Original subtitles

Welcome to Section 2 of Deep Tissue Massage and Myofascial Release,

a video guide to techniques.

My name is Art Riggs for those of you that are just joining us.

And I am working under the assumption that you have either seen the first section,

the fundamentals section,

or that you are experienced therapists who have cultivated your touch.

So now we will apply those tools that we have learned in the fundamentals section into section 2,

which is the strategies section.

So I will remind you that I'm going to be working considerably faster than I normally work in a regular massage.

And this is because I want to show you many,

many strokes and options for you to improvise with.

So please do feel free to alter any of the strokes I'm using.

If I'm using an elbow and you prefer to use the knuckles or a fist,

please try that and experiment with what works best for you and works best for your clients.

We'll begin our foray up the body with the feet.

I think the feet are tremendously important in many,

many ways.

People injure their feet when they're younger,

develop limping patterns and protective splinting and compensatory patterns.

And as the foot contacts the earth,

that strain pattern will continue all the way up the body.

So it's very important when you're doing structural massage to start thinking about what is actually happening in the ankle joint,

the foot joint,

and how strain patterns move all the way up the leg.

I'm always excited when we move from the fundamentals and theory aspect of deep tissue to actually doing the work.

I can slow down a little bit.

I don't have to be showing a bunch of strokes.

I do want to remind you that you have at your disposal now all of the strokes that we've talked about in the fundamentals tape.

So if I'm using my fingers and you prefer to use the knuckles,

or if I'm using my knuckles and you prefer to use the fist or the fingers,

please feel free to experiment here.

I will be showing you more strokes than I normally would be working.

If I work on this body part,

I want to give you a lot of options to use.

But remember that just as in poetry or good literature,

having a large vocabulary is always very handy.

But sometimes the simplest and most direct way to work is by far the most effective.

So let's begin with the leg and the foot,

and a reminder that I'm going to be using very,

very little lubrication.

I'm really trying to stretch this tissue.

I'm also making the assumption throughout these tapes from now on that you have done your backup work,

you have worked on the outer layers,

you've softened,

you've taken your nice broad strokes,

you've worked at the superficial level.

So beginning down at the foot,

one of the most important joints that we can work with is the talotibular joint.

The talus bone right here articulates with the tibia and as it rotates like this,

it can impede the function.

It also rests upon the calcaneus bone.

So if the calcaneus is too far medial,

if it's too far lateral,

then it's not going to be providing support for the talus bone.

One of the first things I do after I've done my warm up work is just test this foot to see how it moves.

I move to end range and feel if there's a jamming in the front or if there's more tightness in the posterior compartment,

the gastroc and soleus that's preventing it.

The in range feel will tell you a lot.

If it comes to a sudden halt,

then probably it's more of a jamming in the front.

If you keep feeling,

feeling the posterior compartment getting tighter and tighter as you stretch this foot up,

then you're going to know that you're going to want to spend more time on the posterior compartment lengthening that.

So let's just open up the front of this joint right now.

If you're working with someone else,

please feel free at any time to stop this tape and work on.

And work on the small little segments I'm working with.

I do want to get some continuity here,

so I'll be working for a longer time period.

Dina's foot plantar flexes very easily.

She's a swimmer and her foot is very often in this position.

So I don't need a lot of work to lengthen this area to enable her foot to come down.

Other people,

when they lie on the table,

their foot may be resting like this.

In that case,

then you need to determine where is the shortness here.

Pull this foot down and you may feel it along the ankle joint,

you may feel it all the way up to the knee.

So I'm just going to do some nice warm up strokes in this area and I'm also going to consider,

do I want to create mobility of the foot to turn in,

to turn out,

to rotate in which direction?

So I'm always moving this foot and feeling where are the restrictions to movement?

How can I improve function to this foot by doing some strokes?

Let's look at the lower leg and the ankle and foot function to give you a little better idea about the importance of understanding how to free bones in the foot so that you have better function of the ankle.

So as we go down the tibia,

we notice that it articulates in the front right here with a bone called the talus bone,

which I just mentioned.

So the talus bone is extremely important in that it rotates on an axis that is going through just about where this little pin is and enables the foot to plantar flex and dorsiflex.

But the talus bone also sits upon the calcaneus bone right here.

So if on the outer side of your leg you have a lot of fascial tightness,

or if you have a compromised ankle from a sprain,

you can see how the relationship of the calcaneus is going to influence how this talus bone rests and articulates with the tibia.

So this is just important things to think about when you're working with the feet,

that you're not just squeezing tissue,

you're going to work with these bones.

How do I get better function?

Is there a lot of fibrous issue in here that's built up that's preventing this from moving?

These are things we want you to consider.

And then when you come out to the next bone in front of the calcaneus,

we've got the cuboid bone,

somebody that's got a very high arch and this bone is rotated this way,

you may want to work with noticing that the plane of articulation is right along this way.

You may want to work by grabbing this bone and rotating it and just freeing it a little bit.

So do study the bones of the feet and try to have a game plan when you're working on your foot.

Do we need to provide more mobility for this medial arch in here so that the navicular bone can actually rotate and these bones,

metatarsals can move in a little bit and have a little lower arch so that we have better balance these.

These are things that you want to start thinking about with the feet so that you're not just squeezing tissue.

The ankle retinaculum.

It is important to work with this ribbon like band that holds the tendons of the leg muscles in place so that they can slide freely and move the foot.

So now I'm just going to sink right in to this retinaculum,

start the foot in a shortened position and do an anchor and stretch.

This is a nice broad stroke and I'm going to work up her tibialis anterior a little ways so that I can get some continuity between these body parts here.

I always try to work across joints.

This might be enough for somebody right there.

This may have a lot more direction than just squeezing tissue like you would with a beginning mass massage.

If I feel specific fibrous restrictions in this,

I can then stand up,

use my body weight and sink into this area and do much more specific work.

Again,

I'm forever trying to find out where's the restriction,

how can I improve mobility of this foot?

I can use my fingers to just stroke this way and go cross fiber on this retinaculum.

Because I do feel some tightness in Dina's calf,

I'm going to work a little bit on the posterior compartment.

One of the advantages of working on the calf muscles.

When a client is lying supine is that you can manipulate with your shoulder this foot into dorsiflexion and flex it and then work with sort of a milking stroke to stretch this muscle.

Don't be limited to always working on the up surface.

The down surface is often a very good surface to work on all through the body.

Those muscles are nice and relaxed.

You don't have to work very hard because they're just going to provide most of the impetus themselves with their own gravity.

And as I anchor on any tight places here,

I'll just push forward.

Notice that I don't limit myself to just working on the foot.

Everything is connected.

Don't feel like you're just going to work on the foot.

You're done with that foot,

then you move up the leg,

try to connect everything.

Sometimes I'll go clear across the knee joint when I'm working to get this feeling connection all the way up the body.

The plantar surface of the foot is an excellent area to work for stretching tissue.

Dina has a rather flat foot,

so I'm going to be careful that I don't try to stretch along the medial arch here.

Her foot turns in fairly easily anyway.

This would be a hypermobility issue,

and I want to be careful to not accentuate that.

But these muscles and this fascia will be strained from the everyday standing and walking and athletic activities that she does.

So I can possibly work a little more cross fiber on these to solve soften that fibrousness.

But I want to be careful not to lengthen them on the other side with somebody with fairly flat feet.

If you can mobilize the lateral arch clear here on the outside,

then that can create some mobility so that all that strain when her foot lands is not transmitted to the medial where we get all these rotational issues.

So I'm actually going to work on Dina's lateral arch here and get some mobility there.

Just using a nice soft knuckle for somebody with a very high arch and lack of mobility,

Then you could do anything you wanted here.

You could move to the inside and start working with that medial arch.

You can also increase the function of the transverse arch here.

All I need to do is put stretch here,

maybe even stretch the ankle a little bit and work along the transverse arch here.

I'm showing a lot of strokes here.

