Original subtitles

Hello, my name is Art Riggs. I'm a certified advanced rolfer and massage

therapist, and I've been teaching massage for over 15 years.

Welcome to Deep Tissue Massage and Myofascial Release, a video guide to

techniques, which is the companion for the book Deep Tissue Massage, a visual

guide to techniques.

We are about to embark on a 10-hour journey of massage, which is designed

for experienced massage therapists.

It is important that you use these tapes in such a way to maximize your learning.

So please do take the time to look over the enclosed booklet for suggestions on

how to get the most out of these tapes.

Information will be built upon itself, so tempting as it is to spend time

looking ahead at the areas that you're particularly interested in, please take

your time to view these tapes in order to cultivate your touch and learn the

early stages of information that the later stages will be built upon.

I hope you have an informative and fun journey with these tapes.

This video is divided into three sections. The first section is the

fundamental section where we'll really focus in on your touch, the tools that

you'll be using, fingers, knuckles, elbows, forearms, fists to use in

your work.

The second section will then move with these skills that you have built into

having protocols and strategies to use in your sessions.

The last section will deal with troubleshooting and dealing with

injuries, which is something that a lot of my students are very, very interested

in when they get into their practice and having people come in with problems.

So when you're viewing these tapes, please watch very slowly and in small

sections. I provide a lot of information, and I would not expect you

to learn this in one or two seatings. It's best for you to practice with

someone, push stop, and if you have a table right there, work on these

sections as you're moving through the series.

One of the most important buttons you have when viewing this would be the

rewind button.

Please do take the time to see if you can notice the changes in the tissue.

If you have any questions about the way I'm working, push stop and rewind and

review the tape.

I make a real conscious effort to keep away from giving rote descriptions of

strokes. My main goal is to stimulate your thought process and for you to be

able to express your individuality.

of this, I'm going to be offering you many, many alternatives to use for

strokes. Far many than you would be using in a single massage.

And different people, different massage therapists will gravitate toward

different strokes and different clients will like different strokes.

So please realize when I'm demonstrating that because I have so much material,

I'm working much, much faster than I normally do in my practice. And do take

that into consideration.

One other thing that I think is so important when you're doing these

strokes is to have a firm knowledge of anatomy and how the body works. We'll be

doing a lot of work.

moving bodies through different ranges of motion.

And just because of time limitations, it's really impossible to go into too

much anatomy during this series. So please find an anatomy book that you're

really comfortable with that can help you out with some of the kinesiology and

the muscle attachments.

An excellent book.

that I have found is Trail Guide to the Body by Drew Beal. And this is just an

absolutely wonderful book. So I would highly recommend getting this book to

give some clarity to your work and understanding of the anatomy behind the

moves.

I'd like to talk a little bit about the quality of your touch.

Whenever I teach classes, one of the first things I do is ask my students how

long it takes them to realize when they're getting a massage from a brand

new massage therapist, how good the quality of the massage is going to be.

Invariably, a minute to two minutes is all the time needed for these students

to determine how good the massage is.

This is before they've had any fancy strokes, before they've had any

particular problems dealt with.

It basically comes down to how do you contact the tissue that you're working

with. I'd like to discuss a few of the factors that influence touch. There are

many more listed in the book, but I want to talk about a few that I can

demonstrate.

One of the first is how hard are you working?

If you're working too hard, your hands will be tense.

As soon as you find yourself shaking, if you find your fingers hyperextending, if

you find another joint bending that you have to tighten against that, then

you're working too hard.

The basic theory that I'll be trying to get across here is as you find yourself

straining, you will move to another tool or get a different body position so that

it becomes easy for you to work.

Another factor is the angle at which you're working. If you're working too

directly down into tissue where you can compress it against bone, this is

particularly interesting and important in the area of the gluteals because you

have the sciatic nerve running deep to them.

As soon as you start pushing down and start using the sharp points of your

fingers, it's not going to feel good.

even if you're using the knuckles. Any other tool that you point down into the

tissue is going to be strained and you will feel the body recoil against you.

What you want to do is sink to the level at which you're working and then work at

an oblique angle or a diagonal.

I very often am working at 10, 20, at the most 30 degrees for almost all of

the work I do.

Another major factor in The perception of depth is actually the speed at which

you're working.

