
2328.

Barefoot Running
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DEAR ART,
You sometimes mention working at
the end range of motion. Why do you
suggest that, and how do I work this
way? EXPANDING HORIZON

DEAR EXPANDING,
In a nutshell, short and tight fascia,
ligaments, and muscles can prevent
full range of motion of the bones. If
we work on these tissues in a short-
ened or even neutral length, we can
soften them, but we lose the chance to educate them to
release and lengthen, thereby re-establishing move-
ment and protective neural patterns that allow more
mobility. I rarely see someone complaining of a prob-
lem in the neutral range of motion; instead I hear, It
hurts (or is limited) when I do thiswith this being
some limitation near the end range of motion where
soft-tissue restriction prevents more movement. For
this reason, I frequently work with joints extended
comfortably very near the end range to challenge the
restriction by asking for active movement as I work.
Most of us work this way in varying degrees when we
rotate or side-bend the neck. Working this way is par-
ticularly helpful (and popular) with athletes, yoga prac-
titioners, or anyone with an active lifestyle who wants
more mobility. There really isnt anything fancy or diffi-
cult about it; I just ask people to get into positions
where they complain of limitations and work in these
positions at the precise area where they feel the rubber
band tightening. Rather than demonstrating many
different postures, lets examine a couple of yoga pos-
tures to illustrate the versatility of these techniques;
you can then generalize from these to suit your needs.
Once you begin working in this way, the positions are
limitless. My students often mention how it transforms
their practices, making their work more interesting and
fun, and gets them rave reviews from clients.
Restriction will vary from person to person; just have
your client assume the position and ask what areas are
hampering the posture. As you free up the most obvi-
ous one, you will often find that another link in the
chain is crying out for some caring attention.
Q
A
Working at the End Range of Motion
Q&A with Art Riggs
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Downward-Facing Dog
1. If tight calves or Achilles tendons are limiting factors, simply focus on
those areas by either stretching a muscle or fascia away from an anchor,
or by facilitating release by working in the direction of muscle lengthen-
ing. Notice if the restriction is superficial or deeper (Image 1).
2. Hamstrings, gastrocnemius, plantaris, popliteus, or tight superficial
fascia can all restrict full extension of the knees. In addition to releasing
short tissue, consider working with rotational patterns by rolling muscles
or fascia to stretch in a straight line and improve tracking of the joint
(Image 2).
3. Of course the proximal hamstrings are often restricted, but some re-
striction is almost always located at the transition between the pelvis and
the low back. Have your client rock her pelvis back and forth, freeing ex-
ternal fascia near the sacrum, the lumbar fascia, and deeper muscles
near the spine, including gently mobilizing the lumbars to facilitate ex-
tension (Image 3).
4. To free the shoulder girdle and arms, work to mobilize the scapulae to
slide over the ribs, focus on the transition to the arms for abduction and
rotation, and gently mobilize the thoracic kyphosis to improve its ability
to extend (Image 4).
The Lotus Pose
Either the full or half Lotus requires flexibility in many areas not demon-
strated here (such as the ankle or rotation of the tibia on the femur), but
lets look at external rotation of the femur and freeing the low back and
upper pelvis.
1. On a deep level, this is an excellent way to work with freeing the joint
capsule by placing your intention on sinking through superficial tissue
and rotating the actual femur in the acetabulum. Experiment with both
compression or traction of the joint as you work the thigh through vari-
ous ranges of motion. Move superficially, working with muscles and su-
perficial fascia to freely rotate around the bone by grabbing large sections
of the quads and iliotibial band. Remember to bring the tissue to its re-
strictions and then slowly wait for the tissue to melt (Image 5).
2. Pelvic mobility is very important. Work on the lumbar fascia, quadra-
tus lumborum, and the upper attachments of the gluteals, asking your
client to tilt her pelvis both anteriorly and posteriorly (Image 6). You can
work on the table, seated, or on the floor. Working this way necessitates
a rewarding communication with your clients and a few minor changes,
such as explaining what you have in mind and why, and having them
wear proper clothing to enable the different postures. Working on flexi-
bility, not only of our clients, but with our definitions of bodywork, will
keep your work fresh, fun, and effective.