You might actually be working this way,

although only a fraction of these would be enough to increase the function of the foot.

And the next time the person comes back,

you work a little bit differently.

I very often will take my other hand underneath the calcaneus and try to mobilize it internally or externally or lateral or medial,

and possibly even stretch it.

I'm going to show you one other way to work on the bottom of the foot.

That feels very,

very good for your client,

and that is just have them lift their knee up,

have the foot sitting flat on the table like this,

and then take your hand underneath and do any kind of strokes you want to do.

You'll get a nice soft surface with your fingers here.

At the same time,

you can be mobilizing the foot one way or another.

The main thing is you're not just squeezing tissue in the foot.

You are increasing mobility.

You're getting all these bones moving.

I'm very often thinking about the bones in the foot.

How do they articulate with each other?

How can I mobilize them?

So I'm very often moving bones around here.

I can actually do a snowplow by curving my fingers slightly,

anchoring the foot and pushing toward the calcaneus here.

We'll go into more detail on the bottom of the foot when we talk about plantar fasciitis in the injuries.

The front of the shin or the tibia is another area that is sometimes neglected by early massage students because of the bony surface of the tibia.

It just feels like it's pretty vulnerable,

but it's also an area that really gets bound up.

The fascia here and the superficial muscles can get very,

very caught up with the tibia here and bound there.

So I like to do a lot of work on the front of the shin.

Clients,

when they stand up,

can feel a lot of difference.

So this is a great one to be using nice soft fingers.

And I'm just thinking about maybe an eighth of an inch down that I'm taking all this fascia and this skin and I'm just lengthening it and softening it.

I can work about this speed.

You don't have to work quite so slowly there.

A lot of people after massage have never even been touched on this area.

If you want to use a nice soft surface,

you can just get on the inside of your arm here with your hand rotated this way.

So you're using the fleshy surface and just work on up.

Of course,

the tibialis anterior is probably the most important muscle on the front of the shining the tibialis anterior muscle.

This muscle is often tight and fibrous,

but it is important to determine whether it is short or long in its tightness so that you can determine whether to place the muscle on a stretch.

When working with dorsiflexes the foot,

most people know about that.

So somebody that's foot is needing to often raise up,

such as a bicyclist or something like this,

when they're pulling up on the pedal,

then this muscle can get overworked.

But the other issue I want to talk about with the tibialis anterior is that as it travels down,

goes underneath the retinaculum here,

it actually connects to the medial arch of the foot,

and it's what holds the stability of this medial arch so that it doesn't rotate too much.

So somebody with a very,

very flat foot,

you,

you're not going to want to lengthen this too much because you want to have that shortness to hold this foot up on the other side.

However,

this muscle may be very,

very tight.

So what you would want to do is rather than stretching the muscle,

work on it in a shortened position instead of pulling the foot down.

So now let's go back to some of the earlier strokes I've demonstrated and return to lengthening this area.

So the first stroke might be the anchor and stretch.

So I'm moving this Tissue in the opposite direction.

You'll notice some people that really have a lot of problem pulling their foot up.

And there's sort of a jerkiness there.

I mentioned this earlier in the previous fundamentals tapes.

And you may want to actually facilitate shortening by moving the leg in this direction so that these muscles can be helped out by you in a shortening direction as well.

If you want to do a lengthening direction,

all you need to do is come above and facilitate that lengthening by moving in that direction.

Notice that my fist is nice and soft.

There's a lot of play here.

It's a very important muscle.

Don't forget to work the tibialis anterior.

Let's show some other strokes on the near leg.

Now,

these have been fairly broad strokes I've been showing.

And sometimes you can feel that this tibialis anterior is rotated medially and really bound up to the tibia here.

There's very little freedom between the tibia and the tibialis anterior.

So on that,

I will just take my knuckles here and you can use the soft part,

or depending on their sensitivity,

you can use more and more of the little sharper part of the knuckle.

And you can do some very,

very precise work moving up the leg here.

It doesn't always have to be in a straight line.

You can take your hand and get rotational work like you would with a thumb.

And.

And yet you can see the mechanics are very easy here.

I'm keeping my wrist in a neutral position,

and most of the turning is coming from my whole body and my shoulder.

Another tool that you can use,

if you're coming up here with somebody that's got a fairly good pain threshold and is nice and relaxed so you're not feeling them flinch,

is the elbow is a wonderful tool to work on the front of the leg.

All you do is you want to be sure that you're not sliding off,

because there's a lot of issues.

Here of this muscle rotating and along the longitudinal axis here.

So you just take your thumb and your hand and create a little area that you can put your elbow in and then work on up every once in a while.

No matter what I'm doing on the tibia,

I try to go over the knee joint,

at least to connect this area here,

and then contact the back of the leg so that we're not always just working on the front.

This gives the person a little respite from all this deep work.

The gastrocnemius muscle and Achilles tendon.

A tight gastrocnemius muscle can cause strain upon the Achilles tendon and be associated with Achilles tendonitis.

Do take care to notice if the lateral or medial head of the gastrocnemius is causing more strain.

Working on the posterior compartment of the lower leg or the calf muscles,

the prone position is by far the most expedient way to accomplish this.

One thing I've started with here,

if you take a look at this bolster,

is this is the usual position that people are working on,

the posterior compartment.

And certainly when you're not working on this area,

this is a very good idea to have a bolster here.

But I do want you to notice as you move up the leg and show the transition of the gastrocnemius over the knee,

that this muscle is going to be shortened.

I'm not going to be getting as much of a stretch as I would if the knee were fully extended.

So for this reason,

I'm going to demonstrate the posterior calf work with Dina's foot off the table so she has slid down off the face rest.

I think you'll find that if you allow yourself the freedom to ask your clients to move a cage occasionally,

you'll get a much more functional massage.

In reality,

I might leave Dina into the face rest in the prone position and just move her leg off the table a little bit so that I can get some stretch here.

But in this position,

I'm not going to be able to show the work as well because my body would get in the way.

So I'm going to move her back to her foot hanging over the table here.

First thing that I want to cover is that when you're putting your lotion on,

you're not just going to be slathering the lotion on without thinking.

I immediately start evaluating this leg,

seeing where the strain patterns are.

Dina is fairly even because she has a fairly low arch and a lot of shock goes up the inside.

I feel a little bit of tension Right along the medial head of the gastroc more than on the lateral head.

A lot of people with high arches or runners are going to have much more tension on the lateral head of the gastroc.

And so you want to be deciding where do you want to put your work in?

If you need precise,

focused work,

you don't want to be giving the same amount to the medial head of the gastroc as the lateral head.

Sometimes even a few separation strokes that we've talked about where you're separating muscle compartments,

you may want to take your fingers and just sort of get a little clarity between these two heads.

After your kneading,

work your effleurage moving into a little deeper level.

I'm going to come into my forearm and work up this way.

Notice that my wrist is nice and relaxed.

If I have my wrist up tight or my fist,

that's going to transmit to her with a different fist feeling.

Now,

the advantage to having Dina's foot over the edge of the table and her knee fully extended is that I can stretch this gastroc all the way down.

So what I want to do is to free up both hands.

I'm going to stand and put my knee right on the front aspect of Dina's foot,

and I can stretch this.

So now I can work on this in a stretched position and.

And try to affect a release of that muscle rather than just a softening.

I may want to do a raking stroke so I'll get clear at the top.

So now I'm facilitating a stretch by moving the same direction so I'm raking toward myself.

I'm just leaning into this with my body weight and.

Sort of pulling my body back at the same time.

I'm not doing all this work with my arm.

One of the strokes we described in the fundamentals tapes was how to free muscles from adhesions and restrictions to deeper structures and even bones.

These restrictions can impede the proper function of muscles and joints.

So what I'm going to do now is just going to grab this gastroc,

lift it away from the bone,

and roll it.

And remember,

when you're rolling,

you're not just going to go back and forth.

What you're trying to do is to really free the end range of mobility here.

So as I come near the end here,

I'm.