Oftentimes when clients complain or you find them tightening against your work,

they mention that you are working a little bit too deeply, you're actually

not working too deeply, you're working too fast. And it does not give the

client time to adjust to the work you do. So if you're moving in fast strokes

and you feel that you're straining or that the client...

is not relaxing against you. It doesn't mean that you're working too deeply.

It only means, in all probability, that you need to slow down.

Basically, your stroke is going to be a combination of the depth at which you

are working and the speed at which you are working.

If there's one thing that I could change in the first five to ten years of my

work, it would be that I worked less hard and tried to work with tissue

rather than on tissue.

So whenever you're straining back off go easy on yourself go easy on your client.

You'll both be grateful

Another

factor I'd like to mention in the quality of touch is the amount of

lubrication and the kind of lubrication you use Most students, when they first

come out of their initial massage training, use literally four or five

times too much lotion. A lot of times I don't use lotion at all and can just

work with the natural oils of the body. If you use too much lotion, you're going

to be sliding over the tissue and almost giving the feeling of a rolling pin just

compressing tissue.

So what you want to be doing is rather than compressing tissue, you want to be

stretching tissue.

So be sure to use your lotion sparingly, just enough to have your hands be able

to grip the skin.

Always remember to be doing work when you're putting the lotion on.

Sometimes I feel like I'm a roast being basted. People throw on a lot of oil or

a lot of lotion and they...

are just slathering it around on my skin rather than accomplishing something.

It's much better to add lotion two or three times than actually be doing work

when you're applying the lotion.

The main benefit about not using too much lotion is having the ability to

have your hands sink into the level at which you're working and then move in a

diagonal and visualize that you are pulling taffy.

What you're actually doing is finding tight muscles, finding where the

restriction is, and trying to soften those by stretching them rather than

just rolling over them.

This will change the quality of your touch probably more than anything that I

will talk to you about.

I'd like to expand on a concept that I just previously mentioned, which is the

idea of sinking through tissue and then working at the level, however deep that

is, that your intention is focused at.

I want you to be sure to do this exercise. This is a palpation exercise.

It's not teaching you a stroke. So if you don't have somebody there to do this

now, mark this down so you can practice this with whomever you trade with or

anybody around the house that you happen to be in contact with.

I'm going to talk a little bit about working on the soleus muscle or

palpating the soleus muscle through the gastrocnemius muscle.

The gastrocnemius muscle is a two joint muscle which crosses the knee here. So

that if I bend the knee up to 90 degrees or even less the gastroc is going to be

relatively soft.

And this isolates the soleus muscle so that if I dorsiflex the ankle I'm

stretching the soleus muscle.

So all I want you to do is to put

Your clients foot underneath your axilla here where you can actually flex the

foot and still use both hands to work Remember all we're doing is actually

palpating here So what I'd like you to do is find a nice fairly soft

area through the Gastroc muscle it may be on the outside It may be on the

medial aspect or it may even be in the septum between the two muscle heads and

let your hands slowly sink through that gastroc muscle until

you feel some resistance.

It might be a half an inch. It may be three quarters of an inch down.

And that will be the soleus muscle.

And what I want you to do is hold your hands at that depth and then dorsiflex

the ankle by leaning.

your axilla against the front part of the foot, and you should feel this

soleus muscle coming up to meet you almost like it's a rubber band that

you're stretching.

If I wanted to exaggerate this a little bit, I can actually grab this soleus

muscle through the gastroc, and as I flex it, I can feel it.

stretching and moving my hands as I stay on contact there. One image I sometimes

give with this is the idea of a frozen stream, and the outside would be the

gastroc muscle or the ice over the stream, and then you can just feel this

movement of the water, which would be the soleus underneath as you sink

through this. This is a very important concept to grasp because anywhere you

work on the body, you are going to have to determine what level you're working

at, and it may be...

very important for you to work through superficial layers so that your work is

focused at a much deeper layer.

Deep rotators of the femur.

Notice the direction of the deep rotators of the femur and particularly

the piriformis muscle.

and the difference in direction between them and the gluteus maximus, which lies

superficial to them. Also notice the sciatic nerve.

The hip rotators, piriformis being probably the most important, quadratus

femoris is also a very important one, move from the lateral border of the

sacrum and go to the trochanter here, and when they contract, they externally

rotate the leg.

So as they shorten they pull this femur this way so that it rotates.