Art Riggs is the author of Deep Tissue Massage: A Visual Guide to Tech-
niques (North Atlantic Books, 2007), which has been translated into
seven languages, and the seven-volume DVD series Deep Tissue Mas-
sage and Myofascial Release: A Video Guide to Techniques. Visit his
website at www.deeptissuemassagemanual.com.
Working at the End Range of Motion
1
2
3
4
5
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Recently, an article on biomechanics and evolution
published in Nature (Roach et al., 2013) managed to
attract much attention in the US based press. It did so
by comparing the throwing abilities of Homo Sapiens
to that of our primate cousins. Headlines screamed
Scientists Unlock Mystery in Evolution of Pitchers
which is, of course, an area of huge interest to the aver-
age American sports fan but also, as a therapist, piqued
mine.
Within the Nature article, researchers compare many
unique features that differentiate our shoulders from
those of the apes, especially the lower torsion through
the humerus that allows us a greater range of motion
into external glenohumeral rotation. This increased
range, according to the authors, allows more build up
of elastic energy that can compensate for our weaker
muscles. What they did not identify was which tissues
are involved in this elastic mechanism.
An interesting addition within the article noted Dar-
wins idea of how bipedalism has emancipated the
arms, allowing us the freedom to manipulate and to
throw. It is my contention, however, that whilst lumbar
extension allows us bipedalism it also provides us the
ability to couple and as well as uncouple the arms from
the rest of the body.
The longer waist that developed from Australopithecus
(3.4 -1.9 million years ago) onwards also decoupled
Throwing and Elastic Storage
By James Earls
Fig 1 . Baseball pitcher.
the torso and the pelvis allowing greater range of move-
ment between the lower and upper limbs. By going to
greater ranges of rotation and extension the pitcher/
hunter/thrower can build up more elastic tension be-
tween each segment giving added acceleration to the
distal hand. We can see this as a series of separate
blocks and units (lower limb, pelvis, thorax, and upper
limb) with the relevant elastic tissues between each)
with the relevant elastic tissues between each however,
this is only part of the truth within the body.
Following the demonstration of strain distribution by
Franklyn-Miller et al. (2009), we can also view the rela-
tionships through a myofascial lens that emphasizes
the fascial connections from one segment to another. In
looking at the extreme cocking position of the pitcher
in figure 1 we see the left hip and spinal extension along
with the pelvic, thoracic and shoulder girdle rotation.
These combine to increase the range of movement be-
tween the left hand and both feet that requires a
lengthening of the tissues in between. The lines of ten-
sion used for this extreme throwing position are some-
what predictable if we consider the myofascial conti-
nuities mapped out by Myers (2013, Figs 2 and 3).
The pitchers left Superficial Front Line (Fig. 2) is
lengthened and thereby, one has to presume, elastically
loaded. Much of the anterior thigh tissue from his left
lower limb will assist with deceleration in the cocking
phase, capturing kinetic energy in the elastic tissues
that can then be released to assist the acceleration of
the pelvis during the throw. However, this dynamic will
not be limited to individual segments through in-series
tensioning the anterior thigh tissues may also assist the
rectus abdominis and sternal fascia in their role of spi-
nal control.
Similarly, the adductors of the planted right lower limb
assist with the control of the rectus abdominis and
obliques with their connection into the pectoralis major
via the so-called Front Functional Line (Fig. 3).
These in-series myofascial connections rely on appro-
priate ranges of motion through the whole system. If
we are to recruit the potential energy created in the
lengthening of the lower limb and trunk tissues to as-
sist the recoil of the throwing arm we must be able to
achieve complex positions similar to that shown in fig-
ure 1. Without the extension and abduction of the left
hip, the flexion, abduction and lateral rotation of the
right hip (all of which require the extension and rota-
tion of the spine) we could not pre-tense and elastically
load the thigh and trunk.
Limitations in joints or tissues beyond the shoulder
complex may therefore contribute to overworking the
local soft-tissue of the shoulder complex. The rotator
cuff and pectoralis major, for example, will work harder
to decelerate the cocking and to accelerate the throw.
Any decrease of in-series tensioning will require more
work from those tissues due to the loss of elasticity and
distal contributions.