I'm really trying to roll this muscle around the bone.

I'm not rolling the bone as I come to the end,

then I'm just going to wait and wait for this to soften.

And you'll feel that muscle melt and relax.

And then you can roll it a little farther.

You can take your hands and just lift the muscle off the leg here and move it up and down.

It's supposed to be able to slide along that bone,

get a hold a little bit further down.

And I can feel her soleus right down at the tips of my fingers.

It's a little bit tight here.

After I've done some fairly intense work,

then I swing out to a little bit broader,

integrative strokes and maybe even cross the knee joint here.

Remember,

the gastroc does cross the knee joint.

So if I want to isolate the soleus,

all I need to do is lift the leg up.

Then the gastroc becomes nice and loose because of this angle here.

And I can isolate the soleus first.

I'll just leave it in a fairly shortened position to work on it.

I'm going to sink through this nice,

soft gastroc now with my fingers,

just feel.

Wherever there's tension,

I can roll it.

And then I can just put the forefoot underneath my axilla or armpit here and stretch that soleus.

Now,

I've already done some softening in a shortened position,

so now I can stretch it.

And way back in the Fundamentals video,

you remember sinking through the gastrocnemius to palpate the soleus.

I'm just going right through the gastroc with both my fingers like this,

finding tension in that soleus and then anchoring there and stretching away from that tendon.

Farther up I go,

I get into the belly of the muscle.

I want to spend a little time on the Achilles tendon.

A lot of early massage classes Only focus on the belly of the muscle.

And if you can free this Achilles tendon to move,

to be flexible,

you'll be doing a big service,

particularly to athletes.

So I'm going to keep my knuckle on this side so you can see what my hand looks like.

But you certainly could come on both sides to work here.

And basically,

I visualize that I'm lifting this Achilles tendon,

I'm mobilizing it.

I can take my hands and work in different directions like this,

and just work my way up the Achilles and try to soften that.

Can use my fingers,

and you can sort of crimp the Achilles if you want.

So I'm going up in one and and down on the other.

What we're doing is we're softening the sheath that surrounds the Achilles tendon right here.

And then I would just reverse the direction.

Any place I feel tension,

I sink in there,

and I wait and I slow down.

And then we work down to the plantar surface of the foot again.

I just want to demonstrate proper use of body mechanics that I'm going to be getting my body far enough away that my elbow is straight and I can lean right into this foot.

Any of the things that we did in the supine position you can do here.

You can flex the foot,

you can rotate the foot one way or another.

And just find strain patterns and work on that.

Now,

if you prefer,

rather than getting farther back with your chair,

as I'm doing here,

you just slide forward,

anchor that elbow against your own body,

and then as you lean forward with your own body weight,

that's going to provide the force for you.

I actually prefer this.

It's a little bit easier for you.

Your lever arm isn't quite as long.

Don't forget to work on the foot in the prone position.

It affords all sorts of mobility and flexion potential here.

And you can grab the Achilles and the calcaneus here,

and you can start mobilizing that this way and that.

And of course,

you do this a little bit more slowly.

I'm trying to show you a lot of strokes in a short time period,

But I can grab this calcaneus and I can rotate it medially,

or if I feel it's too far medial,

I can then just take my thumbs and rotate it laterally wherever I feel tension here.

You can drastically alter the way your client's foot plant and tensions patterns move up their body by mobilizing this foot so that it acts as a shock absorber.

So it's excellent work to free up this foot.

The quadriceps muscles.

Notice that the rectus femoris is the only quadriceps muscle that crosses the hip joint and is important for hip flexion along with the psoas muscle.

The supine position is,

of course,

the most expedient way to work on the quadriceps group and hip function and on the knee as well.

So before blindly diving into this area,

I like to evaluate the whole leg and hip and knee function a little bit before I start working.

So one of the first things that I check is external rotation of the hip and internal.

Dina is pretty neutral here.

A lot of people,

their leg will already be rotated out.

They've got plenty of movement to the outside,

and in that case,

you'll see that they're limited on the inside.

So I may at that time hold the knee into an internal rotation.

When I'm working to try to increase this ability for internal rotation,

somebody that's very internally rotated,

I may want to rotate the leg out when I'm working to try to increase its ability to rotate in that direction.

I very often will see where are the blocks to energy running up and down this leg.

I can compress the hip joint and see is that acetabulum free?

Does that femur seem to glide a little bit in there?

Dina's feel is actually pretty good.

And Then I'll pull it out.

And are there joint issues?

Are there soft tissue issues that are compressing this joint?

Dina's moves up a little more easily than it moves down.

Some of this fascia and the tensor fasciae latae muscle and all of this are a little bit short in preventing this femur from dropping out here.

The main thing is you don't want to just start massaging this area without having a plan.

Generally,

I start with fairly broad strokes,

and I think that the best tool that I can use on the quadriceps group is the forearm.

Elbow is going to be a little bit too sharp,

and it will be rolling like this.

So I just start with a nice fleshy part of my forearm and do some nice long strokes.

Again,

I may want to rotate this femur with my other hand and move in a diagonal as I'm going up,

rather than just going straight up.

This is the difference that will make you stand out to your clients when you start working with direction and purpose.

Dina's IT band here is a little bit tight,

so this is going to be good work for her.

If I have areas that want a little more specificity than the forearm,

then I may switch to the fist.

And the fist works excellently here.

Remember,

don't spend your time doing huge long strokes.

If only 2 or 3 inches of the muscle,

have the fibrousness,

go to where the tension is.

Don't be perfunctory in your strokes.

I may want to do some of the work that we've talked about,

freeing the quadriceps from the femur,

so I may grab it,

lift it up from the bone.

Do some ringing,

do some up and down,

do some rotation around the bone.

People love this.

You just keep your hands nice and soft and work with freeing this muscle.

The tensor fasciae latae and iliotibial band.

When creating balance and ease in the iliotibial band,

be sure to address both the tensor fasciae latae and the gluteus maximus to equalize pressure between the posterior and anterior placements of these muscles.

Let's talk a little bit about separating muscle compartments.

I think you can see fairly well.

Dina's IT band is fairly well defined here.

One of the first things I do is I see if it seems to be moved more easily toward the front or toward the back.

I feel like Dina's moves toward the front fairly easily.

It's not too bound to the hamstrings group,

but when I pull it down,

I feel a lot of restriction from facial areas here.

And like,

it may be adhered to the vastus lateralis over here.

So I'm going to start working to define that border of the IT band.

As I mentioned,

this is moving very nice and smoothly along the hamstring.

It's not bound very much,

so I'll give a few early cues to that.

And then I'm going to spend most of my time working on the upper surface or the anterior surface of that IT band,

trying to free it from that quadriceps group.

I may grab it with this hand and start pulling the quadriceps away from it and just work all the way up.

I may just get right along that border of vastus lateralis here and just try to separate it here.

This is excellent work for people that have knee problems.

Nice soft hands.

I can work on the knee joint itself.

I'm just feeling where all this fascia is.

Are there any strain patterns?

How can I soften this so that this kneecap can slide easily?

Most kneecap problems with tracking,

in other words,

how it slides up and down.

Probably 75%,

at least the kneecap is pulled too laterally.

It's adhered to these tendons coming down from vastus lateralis.

It's adhered to fibers of the IT band.

And so any work you can do to just grab this kneecap,

slide it over,

and create a little bit of stretching here can be beneficial.

Just plain softening on the IT band is,

of course,

very,

very worthwhile.

If I am going to be using my fist here,

I'm going to have my elbow right against my body so that I'm not muscling all the forces then coming off my feet,

and I just take a nice soft fist and move up this way.

Another popular way of working on the IT band is to bend the leg up here and then rotate it this way.

The more that it's over this way stretched,

you're going to be stretching the IT band here.

And I'll just take a nice soft forearm and work my way down.

If I feel it going one way or another,

I'm just going to do whatever direction I feel.

I'm going to go a little bit of a diagonal this way because I want to free it up here with the upper hamstrings.

The drawback to this is that I am compressing this femur joint here.

So I'm not giving her a cue to have this femur dropping out.

If somebody is quite flexible,

you can actually take their leg on the other side and get more rotation in here.

And this,

the farther up that I go toward the quadriceps group and the tensor fasciae latae,

this will create more stretch here.

I probably am not going to get on this side and push this way because I'll just be rotating her whole body this way.

In the prone position,

most people work on the hamstring.

And I still think it's probably all in all the best way to work on the hamstring.

But I do want to cover our theory of putting muscles in stretched position to affect a release of the muscles so that we're not just softening and squeezing muscle.

For.

For this reason,

I'm going to demonstrate work on Dina's hamstrings when she's in the supine position to show the advantage of body positioning on effecting a stretch.

So as you can imagine,

if she's face down,

all she will get is a neutral length on the hamstrings.

However,

in the supine position,

if I lift Dina's leg up and keep her knee straight,

I can be working on the posterior hamstring back here at the lower edge or end of it and beginning a stretch.

As I feel this muscle release,

I might move my body a little bit closer and move her up even more.

Different people will have stress in their upper hamstring or their lower hamstring.

It depends what kind of activity they're doing.

Somebody that's working on an elliptical stair climber may have a lot of tension in the upper hamstring as it contracts to bring that hip back.

Somebody that's bicycling may have more strain on their lower hamstring.

So another thing you can do is actually bend the leg so that we have a little bit of relaxation of the lower hamstring,

which will enable you to sink in.

I'm using my thumbs here.

You could also use your knuckles or your fingers and you feel where strain patterns are.

Dina has a lot more strain on her medial hamstring than her lateral.

So I'm actually going to take my thumbs and not worry so much about this lateral aspect and move to the inside and anchor that and just see how does this knee,

when it straightens,

how does it work?

Does it work as a straight on hinge or are there a lot of rotational forces?

If I feel my hands pulling one way or another,

then I'm going to counter that strain so that this knee will work in a straight way.

This is again the same type of thing that your clients will notice a difference when they never had their hamstrings worked on this way.

Bicyclists love this work.

So all I'm doing is softening that muscle,

anchoring and then stretching.

If I want to work on the belly of the muscle in a stretched position,

I just need to step back.

Tell Dina to keep her knee relatively straight.

And then with a long lever arm,

just work with my fist.

The lower hamstring,

it's not really that important if I'm going to be focusing.

This would actually be the upper part of her hamstring,

but the lower.

As far as your picture is involved here,

it's okay.

If I bend Dina's knee here so that there's softening in the distal aspect of the hamstring.

I can then come in and do an anchor and stretch by anchoring this hamstring here and stretching away as I move down.

Could use a fist.

And sometimes you'll find a lot of fibrous tissue just distal to the ischial tuberosity.

And that's where you want to get very specific and use your knuckles or your fingers if they're strong enough.

I just find fibrous areas here.

I sink in there,

wait for them to soften,

and get a bit more of a stretch.

You want this hip joint to be working in a straight line like this.

A lot of people,

when you push,

you'll find it goes like this,

or there's a lot of restriction.

You just can't even go over here,

or you'll even find sort of a bunching in the front here.

So I test this joint for function here.

If I have some specific work to do,

I can also have Dina help me out by grabbing her knee so that I can do rotational work with the femur as I'm working here.

So I can take this femur and this tissue,

rotate it this way,

and then work for this hip tracking in a straight line.

This is very good work to do after you've already warmed up the hamstrings in a prone position.

There you can do some non specific work,

soften that,

and then when you've noticed strain patterns when you turn them over,

you can work on this.

You don't need to do all the strokes I'm doing here.

Just focus on whatever area seems to have the most tightness.

Another interesting adjunct you may want to add to your massage strokes are joint mobilization moves.

We talked about this in the fundamentals tape about how to mobilize different vertebra and start thinking about how one joint relates to another.

The hip joint is one of the most locked up joints that people have in their bodies.

And if you can give them some more freedom there by moving it through the range of motion,

rather than just working it in a passive position,

you can really increase their mobility.

So I'm just going to show you a few stretches to do here that are a little bit different from,

say,

yoga stretches.

I'm working with the ligamentous component of that joint articulation.

So if we take a look at Dina's hip here,

we can go through some of the ranges of motion that are involved in hip movement.

This would be hip flexion.

This would be hip extension.

Now,

we're not going to be able to increase extension very much because we're going to just come to neutral here.

So I'm not going to talk about that right now.

But this would be internal rotation of the femur.

You can see it when her leg is down.

Basically it's just running like this.

So this is internal rotation and this is external rotation.

What you can do is with the knee at a right angle here,

if you brace that here,

you can use this as a lever.

So what I do is I move Dina into a position until I feel a rotational component coming in.

As when I move her past here,

her leg wants to externally rotate.

So what I might do is go to her flexion endpoint here.

Keep this knee at a right angle,

and then I will internally rotate.

And I don't keep an active movement here.

I just go to the end range and I call this almost like picking a lock.

I try to move with small,

steady little increments until I find the right angle that all of a sudden this hip can start rotating.

Then I might move them more into flexion.

Try it again.

Go into internal,

go into external.

So if I step back,

you can see what I'm doing is I am rotating this lever that's going straight down into her acetabulum to work on internal and external rotation.

I can also being careful not to compress the patella Just put some pressure straight down on the knee so that it's going to be moving like this.

In the acetabulum,

I can do some general rocking.

I can come near the end and say,

what position do I want?

I'm going to move her leg over here so that I'm almost pushing it out of that acetabulum a little bit,

and there I feel a little bit of a melt.

I can open up her leg,

the abduction here,

and do the same thing.

If I put her leg in a neutral position,

I feel like this is about as far as it wants to go.

I might just bring her to that end range,

support her with my legs so those muscles aren't contracting,

and just push down,

see if I can increase that.

If I want to do a stroke while I'm working there,

that's fine.

But I'm basically working with the joint.

Once I get it down to its end range,

I may want to take my hand underneath here,

have the knee bent and work internal and external rotation.

In this position,

people will become limited in internal and external rotation in different positions.

So some people are very,

very mobile in internal and external rotation in a flexed position or an extended position,

but not in an abducted position.

So the main thing you want to do is you want to be sure to support this knee so that there isn't torsion between the tibia and the femur here and start working with these rotational issues.

I have Dina's feet propped up at a fairly high angle for working on the posterior knee and then moving up to the hamstring.

I think it's important to have enough flexion in the knee here that the posterior knee area or the popliteal area will be fairly soft so that you can sink in here.

This is an area that if it's put on too much of a stretch,

it's not going to feel real good to your client and they're going to resist against you.

So when I'm working on the posterior knee,

I'm thinking.

Mostly about strain patterns at a superficial level.

How does the fascia on the outside seem to run down?

Is it shorter on the outside,

or is it shorter on the medial aspect?

And then I think about tension patterns from the gastrocnemius.

Both heads cross and attach the posterior femur,

and then the hamstrings cross and put other strain patterns in.

So I'm going to just talk about the posterior knee right now.

There are two other muscles that are,

although not very important for knee flexion,

if they get strained or sore,

if you've hyperextended a knee,

they can be very,

very painful and can very much impede the function of the knee.

That would be the popliteus and the plantaris muscles.

Both of these are small,

little,

almost vestigial muscles that cross the knee joint,

but they can very much go into spasm and be very painful.

So I usually bolster the foot up at a fairly high angle,

so.

So that this area is soft.

And then with very soft hands,

I work much slower than I've been showing here.

One of the things that I've been doing when I show multiple strokes is that I've been working faster than I usually do.

This is just to show you a multitude of possibilities for working.

So on this,

I'm actually going to lift Dina's foot up a little bit farther so that I can really sink into this area.

I can anchor on plantaris,

which travels from the lateral side of the femur in a diagonal down to the lower medial leg and make very slow and small movements with the anchor and stretch techniques to try to soften that muscle.