Through in-series tensioning the tissues of the lower
body thereby assist the shoulder in its recoil (in parallel
mechanisms will also be present but are beyond the
scope of this article). By being able to see the line of
force involved in long chain movement we can analyse
the actions which should be present at each joint along
the line and then investigate the reason for any restric-
tion - motor control, soft tissue or joint limitations dis-
tal to a pathology could be responsible, or at least
Fig 2 . The Superficial Front Line according to Myers (2013).
Throwing & Elastic Storage
contributory to the problem
Differential diagnosis and treatment programs can
therefore be developed to address the issues distal to
the affected site and that process can be aided with an
understanding of the myofascial continuities.
Finally, returning to Darwins comment on emancipa-
tion of the arms we can hopefully now see that lumbar
extension provides us with both a freedom from weight
bearing and access to manipulation. And, through the
myofascial tethering, it also allows us a connection to
the lower limbs, a greater range of movement that gives
us the ability to harness more power though the system
of our body. To utilize that power however, the path-
ways along the body must be clear a truth not only for
pitchers but for anyone using long chain complex
movements.
References
Earls, J., Born to Walk: Myofascial Efficiency and the Body
in Movement. Chicester; Lotus Publishing; 2014
Franklyn-Miller, A., E Falvey, R.. Clark, A. Bryant, P. Bruk-
ner, P. Berker, C. Briggs, P. McCrory. 2009. The Strain Pat-
terns of the Deep Fascia of the Lower Limb. Fascia Research
II. Edinburgh, UK: Elsevier.
Fukashiro, Senshi, Hay, Dean C. and Nagano, Akinori. Bio-
mechanical Behavior of Muscle-Tendon Complex During Dy-
namic Human Movements. Journal of Applied Biomechanics:
22; 2006; 131-147
Fukunaga, Tetsuo, Kawakami, Yasuo, Kubo, Keitaro and
Kanehisa, Hiroaki. Muscle and tendon interaction during
human movements. Exercise Sport Science Review: 30; 3;
2002; 106110
Gorman, J. Scientists Unlock Mystery in Evolution of Pitch-
ers. The New York Times 26 June 2013, Available at: http://
www.nytimes.com/2013/06/27/science/evolution-on-the-
mound-why-humans-throw-so-well.html?
pagewanted=all&_r=0
Gracovetsky, S. The Spinal Engine. Montral; Serge Gracovet-
sky, PhD; 2008
Myers, T. W., Anatomy Trains: Myofascial Meridians for
Manual and Movement Therapists. Edinburgh; Churchill
Livingstone Elsevier; 2013
Roach, N. T., Venkadesan, M., Rainbow, M. J., & Lieberman,
D. E. Elastic energy storage in the shoulder and the evolution
of high-speed throwing in Homo. Nature, 498(7455); 2013;
483-486.

James Earls is a writer, lecturer and
bodyworker specialising in Myofascial
Release and Structural Integration. In-
creasing the understanding and practice
of manual therapy has been a passion of
James since he first started practicing
bodywork over 20 years ago. Through-
out his career James has travelled
widely to learn from the best educators in his field, in-
cluding Thomas Myers, developer of the Anatomy
Trains concept. James and Tom founded Kinesis UK,
which co-ordinates Anatomy Trains and Kinesis Myo-
fascial Integration training throughout Europe, and
together they authored Fascial Release for Structural
Balance, the definitive guide to the assessment and
manipulation of fascial patterns.

Fig 3 . The Front Functional Line according to Myers (2013).
Throwing & Elastic Storage
Born to Walk presents the therapist
with a powerful tool to assess and ana-
lyse movement. It breaks down walking
into the 'essential events' that are re-
quired at each joint, then analyses how
this series of events is integrated
through the transfer of force along the
Anatomy Train lines to create efficient
human locomotion. Author James Earls
combines the insights of evolutionary
anatomy with the Anatomy Trains
model and the latest research on the
many roles of the fascial tissues to cre-
ate an up-to-date and novel vision of
how we walk.
In Fascial Release for Structural Balance,
authors James Earls and Thomas Meyers-
both respected bodywork professionals-
argue that approaching the fascia requires
a different eye, a different touch, and tis-
sue-specific techniques.