You might want to spend five minutes or more working on this area very,

very slowly.

It has a tendency,

if you work too hard,

to not necessarily flare up right away,

but the next day it might be sore.

So work this incrementally here.

The hamstring muscles,

although they share a common origin at the ischial tuberosity,

notice that the different attachments below the knee cause different degrees of stress and torsion on the knee.

And it is important to differentiate which muscles are tight when planning your strategy.

There's really not a lot of important,

special strokes to take on the hamstrings.

Basically,

it's a nuts and bolts approach.

Soften the tissue,

lengthen the tissue,

find strain patterns.

Is it strained toward the outside?

Is it strained toward the inside?

And I take some nice broad strokes.

At the same time,

I'm taking my left hand and trying to basically stretch the hamstrings and all this external tissue to get a message to this knee joint to let loose and to open up this way.

Basically,

I'm distracting this knee joint.

So I'm giving her a cue from both sides.

I'm moving in opposite directions here.

The fist is also another tool here.

If you feel some really fibrous areas,

just sink in,

Wait.

Let that fist stay soft.

You might expedite that softening a little bit by raising the leg and then anchoring and stretching.

If you want a little better stretch,

this would be a good time to move the bolster out.

So I would anchor and stretch here and then lengthen that muscle.

If I felt very,

very isolated little areas of tension,

then I could come in with my fingers.

Wherever I feel adhesions or tenseness,

just come right in there,

anchor and bring it down.

You can see how I'm outlining the biceps femoris or lateral hamstring here.

So what I'm actually doing is defining the border of this muscle,

and I feel a lot of real hard tension in this area.

So I'm actually going to slow down a little bit and show a little bit more like I would normally be working.

When I'm showing a lot of strokes,

I have a tendency to work a little faster than I normally do.

So in an area like this,

you might work just this slowly.

I have her leg elevated.

I can rotate it if I want to,

if I want to find a strain pattern.

But basically,

I just wait for this tissue to melt,

and it's starting to melt right there.

It's a very subtle feeling.

When tissue melts.

But if you move slowly enough,

it makes your work a lot more rewarding and it can tell you when to move on.

I'm coming out and working a little more shallowly now.

This needs about two to three times as much work on the lateral aspect as on the medial.

My fingers start getting tired.

I can use a fairly sharp knuckle.

It's not going to be quite as precise as my fingertips.

I could follow this all the way up to the ischial tuberosity.

I'd be planning ahead of time to soften tissue.

So I'm not diving in that deeply without first softening the external muscles.

So let's go right to the ischial tuberosity.

This is an area that you should be able to find in your sleep.

You don't want to be probing around here,

hit and miss.

To try to find the ischial tuberosity.

You should always be able to find it within,

say,

a quarter of an inch of where it is.

And it's an extremely important landmark for the pelvis because both hamstrings attach at the ischial tuberosities.

If they're tight,

they can be pulling this pelvis under.

If one is tighter than the other,

it can be causing rotational force here.

So it's an excellent area to spend a lot of patient time.

And basically I usually work distal to the ischial tuberosity.

I start with fairly soft fingers.

I can work on the broad facial components and then work myself down deeper to the actual hamstring tendons.

I can do some cross fiber work.

I like to just basically sink here and weight and you'll feel those muscles soften.

And you can save a lot of time by working at the tendonous insertion of the hamstrings,

the Golgi tendon organs,

Things like this will give feedback to these muscles so that they will relax just by working on the tendon.

If you feel your fingers are a little bit too sharp or a little pokey,

then knuckles work very,

very well.

I've got two knuckles with a fairly broad surface here.

The other alternative would be to put your hand here so that it's not going to be sliding around too much and just sink in with your elbow and just wait.

This is very important work.

Again,

there's nothing fancy about working on the hamstrings.

It's just taking your time softening tissue,

lengthening tissue where it needs it.

Let's talk a little more about working on the it band in the prone position.

Now,

if there's too sharp of an edge on the table or they're too sensitive.

Obviously,

you can put a pillow or something else right here to bolster this leg,

Realizing that the higher you lift it,

however,

the more torsion you're going to have on the back.

So unless you feel them recoiling against the pressure you're putting,

you're better off leaving the leg down here and minimizing your rotation in the spine.

Work on the IT band just like you would in any other position that you can access it.

Some nice broad strokes.

I never use anything very sharp here.

I don't use my side of my arm with the ulna.

Anything that's going to be hard and bony is going to be too sensitive there.

So I always rotate my hand so that I'm using the fleshy aspect.

The advantage to working prone on the IT band versus supine is that I'm giving this picture to this femur to drop out of the acetabulum here.

I'm distracting this joint.

And just as any other way,

if I feel particular strain patterns,

I can move to fingers and just work nice and slowly.

I'm lengthening in a very broad sheet here.

If I felt I wanted to.

To outline the IT band here and work on one border.

Then I turn my hand a little bit different angle and follow just.

Down this way.

The other possibility with the leg in this position,

you can tell about mobilizing the femur here.

So what I'd be doing is just taking both hands like this and pushing this femur down in the joint.

So now I'm working at a ligamentous level.

I can do fairly fast rocking initially to override any holding patterns.

And I'm going to switch to just one hand so you can see a little bit more.

I would have my other hand helping,

but I've just got a nice broad surface all the way around here.

I can also push it down and just wait,

see if those ligaments are going to let go a little bit.

I can work a little bit with rotation,

see if I can find the correct combination of this lock I'm trying to pick to let this femur relax.

Very often.

If I feel I'm not making much progress with this,

it's because I'm pressing too hard,

not because I'm not pressing hard enough.

The body's going to be pushing back against me.

So if you don't feel the movement you're looking for first,

try backing off a little bit and see if you can sweet talk this joint into behaving.

The side lying position is by far the best way to work on the whole medial leg.

From the heel all the way up to the ramus of the ilium.

You can work with the heel itself.

This would be for somebody's heel that was sort of gravitating toward the medial side.

What I'm trying to do is just free this tight area in here so this heel is able to move a little bit laterally and provide a little bit of support on the outside of the foot.

You can work with flexion issues.

A lot of people have had sprained ankles and Achilles damage back here.

This is a excellent access for you to be moving the foot through range of motion as you work on areas more people sprain their feet on the outside.

At the lateral malleolus,

there's a ligament called the anterior talofibular ligament that probably 80 to 90% of the sprains strain.

So you could also work on the above leg in this matter if you wanted to work on that.

So this is also an excellent access point to the soleus.

Instead of trying to work through a very,

very well developed gastroc that some people may have covering the soleus,

all you need to do is get on the medial border,

start working underneath the gastroc and follow the soleus up.

Any kind of work you want to do there you could work from your elbows,

knuckles,

fingers or anything in addition to the soleus.

This is not a bad way to access the posterior tib muscle as well.

And you want to put some stretch.

All you need to do is take your hand,

grab the front part of the foot,

flex it up and you're working there.

From these deep muscles like posterior tib and soleus,

I'm going to move to a much more superficial way of working on the knee itself.

And I just feel how the tissue moves.

Does it move up and down?

Is this knee joint able to slide in this tissue?

And just do some nice broad strokes stretching this tissue here.

If I feel particular fibers of the hamstring or the quadriceps are tight,

I can then do some separation work.

Again,

this is a good way if you want to soften tissue.

You just bend the knee anchor and then straighten,

bend again,

straighten.

You can work it much quicker if you want to,

moving up the leg all the way along the adductors.

This area very often is neglected and massaged.

So certainly do some superficial work,

soften that area.

But you can get much more specific.

If we take a broader view of this and we start looking up the back,

you can see that however you position the knee,

if you move it forward or if you move it back,

you're helping the ability of this leg to almost just drop right out of the pelvis and move independently.

People that are very,

very tight in the upper medial leg here,

when you move the leg back,

it moves the whole pelvis along with it,

and you'll see their spine moving forward here.

So what you're working for is independence of the leg from the attachments of the leg right along this ramus right up here.

Now,

of course,

you're not going to do this the first time you meet somebody at a spa massage.

But if you're working with an athlete or somebody that's got a particular issue with the inside of the legs where they're tight,

all you need to do is be clear about what you're doing,

explain to them why you're working that way,

and it never is a problem.

This is an area in my massage classes that students often have a little bit of trepidation about approaching,

and I've never had any problem.

Everybody is always amazed at how safe it feels in this position.

Of course,

you'd have proper draping,

but I'm not doing that so you can get a sense of the leg placement.

So all I do after I've warmed up with some nice broad strokes here is I make my fingers nice and soft and curved and then just come in right at the upper area and do some spreading work.

I come right up.

I'm just about to the issue of tuberosity right now,

so that'll give you a bit of a landmark.

And if you want to.

If you want to stretch the anterior portion of the medial muscles,

then you can move the leg back,

and that's going to put more of a stretch up toward the pubic symphysis.

And if they're very tight near the hamstrings,

you just bring the knee forward and work in that way.

You don't need to work nearly that specifically if you don't have an actual purpose.

It still is an excellent way to do some nice energy work and superficial work on the leg.

The side lying position,

as I've mentioned earlier,

I think is by far the best way to work on all aspects of the lateral leg,

all,

all the way down from ankle issues all the way up to the trochanter,

and even above up to the quadratus area.

So let's start down below.

A lot of people have had trauma to the outside of the ankle.

Here's where the talofibular ligament comes down and attaches from the fibula here at the lateral malleolus down to the talus bone here.

And when an ankle is sprained,

generally it's pulled like this and stretched.

And then you get a lot of scarring and fibrous buildup here.

So this is a nice area,

just with n soft fingers.

Soften up this area.

Somebody rather recently sprained their ankle.

This might be all you would do to it.

After a period of time,

if you feel that this ankle really is not working well,

then you would find any fibrous issues and start moving the ankle through its range of motion.

Plantar flexion,

dorsiflexion,

inversion and eversion,

moving up the leg.

It's a perfect way to work on the peroneals,

or the peroneals,

however you want to call them.

And they're involved with anchor inversion and eversion.

And so they can be very,

very tight in holding a foot into the outer position.

So.

So I just feel for any fibrous restraint here,

any hard musculature,

any spasm,

and just wherever I can,

following up these peroneals,

try to soften that.

If I move the foot in,

I'm going to be putting a stretch to it.

I want a little better access,

and I feel that I'm approaching the threshold where it's too sensitive.

I can shorten the muscle to soften it,

lift the foot up and then just keep trying to stretch it here.

This is basically just being specific in your intention instead of just doing repeat strokes to try to soften.

The outer layers.

Certainly the forearm could be fine here.

Fist feels quite nice along here.

Move the foot through any range of motion you want.

Moving up to the knee.

It's essentially the same thing we did on the inside of the knee.

We're going to look for strain patterns.

Sort of move this leg through its range of motion.

Feel is there more strain in the lateral hamstring area or is there torsion in the quadriceps group?

Just feel wherever there's tension.

You might want to be working on the lateral head of the gastroc here and rolling that and stretching.

It could do the same thing on the hamstrings here.

This is by far the best way to work on the IT band,

which I'm accenting right up here as I go up Dina's leg.

If you could picture this IT band lying in between the anterior compartment of the quadriceps and the posterior compartment of the hamstrings.

It's very easy to see the importance of,

of delineating this IT band from each of those groups,

because as you flex and extend the knee,

you can picture as I flex Dina's knee,

the quadriceps group must be lengthening and moving this way,

while at the same time,

the hamstrings must be shortening and moving this way.

And as I move into extension,

hamstrings need to be lengthening and the quadriceps need to be shortening.

So they need to be sliding along this IT band and have some differentiation.

So this is just excellent work.

I actually go to one of my favorite massage therapists and we spend an hour just working on my IT band.

Take your time on this.

Work slowly.

You don't want to have the person sore the next day.

There are tremendous number of tight knee problems and just malfunctioning knees clicking,

things like that.

If you do meticulous,

slow,

patient work on the IT band,

it will pay off.

The other advantage is it will pay off in your practice and that people will come for spot work.

You,

you're not going to be running at breakneck pace all the way through trying to work the entire body.

It's really a luxury to be able to take your time and spend 15,

20 minutes or so just on an IT band and its attachments up at the hip on the other side.

If you're doing a full body massage and you feel this,

you don't need to be quite as meticulous.

But I'll just go back to the image of driving a sports car on a curvy mountain road.

When you come to really curvy and hilly areas.

You just downshift,

go slow for a while,

and then pick up the pace.

I'll often mention to people I'm working on saying,

this really feels pretty tight here.

I'd like to free this up.

They generally go right along with that and say,

I'd like to spend a little extra time here and maybe I'll spend a little less time on your arms today,

or something like that.

And that's the way to sort of start leading people into realizing how important it is not to be working at just a superficial level and actually do something that's going to last for a while.

The Tensor Fasciae Latae and the IT band Sometimes just working the tensor fasciae latae will be enough to soften the entire iliotibial tract,

or IT band.

The last area of the legs on the sideline I want to cover is the tensor fasciae latae,

which attaches to the IT band.

The IT band is also called the fasciae latae,

so tensor fasciae latae usually should be able to feel the anterior and posterior borders of this.

If you have any questions,

all you need to do is have your client just raise their knee and back down and you'll be able to feel that muscle right here.

So what I try to do with the tensor fasciae latae is to try to determine is it pulled too far forward or is it pulled too far back.

This means that you have to work with quite a few people so you can develop a norm,

but you can also just feel if there's more fibrousness.

Dinas I'm going to work on the anterior border just to sort of show how you can work on this.

One of the first things you can do is just get on the anterior border,

pull that muscle back,

And then start working with your other hand.

If you want to lengthen this a little bit,

you just have your client reach down with her leg a little bit.

There we go.

Good.

You can even come in there with your elbow.

I'm going to continue to pull this whole it band back,

come in with my elbow,

and just work along the border here.

As long as I'm there,

I'm going to try to get some continuity by carrying down off the tensor fasciae latae down into the IT band.

Little integration stroke.

And also you can come right to the trochanter where the femur joins and just do some nice broad work working all along there.

You can work in any direction you want.

Basically,

you're just spreading this tissue all along the acetabulum.

I'm going to come with my elbow with one other stroke that I haven't shown very much,

and that's just the waiting stroke.

So when you feel particular tension in an area,

sometimes all you need to do is just rest your elbow there.

Start with minimal pressure.

Slowly sink.

Just visualize that your elbow is just sinking into some very,

very hard butter.

And it's just got to melt,

and it's got to let you in.

Take a breath.

Remind your client to take a breath and just wait,

and you'll feel that melt.

It's such a rewarding feeling when that muscle melts.

Very often your client will give a sigh or some other sign that they've let loose.

And when that happens,

very often,

I will ease out very slowly and then just let that sink in.

Sometimes it's a little bit like stirring the jello.

If you continue to move and move and move on tissue,

it never has a chance to imprint and leave itself at a deep level.

So sometimes after a very important stroke where you feel a good change coming in,

just sit and relax for a little bit.

Let that take 10,

15,

20 seconds or so to be imprinted into the nervous system.

I'd like to talk a little bit about some of the forces that are exerted upon the pelvis and that can throw the pelvis out of alignment.

This is something that you can be working on for the next 40 years to try to improve your skills on.

But it's really fairly simple to understand the major forces acting upon the pelvis.

And as massage therapists,

we can give a lot of relief in this,

particularly when one side of the body is tighter because of an activity or any other reason,

an injury or something like this.

Returning proper function to the muscles that are pulling on this Pelvis can be a very,

very beneficial thing that you can give your client.