Designed for any bodywork practitioner
using manual therapy, this book offers a
detailed introduction to structural anat-
omy and fascial release therapy, including
postural analysis, complete technique de-
scriptions, and the art of proper assess-
ment of a patient through bodyreading.
Available at www.terrarosa.com.au
JUST PUBLISHED
New Ligament in the Human Knee
Two knee surgeons at University Hospitals Leuven in
Belgium have provided the first full anatomical de-
scription of a previously enigmatic ligament in the hu-
man knee. The study was published in the Journal of
Anatomy. The ligament appears to play an important
role in patients with anterior cruciate ligament (ACL)
tears.
Despite successful ACL repair surgery and rehabilita-
tion, some patients with ACL-repaired knees continue
to experience so-called 'pivot shift', or episodes where
the knee 'gives way' during activity. For the last four
years, orthopaedic surgeons Dr Steven Claes and Pro-
fessor Dr Johan Bellemans have been conducting re-
search into serious ACL injuries in an effort to find out
why.
Their starting point: an 1879 article by a French sur-
geon that postulated the existence of an additional liga-
ment located on the anterior of the human knee. That
postulation turned out to be correct: the Belgian doc-
tors are the first to provide a full anatomical descrip-
tion of the ligament after a broad cadaver study using
macroscopic dissection techniques. Their research
shows that the ligament, called the anterolateral liga-
ment (ALL), was noted to be present in all but one of
the 41 cadaveric knees studied. Subsequent research
shows that pivot shift, the giving way of the knee in pa-
tients with an ACL tear, is caused by an injury in the
ALL ligament.
The anatomical and functional relation be-
tween gluteus maximus and fascia lata
Gluteus Maximus (GM) is usually described as the larg-
est muscle of the human body having various functions.
Some studies have identified GM as having the largest
capacity for external rotation of the hip thanks to its
insertion into the linea aspera of the femoral bone.
Others consider fibres from the more cranial sites of
origin primarily end in a thick laminar tendon that in-
serts on the iliotibial tract. The activity of the cranial
portion is considerable increases during jogging and
running. Other studies have identified a role in hip flex-
ion due to the insertion of the GM in the iliotibial tract.
Meanwhile another study said the most important in-
sertion of GM is the iliotibial band.
There is not full agreement regarding the distal inser-
tions of the gluteus maximus muscle (GM), particularly
the insertions into the iliotibial band and lateral inter-
muscular septum.
A study led by Antonio Stecco from University of Pa-
dova, Italy studied 6 cadavers, 4 males and 2 females,
mean age 69 yr, dissected to evaluate the insertions of
the GM into the iliotibial band, fascia lata, lateral inter-
muscular septum and femur.
They found that the distal insertions of the GM are
more fascial then osseous. The iliotibial band is a rein-
forcement of the fascia lata and cannot be separated
from it. Its inner side is in continuity with the lateral
intermuscular septum, which divides the quadriceps
from the hamstring. In all subjects the gluteus maxi-
mus presented a major insertion into the fascia lata, so
large that the iliotibial tract could be considered a ten-
don of insertion of the gluteus maximus. The fascial
insertion of the gluteus maximus muscle could explain
the transmission of the forces from the thoracolumbar
fascia to the knee.
Barefoot Shoes May Cause Injury And Pain
Advocates of barefoot running shoes promise a more
natural experience, but runners in a new study re-
ported higher rates of injury and pain with the less
structured shoes.
Published in the December 2013 British Journal of
Sports Medicine, 99 adult runners in Vancouver, Can-
ada, started a three-month training program in prepa-
ration for running a 10-kilometer race. They had never
tried barefoot running or minimalist running before. A
Research Highlights
Compiled By Jeff Tan
third of the participants were given so-called partial-
minimalist running shoes, or a full-minimalist shoe
with separated toes. The final third got a traditional
structured running shoe, for comparison.
Of the 23 injuries that happened during the training
period, four were among the runners wearing tradi-
tional shoes, 12 among those wearing partial-
minimalist shoes and seven in the full-minimalist shoe
group. Runners using the full-minimalist shoes also
reported higher rates of shin and calf pain than the
other participants.
This study supports what I and others have been argu-
ing for years, Daniel Lieberman, author of widely cited
studies comparing barefoot running to running with
shoes.
If you switch to minimal shoes or go barefoot you need
to (a) do so gradually so your body can adapt, and (b)
you need to learn proper running form, said Lieber-
man, who is chair of Human Evolutionary Biology at
Harvard University in Cambridge, Massachusetts, and
not involved in the new study. But, Lieberman said he
would not go as far as calling minimalist shoes worse
than conventional shoes, at least not based on this
study.
The runners did not transition gradually, the study did
not examine their running form, and it only included
the initial transition period to the new shoes, which
many runners would adapt to over time, he said. What
matters most for injury is how you run, not what is on
your feet, and this study only looked at the latter, Lie-
berman said.
In their report, Ryan and his colleagues speculate that
the runners who switched to full-minimalist shoes may
have been forced to change their running form, and
that might account for the highest injury rate being
seen in the group wearing partial-minimalist shoes.
Foam rolling as a recovery tool after an intense
bout of physical activity.
A study from Canada published recently in Medicine
Science in Sports and Exercise evaluated the effective-
ness of foam rolling (FR) as a recovery tool after exer-
cise-induced muscle damage.
Twenty male subjects (3 yr of strength training ex-
perience) were randomly assigned into the control (n =
10) or FR (n = 10) group. All the subjects followed the
same testing protocol. The subjects participated in five
testing sessions: 1) orientation and one-repetition
maximum back squat, 2) pretest measurements, 10
10 squat protocol, and post-test measurements, along
with measurements at 24 hours, 48 hours and 72
hours.
Results showed that foam roiling (FR) substantially
reduced muscle soreness at all time points while sub-
stantially improving ROM. FR negatively affected
evoked contractile properties with the exception of half
relaxation time and electromechanical delay (EMD),
with FR substantially improving EMD. Voluntary con-
tractile properties showed no substantial between-
group differences for all measurements besides volun-
tary muscle activation and vertical jump, with FR sub-
stantially improving muscle activation at all time points
and vertical jump at 48 hours post exercise.

The most important findings of this study were that FR
was beneficial in attenuating muscle soreness while
improving vertical jump height, muscle activation, and
passive and dynamic ROM in comparison with control.
FR negatively affected several evoked contractile prop-
erties of the muscle, except for half relaxation time and
EMD, indicating that FR benefits are primarily accrued
through neural responses and connective tissue.
Longer Massage Sessions Effective for Neck
Pain
A new research published in the March/April 2014 is-
sue of the Annals of Family Medicine concluded that
multiple 60-minute massage sessions are effective for
neck dysfunction and pain among patients with chronic
neck pain.
Karen J. Sherman, PhD, MPH, from the Group Health
Research Institute in Seattle, and colleagues examined
the optimal dose of massage for individuals
with chronic nonspecific neck pain. 228 individuals
with chronic nonspecific neck pain were recruited and
randomised to five groups receiving a four-week course
of 30-minute visits two or three times weekly or 60-
minute visits once, twice, or three times weekly, or to a
single waitlist control group.
The researchers found that, regardless of the frequency
of treatments, there was no significant benefit for 30-
minute treatments versus waitlist control in terms of
clinically meaningful improvement in neck dysfunction
or pain, after adjustment for baseline age, outcome
measures, and imbalanced covariates. The likelihood of
such improvement was significantly increased with 60-
minute treatments two or three times per week in
terms of neck dysfunction (relative risks, 3.41 and 4.98,
Research Highlights
respectively) and pain intensity (relative risks, 2.30 and
2.73, respectively).
"After four weeks of treatment, we found multiple 60-
minute massages per week more effective than fewer or
shorter sessions for individuals with chronic neck pain,"
the authors write. "Clinicians recommending massage
and researchers studying this therapy should ensure
that patients receive a likely effective dose of treat-
ment."
Massage Therapy for Fibromyalgia: A System-
atic Review
Although some studies evaluated the effectiveness of
massage therapy for fibromyalgia (FM), the role of mas-
sage therapy in the management of FM remained un-
clear. A new systematic review published in PLOS One
journal evaluated the evidence of massage therapy for
patients with FM.