So let's just talk about the pelvis and some of the forces so that when somebody comes in and says,

my pelvis feels out of balance,

you can start considering some options for treatment that are more than just giving some nice squeezing of tissue where it hurts.

Okay,

so here we have our pelvis made up of the two innominate bones,

the right and the left here.

So let's take a look at some of the major landmarks.

The first would be the pubic symphysis.

And the major muscle group that attaches at the pubic symphysis,

particularly right at the middle here,

would be the rectus abdominis.

Muscles that are coming from above.

They go all the way up to the rib cage,

and they can have a very,

very important effect upon the pelvis.

If they're too tight,

they can be tilting the pelvis back.

And so that's very important.

Somebody walking around without any stability of their back because their pelvis is.

Is bent too far back.

You may want to add some length there.

We talk in the tape in various places about how to deal with these specific soft tissue issues.

But you do want to understand how they can impact the pelvis.

Obviously,

if they're very tight,

they can also be pulling down on the rib cage as well.

But we're mostly talking about the pelvis here.

So as we move to the anterior part of the pelvis,

the anterior superior iliac spine right here is an attachment for sartorius.

And this muscle is going to come down and cross to the medial side below the knee.

And it can have all sorts of effects,

not only on knee rotation,

but if the knee is fixated,

it can be pulled.

Pulling on the pelvis too far anteriorly,

which would be just the opposite of the muscle coming from above,

the rectus abdominis.

One of the other major major vectors pulling on this would be,

of course,

the rectus femoris muscle,

which attaches to the anterior inferior iliac spine.

And so if a person is doing a particular activity where one quadriceps is doing a lot more work than the other,

some sort of unilateral sports activity,

then this is going to be a factor that you're going to want to try to create balance with.

So you would certainly check one side versus the other and see if it's tighter.

Of course,

the psoas muscle,

or most of us are aware of this,

attaches to all these lumbar vertebra,

comes down through the pelvis and attaches to the lesser trochanter here.

So secondarily,

this psoas can have all sorts of effects.

By a tight psoas muscle could be pulling these vertebra forward in one way,

which would be bringing the pelvis with it into an anterior tilt.

And if one psoas is tighter than the other,

then it's going to be putting rotational force on this pelvis.

So again,

that's very,

very important.

Let's talk about the vectors pulling on the pelvis from behind.

One of the most important,

of course,

is the hamstrings,

which attach at the ischial tuberosity back here.

And if they're very,

very tight on one side,

they again could be putting torsional force across the pelvis.

And if they' too tight,

they could be tilting the pelvis posterior by pulling this issue of tuberosity down.

So that's one of the major ones right there.

There's another important ligament we'll talk briefly about called the sacrotuberous ligament that comes from the sacrum down to the ischial tuberosity.

And we will actually feel this and palpate this.

And if one side's tighter than the other,

you can tell even if the pelvis is fairly stable,

it could have rotational force one way or the other upon the sacrum.

So that's another factor.

And then,

of course,

we get up to the quadratus lumborum.

Quadratus lumborum is very,

very important.

It affects both the pelvis,

the ribs,

and the spine.

If one side is tighter than the other,

we're going to get side bending of the spine.

It can also pull the 12th ribs,

which are much,

much lower than here on the skeleton.

It can pull the 12th ribs way down here,

and it can compress the spine in this way.

So knowing how to work on the quadratus lumborum is very,

very important.

It's also very important to know which one you want to work on.

You're not going to work the same on each side if one's tighter.

And the other issue would be just this whole broad sheet of lumbar fascia,

if it's very,

very tight and pulling you into a pronounced lordosis here,

Stretching this out so that these vertebra can move forward and get a little bit flatter can be very,

very effective.

And we'll talk about that and body positioning on how to accomplish that.

So learn your pelvis.

It's extremely important.

It has effects upon the legs going down,

it has effects upon the spine going up.

And learning how to work with balance and with specificity on these vectors,

rather than just working the same on each side,

will be what moves you into much more expert status in solving problems.

The sacrum is another important area to.

Work that's not often taught in early classes.

The basic thing you want to do with the sacrum is to work obliquely and shallowly.

We're not going to try to upset the balance of the sacrum as it's articulating with the pelvis here,

but there.

Can very often be.

If you move down to this area and you look,

you'll feel the tissue.

Is compressed toward the middle.

So basically,

the strokes that I'm doing are spreading from the middle of the sacrum.

If I outline the sacrum,

the sacral apex or bottom is right down here.

The base of the sacrum,

which is actually the top,

is right along here.

So I just feel for areas that.

Seem to be a little bit more fibrous.

And I just try to soften this.

This is a great area to work.

For somebody that's coming in.

They've been held up in traffic.

They're a little bit nervous.

They're uptight about getting all their full hour and a quarter or whatever your massage is in.

And if you come down to the sacrum,

it has amazingly calming effects.

I just work very slowly.

I sink into maybe a quarter of an inch down.

I try to grab tissue,

I'm not sliding over tissue.

Grab that tissue spread.

Very,

very calming work while you're here.

It's often a good time after you've done this preparatory work.

And you might work two to three times as long as I'm doing here.

You could also use your knuckles.

As long as you're not pushing straight down,

you're taking very oblique strokes.

It's often a good way to start warming up for your later work on the quadratus lumborum.

So now I'm going to work along the crest of the ilium,

both sides and use my fist.

I stabilize the pelvis with my other hand so I'm not rocking it too much.

And then once you've moved outside of the sacrum,

this triangle here,

then you can start working on some of these attachments for the muscles here.

I can work a little more deeply.

I can start broadening,

moving into gluteus medius,

gluteus minimus,

and start working at a little greater angle so that I'm not quite so oblique

again. I'm spreading tissue away from the sacrum.

So now I'm just grabbing these gluteal muscles and doing a cross fiber stroke across the gluteals.

The gluteals are one of the largest muscle groups in the body and all sorts of regular massage,

kneading work feels excellent.

Here I'm working across Dina's body so that my body's not in the way and you can see what I'm doing.

But for sure,

do all your warm up work.

Do your work with your thumbs,

your effleurage,

Then start doing some work to integrate down the legs along with the hamstring group.

The gluteals are the major hip extender,

so it would bring Dina's leg up toward the ceiling if she contracted these.

And a lot of people hold tremendous energy in their gluteals.

That's how they keep themselves erect and their pelvis in a neutral position.

So most people really appreciate the work.

To the gluteals,

there's nothing fancy that needs to be done.

Basically you realize that they're coming down like this and attach to the back of the femur.

When they contract,

they extend the hip.

Also fibers of the gluteal come over and attach on the it band.

And that's very,

very important because if someone has tight gluteals and they're pulling the it band posterior,

then that's going to be strain on the knee.

So this is another area that you want to look at.

When somebody talks about knee strain,

start thinking about those gluteals as a possible cause.

So we're not even going to take a lot of time here because that kneading work feels so good and you can actually get some nice lengthening.

But after you've done that,

if you want to get a little more intense,

you just let your forearm.

I think the forearm works excellently on the gluteals.

Sink into the level at which you want to work.

You might want to hold up above so you're getting this stretch and just move down the leg.

Another excellent way to work on the gluteals is to use your fist on this.

I'd be using on this side,

so I would just climb up on the table so that my shoulder is nice and relaxed and then just do a stroke down this way so you can work on this side.

If I were to do it on this side with my fist turned the wrong direction,

it would look like this.

You see,

there's a little strain on my elbow this way,

but it's actually not too bad a stroke.

So this would be a cross fiber stroke on the gluteals.

Four or five minutes on the gluteal should be ample time,

unless your client is crying for more.

Most people really,

really like the gluteal work.

It's important to remember,

even though it looks like I'm pushing straight down here,

we do have the sciatic nerve that travels down through the back of the pelvis here and moves down the leg right here.

So if I'm pushing straight down against that sciatic nerve,

I could impinge it and set off a reaction of sciatica or something like that.

So even though I'm sicking in here,

my action is cross fiber.

I am not pushing tissue into the pelvic bones.