Electronic databases (up to June 2013) were searched to
identify relevant studies. The main outcome measures
were pain, anxiety, depression, and sleep disturbance.
Two reviewers independently abstracted data and ap-
praised risk of bias. The risk of bias of eligible studies
was assessed based on Cochrane tools. Standardised
mean difference (SMD) and 95% confidence intervals
(CI) were calculated by more conservative random-
effects model. And heterogeneity was assessed based on
the I2 statistic.
Nine randomized controlled trials involving 404 pa-
tients met the inclusion criteria. The meta-analyses
showed that massage therapy with duration 5 weeks
significantly improved pain , anxiety , and depression in
patients with FM, but not on sleep disturbance
The authors concluded that Massage therapy with dura-
tion 5 weeks had beneficial immediate effects on im-
proving pain, anxiety, and depression in patients with
FM. Massage therapy should be one of the viable com-
plementary and alternative treatments for FM. How-
ever, given fewer eligible studies in subgroup meta-
analyses and no evidence on follow-up effects, large-
scale randomized controlled trials with long follow-up
are warrant to confirm the current findings.
Full article available here
Massage therapy improves circulation, eases
muscle soreness
Massage therapy improves general blood flow and alle-
viates muscle soreness after exercise, according to a
study by researchers at the University of Illinois at Chi-
cago. The study, reported online in advance of print in
the Archives of Physical Medicine and Rehabilitation,
also showed that massage improved vascular function in
people who had not exercised, suggesting that massage
has benefits for people regardless of their level of physi-
cal activity.
"Our study validates the value of massage in exercise
and injury, which has been previously recognized but
based on minimal data," said Nina Cherie Franklin, UIC
postdoctoral fellow in physical therapy and first author
of the study. "It also suggests the value of massage out-
side of the context of exercise."
The researchers had set out to see if massage would im-
prove systemic circulation and reduce muscle soreness
after exercise. Healthy sedentary adults were asked to
exercise their legs to soreness using a standard leg press
machine. Half of the exercisers received leg massages,
using conventional Swedish massage techniques, after
the exercise. Participants rated their muscle soreness on
a scale from 1 to 10.
As expected, both exercise groups experienced soreness
immediately after exercise. The exercise-and-massage
group reported no continuing soreness 90 minutes after
massage therapy. The exercise-only group reported last-
ing soreness 24 hours after exercise.
Exercise-induced muscle injury has been shown to re-
duce blood flow. In this study, brachial artery flow me-
diated dilation (FMD) a standard metric of general
vascular health, measured in the upper arm was
taken by ultrasound at 90 minutes, 24, 48 and 72 hours
after exercise.
For the exercise-and massage-group, FMD indicated
improved blood flow at all time points, with improve-
ment tapering off after 72 hours. As expected, the exer-
cise-only group showed reduced blood flow after 90
minutes and 24 and 48 hours, with a return to normal
levels at 72 hours.
"We believe that massage is really changing physiology
in a positive way," said Franklin. "This is not just blood
flow speedsthis is actually a vascular response." Be-
cause vascular function was changed at a distance from
both the site of injury and the massage, the finding sug-
gests a "systemic rather than just a local response," she
said.
"The big surprise was the massage-only control group,
who showed virtually identical levels of improvement in
circulation as the exercise and massage group," said
Phillips. "The circulatory response was sustained for a
Research Highlights
number of days, which suggests that massage may be
protective," said Phillips.
Myofascial Roller Massage Reduces Delayed On-
set Muscle Soreness
A recently published study in The International Journal
of Sports Physical Therapy demonstrated the effective-
ness of an inexpensive, easy-to-use massage tool on re-
ducing hamstring muscle soreness after high intensity
exercise. The study, conducted at the National Research
Centre for the Working Environment in Copenhagen,
Denmark, investigated the acute effect of massage with
the TheraBand Roller Massager+ on delayed onset
muscle soreness (DOMS).
This study involved 22 healthy untrained men perform-
ing high volume stiff-legged dead lifts to induce DOMS
of both hamstrings. "In addition to sports performance,
soreness, pain and stiffness of muscles and joints can
interfere with work and activities of daily living for mil-
lions of individuals," stated Lars L. Andersen, PhD, Pro-
fessor with the National Research Centre for the Work-
ing Environment. "Because of this, we elected to use
non-athletes in this study so that the results would be
meaningful and transferable to a larger population
base."
Approximately forty-eight hours after performing the
DOMS-inducing exercise, the 22 participants were
asked to rate the level of their hamstring muscle sore-
ness. Hamstring flexibility and hip flexion range of mo-
tion (ROM) and pressure pain threshold (PPT) were
also recorded. Each participant was subsequently ran-
domly assigned to either a roller massage treatment
group or a control group. The TheraBand Roller Mas-
sager group received a roller massage for 10 minutes on
one hamstring with moderate pressure at one to two
seconds per stroke. The other hamstring remained un-
treated.
Study participants that received the roller massage
treatment had significantly less soreness and tenderness
compared to the control group. There was no significant
difference in flexibility between groups.
"Our research team concluded that the massage admin-
istered with a TheraBand Roller Massager+ had a sore-
ness reducing effect to the affected hamstring," contin-
ued Dr Andersen. "Interestingly, there was also a sig-
nificant reduction in pain in the non-treated hamstring,
suggesting a central nervous system or cross over effect
of the Roller Massager+ on DOMS pain."

Benefits of Clinical Massage Therapy for
Chronic Lower Back Pain
Clinical massage therapy has alleviated chronic lower
back pain (CLBP) in patients who participated in a re-
cent University of Kentucky study of complementary
therapies.
Researchers in the University of Kentucky Department
of Family and Community Medicine recently completed
a study pointing to real-world evidence that clinical
massage therapy helps reduce symptoms in CLBP pa-
tients. The department partnered with 67 primary care
providers (PCPs) and 26 massage therapists in urban
and rural Central Kentucky to study provider decision-
making for complementary treatments and short-term
effects of clinical massage and progressive muscle re-
laxation therapies for CLBP patients.
Through the study, PCPs in five counties referred CLBP
patients with point of service cards to community prac-
ticing, licensed massage therapists for clinical massage
therapy or to a course of patient-administered progres-
sive muscle relaxation therapy. All study therapies were
provided to patients free-of-charge. Of the 100 partici-
pants in the study, 85 received clinical massage therapy,
and 54 percent of those patients reported a clinically
meaningful decrease of pain and overall disability.
Dr. William Elder, UK Family and Community Medi-
cine, principal investigator for the study, said CLBP is a
common diagnosis, especially in people who have per-
formed physical labour as part of their job. The muscu-
loskeletal problem is perpetuated by the patient's emo-
tional stress or anxiety. Because more members of the
aging population expect to maintain healthy functioning
into their later years, medical researchers are interested
in measuring the effectiveness of alternatives to habit-
forming pain medications, such as narcotics.
The study served to forge relationships between the
University and community massage therapists. In addi-
tion, the study indicates a need for future research in-
vestigating the extent to which complementary thera-
pies could lessen or eliminate the patient's reliance on
opioids for CLBP symptoms. While long-term studies
are needed to fully understand the benefits of clinical
massage therapy, Elder said the initial study may give
physicians a higher level of confidence to refer patients
to massage therapists practicing in the community.
See the YouTube video here
Research Highlights
1. When and how did you decide to become a body-
worker?
I fell in to it! After a serious back injury (in 1995), I
gave up gymnastics coaching and started my Diploma
of Remedial Massage (incl . Sports & Swedish Massage)
finishing in 1998. In that first year of study, I met Dr.
Paul Connelly, a musculoskeletal and pain specialist,
whom described my pain and I went on to study
Advanced Musculoskeletal Techniques (osteopathic
therapy) under him, which lead to Traditional Chinese
Medicine study at University of Technology Sydney
where I graduated in 2004.
2. What do you find most exciting about bodywork
therapy?
The most exciting is two fold, firstly watching someone
hobble in in pain and the expression of relief and joy
when they walk (sometimes skip) out the door!
The second is when the patient gets their body. When
they take the advice and do the work themselves and
start being more mindful of what they are doing to
themselves and what they can do for themselves.