The piriformis and rotator muscles,

internally rotating the femur during your work is an effective way to stretch all the rotators and effect a release of these muscles.

Let's move on to the rotators.

In the first video,

as a palpation exercise,

we tried to just feel these rotators underneath the gluteal.

So let me just sort of emphasize to you again the muscle direction so you can feel these.

The gluteals would be moving down in this direction.

And underneath the gluteals you'll have the rotators and the angle of my fingers right here.

And what you can actually do is you let your hands soften with nice bent fingers.

We're not going to go straight in like that.

And you just slowly sink through those gluteals,

just melt through.

And then you'll start feeling these fibers underneath and they're running in this direction.

They're attaching right over here,

the trochanter.

And when they contract,

they pull the leg this way into external rotation.

So all I'm going to do is come down here,

feel those,

and they almost feel like little pencils or peaks and valleys that I can actually,

with my hand,

I can go over each one.

And then you'll feel that some are more strained than others.

Of course,

the piriformis is the main one that most people mention.

The sciatic nerve can run deep to,

it can run through,

or it can run superficial to the piriformis.

So what I first do is I just sink in.

You're going to have the easiest access,

a little bit lateral toward the trochanter here.

And then I can do some very slow cross fiber work.

And wherever I feel tension,

I just stop.

I wait,

may do some small undulating moving this out and just wait for that to soften there.

We got a little bit of a melt right there.

I'm working right through the gluteals.

I'm not even thinking of the gluteals.

As we talked about in the fundamentals tape,

we really want to put muscles on a stretch.

So the problem with lying face down and having the leg in a neutral position here is basically those rotators are going to be in a neutral position.

It's going to be hard to stretch them in this position.

So what I often do for this is I flex the D to about 90 degrees.

Then I'll sink in until I feel those rotators underneath me again.

And very often to test myself,

I will move the leg into internal rotation.

And that's going to feel like the rotators are put on a stretch,

and then I'll move the leg into external rotation,

and you'll feel those rotators soften.

So you can see that this femur is now rotating externally.

And these rotators,

because the acetabulum and the trochanter are moving in this direction,

are almost like a rubber band that's softening.

So carrying this farther than we did with the palpation exercise at this time,

I might want to do some cross fiber work there.

But when I really feel that I want to put a stretch on there,

I want to move this leg into internal rotation.

I'm going to move the foot out.

That's going to pull the femur along with it,

and it's going to stretch these rotators.

So now,

instead of doing cross fiber strokes,

doing lengthening strokes on those rotators,

the fingers work by far the best here.

If you need to,

you're not going to have the specificity.

And again,

I'd be doing this on the same side rather than reaching over.

You certainly can go in with an elbow.

Can you feel that resistance?

And then stretch a little bit more.

Nice patient work.

If you feel them tensing against your work,

then it doesn't necessarily mean that you have to stop.

Just slow down,

let them adjust,

and then start working again.

I will mention,

of course,

that before doing this,

you're going to check with them to see about their knee stability and do a few trial runs.

Ask them if their knee feels stable.

In this position,

you're not going to be doing flexion and extension while you're also doing rotation of the knee.

So once you get the knee into a fixed position,

that's when you do the lever arm here.

The sacrotuberous ligament and the coccyx are two areas you probably wouldn't volunteer to work on somebody the first time you meet them.

However,

it is an area that for many people has been injured,

particularly the tailbone or coccyx.

Many people have taken a fall sometime in their career skiing or with other sports or coming down icy steps or something.

And the coccyx,

coccyx can actually be very,

very fibrous and have a lot of built up tissue from an injury there.

It can actually be,

instead of hanging down at an angle like this,

like it's supposed to,

it can be bent very far forward so that it's almost at a right angle to the sacrum.

It can be very,

very beneficial work.

If you can look at this coccyx as the very end of the sacrum and you can see if it's pushed to one side and it's exerting force,

it can actually have large effects,

relatively large effects,

at least upon the sacrum's rotation in the pelvis.

So if the sacrum is pulled over by fibrous material on the left hand side here,

it's going to be putting strain all the way up the sacrum and then all the way up the spine.

So I'd like to talk a little bit about the coccyx first and then we'll talk about another strain pattern from the sacrotuberous ligament.

Generally,

people will be coming to you saying,

I have injured my coccyx.

I have a lot of problem down there.

And you're probably not going to be exploring around there,

trying to hunt for gold there,

unless they've told you about that.

So the key on the coccyx is to keep your hands soft and use the fleshy part of your fingers.

So in this,

I always work on the opposite side of the coccyx because if I work on the near side,

my fingernails are going to be much harder and give a much more unpleasant sensation there.

So all I do is I come from above rather than below.

It's much easier to follow the sacrum down and then when it starts tapering,

you're going to know that you're nearing the coccyx.

And then I just,

with soft fingers,

I just roll right around that edge.

Sometimes I'll take my other hand right here.

And it's a little difficult to see right here,

of course,

because you're never going to be working on the coccyx without a drape.

And here we have the bathing suit on.

And all I do is I wait for that tissue to soften.

It may take a minute,

may take two minutes.

You can just picture these fingers starting to grab and feel that bony outline of the coccyx.

I'm just providing a little stability with my left hand.

And then you can start feeling,

is it pulled to the left?

Is it pulled to the right?

And if need be,

you can actually,

in addition to softening tissue with very,

very steady and not forcing it,

you can also work to actually turn this coccyx a little bit.

So I'm exaggerating a little bit.

What I'd be doing is moving it counterclockwise here if it were pulled to the left hand side.

That's about all that would be expected of you in a massage.

But a lot of people come in with problems there,

and it's nice to be working in a medicinal way.

In addition to all the nurture that you're giving people when you leave,

you want to leave gracefully and slowly.

I would then,

of course,

always,

no matter what,

go over to the other side and work it to try to create balance.

And then,

if need be,

if I felt that the second side I worked on was much,

much softer than the first,

I might even go back to the first side.

You're not going to work exactly the same.

You're going to feel differences from side to side.

So let's talk about the sacrotuberous ligament.

Here I have the bottom of the sacrum,

and here I have the ischial tuberosity.

So from my thumb to my fingers here is a very important ligament that runs in a straight line between these two points and acts to stabilize.

This clockwise,

counterclockwise rotation of the pelvis.

And what you'll find with people is that sometimes that sacrotuberous ligament is going to be a half an inch higher on one side or the other.

And this can be causing or it can be a result of pelvic torsional patterns.

Actually,

when I feel Dina's sacrotuberous ligaments,

her right sacrotuberous ligament is probably a third of an inch or even more up,

more toward the ceiling.

So there's a bit of a rotation going on here.

So the easiest way,

as I've mentioned,

you should always be able to find that landmark of the ischial tuberosity is just put your thumbs on the ischial tuberosity,

roll over,

and you're going to be on that sacrotuberous ligament.

And then when you're there,

you can either use your fingers to just soften it,

visualize a little bit of a shearing motion to maybe even push that ischial tuberosity straight down toward the table.

If that's enough.

If you feel some softening there,

that's all you need to do.

If you feel you need a little more direct pressure,

then the elbow is a very good way to do this.

You want to stabilize it with your hands so it's not rocking too much,

and you just lean in.

I'm probably putting about 4 to 5 pounds of pressure right now.

You don't want to put too much more pressure because you could disrupt the balance of the to innominate bones here in the pelvis.

But if you can put enough very specific pressure,

this is why you're going to use the sharper part of your elbow,

because you don't want to be putting broad force and disrupting the pelvis.

You sometimes will feel that soften.

Okay.

This is something that you're probably not going to do in a generic massage.

But when somebody comes in that you've seen on a regular basis,

this is a kind of sophisticated work that can really add a whole new dimension to your work.

So if you need to practice with your friends,

find these landmarks so that you feel confident,

because you're not going to be poking around and experimenting with this.

But once you get these landmarks down,

it's very easy work,

and it's very,

very important.