3. What is your most favourite bodywork book?
That is tough as I've got about ten that live on my work
bench in the clinic as constant reference. If there were
a fire and I could only take one or two it would be:
Travell & Simons Myofascial Pain and Dysfunction.
The Trigger Point Manual (Vol 1 & II) and Deadmans
A Manual of Acupuncture. I couldn't leave without
those.
4. What is the most challenging part of your work?
Most challenging is patient compliance. Getting West-
erners to take a proactive approach to their body. To
have them do their movement practice DAILY and
come seasonally for tune-ups rather than let life get in
the way and come when they are in agony again.
5. What advise you can give to fresh massage therapists
who wish to make a career out of it?
For the newbie: Look after yourself. Get regular body
work done yourself. Find a mentor whom you can take
clients to and sit in on those sessions so you learn the
tricks and subtitles of your mentors work. Thats what I
did, I spent many hours sitting in on the sessions of
clients as my teacher worked on them.
6. How do you see the future of massage and body-
work?
Hmmm... I see great things as the generations coming
through are more aware and have had manual and al-
ternative therapies in the main stream their whole
lives.
Its been a case of Massage separating from the sex in-
dustry and all manual therapists being given respect
and kudos for the great (often now scientific/ evidence
-based) modalities that are out there.
Massage and bodywork has come out of the shadows,
there is a fair way to go before the utopian dreams of
most manual therapists come true. But, I see progress.
Speak to anyone and the majority have been if not al-
ready have a therapist they go to.
6 Questions 6 Questions 6 Questions
to to to
Donna Eddy Donna Eddy Donna Eddy
1. When and how did you decide to become a body-
worker?
I first experienced bodywork as a client in the late
1970s to early 1980s, when I was exploring different
ways to improve flexibility and strength as a profes-
sional ballet dancer. I trained with who was considered
some of the best of that era in New York City - Romana
Kryzanowska for Pilates, Juliu Horvath for what is now
known as The Gyrokinesis Method and R. Louis Schultz
for Rolfing.
These masters all had a positive influence on me decid-
ing to become a physiotherapist after an injury ended
my dance career. Since 1989, I've focused on getting
experience and training in advanced manual therapy
specialties of physiotherapy.
Although I have taken a multitude of manual therapy
courses, my first most impactful bodywork training was
privately with Ann Frederick, creator of Fascial Stretch
Therapy (FST), in 1998. The next was certification in
Kinesis Myofascial Integration with Thomas Myers in
2004.
2. What do you find most exciting about bodywork
therapy?
The most exciting aspect of bodywork therapy for me is
the never-ending integration of creativity, intuition and
evidenced based science that grows daily over years to
form a valid and reliable base for best client outcomes.
After 25 years, it is extremely gratifying to be able to
confidently, accurately and rapidly help people improve
the quality of their lives.
3. What are your most favourite bodywork books?
Rolfing: The Integration of Human Structures by Ida
Rolf first caught my imagination being introduced to
the amazing world of fascia. One of my many favorite
books is Anatomy Trains by Thomas Myers because it
lays the anatomical foundation for bodywork in a way
that is easy to learn, fun to read and lasting in its im-
pact of how to effectively visualize the connective tissue
system of the body.
4. What is the most challenging part of your work?
The most challenging part of being a bodyworker for
me was to diligently search for the best ways to accu-
rately assess the problems of a client in order to dis-
cover the most efficient and effective manual and
movement therapy solutions to achieve the clients
goals as quickly as possible.
5. What advise you can give to fresh massage thera-
pists who wish to make a career out of it?
The best advise I have to give to massage therapists
new to the field is the following:
Maintain the open attitude that learning never ends
and that it is not necessary to have all the answers in
order to find effective solutions to client problems.
Practical, reliable professional experience from ones
personal practice integrated with input from experi-
enced colleagues or mentors, when needed, which is
then informed by evidence in research is the best strat-
egy for optimal client outcomes.
6. How do you see the future of massage therapy?
In my opinion, the future of massage therapy and
bodywork depends on developing better assessments
for movement dysfunctions and offer not only manual
therapy solutions but neuromotor re-education solu-
tions in order to improve long term outcomes for cli-
ents.
6 Questions to 6 Questions to 6 Questions to
Chris Frederick Chris Frederick Chris Frederick

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