So they're moving this way and above them you have the gluteal muscles moving

this way as a hip extender.

What I want you to do is to try to sink through the

gluteus muscles very slowly.

Just let your hands

Slowly sink through that. Keep them soft and don't force anything.

And then you should be able to, as you feel resistance, sometimes an inch or

two down, you should start feeling a different quality of tissue there

running in a different direction. If you move your hands from right to left, you

can almost feel the peaks and valleys, and you may be able to really focus

right on the piriformis muscle and notice if it's tight.

So once you've sunk into this level,

Bend the knee to 90 degree angle. Be sure that you keep it at 90 degrees

because the knee is fairly stable as you use it as a rotational force here.

Keep your hands sunk in there.

And notice as you move the leg into external rotation, you will feel that

piriformis or other rotators actually shorten and soften.

As you move back to neutral, you'll feel them starting to stretch again.

And as you move into internal rotation, which is stretching those external

rotators, you'll feel them like that rubber band getting tight, coming out to

meet you, and you'll feel a different quality there.

These descriptions that I'm giving sound quite easy when I'm showing them, but

they're much more subtle than I'm implying right here. So take your time,

feel this, and don't be too hard on yourself. A lot of times students expect

to have...

very profound feelings of the piriformis through the gluteus. If you think you

feel it when you move the leg, that's it.

And then later on in later tapes, we will talk about how to actually work on

the piriformis to stretch it and release it.

One of the issues of biomechanics that I hear talked about in videotapes and in a

lot of classes is what table height to have. I will mention that when all of

you have your own private practices, having an automatic electric table and a

chair, if you do seated work, that has an adjustable height to it will really

obviate a lot of these questions we're talking about right now.

Most often I hear people talking about with your fingers slightly curved that

they should just be able to just barely touch the table. I think this is a fine,

basic plan to work with, but the reality of doing massage is that...

the person you're going to be working on may be two to three inches taller or

higher at their gluteal area than they are at the ankle area.

You may be turning them on their side.

So I think a lot of times in classes I see students going to great trouble to

get in the middle of a massage to change the height of the table and raise it one

notch when they're working down on the legs, and then they move up on the

gluteal area and the table's too high.

I don't think it's nearly as important as a lot of people try to make that out.

One of the other issues that you have to deal with is if your back is your weak

point, you may want the table to be a little bit higher so that you're not

leaning forward.

If you have shoulder problems, if you have thoracic outlet strain, then you

may want the table lower so that you can lean into it here.

You can see if I'm working on the ankle here and the table is at the right

height,

As I come up to the gluteal area, it may be too high and you may see that my

shoulders are rising up and I'm having to muscle it here. There are a couple

ways that you can deal with this. One is just get a little bit different angle

and step back and have your force be coming from your legs so that you're

still working in an oblique angle and the table is the right height.

One of the other things you can do is if you feel your shoulders are working too

high and you're straining here, it's a very simple thing to just climb up on

the table and work from your knees so you're to the right height, then you're

using gravity to work for you.

The other alternative, if you're finding your hands are...

that the table is too high and your shoulders are strained and you're

bending your elbows, all you need to do is change tools.

You might actually lower your body, use gravity, and move in to using your elbow

here.

The basic principle that I want to get across is you should always feel at ease

when you're working.

Catch those strain patterns and change.

Very often I see people's feet getting stuck so that As they extend beyond

their power range, they are afraid to move their feet.

All you need to do, if you're too low and you want to get a little bit higher

and use more gravity, is just move your body a little bit closer.

The biggest error I probably see with biomechanics is that people are working

too close.

They have bends at their elbow, at their wrist, at their shoulder, and they're

muscling. All of the force as I work on Dina here is coming from muscular

activity. That's going to wear me out, and it's not coming from a strength core

area for me.

All you need to do is step back, push off your feet and lean, and now

everything is coming from my feet.

My arms are extended in a relaxed, extended position.

My wrist is relaxed, and I'm putting in about half the muscular effort that I

did before.

The alternative to this that I do want to mention, however, is the problem of

extending yourself too far.

So sometimes I see people doing a very powerful stroke, and the

emphasis on making long strokes and continuing...

for continuity as they extend up. I think you can see right now, I have no

power. I'm not able to sink into a deep level on the hamstrings here.

I've passed beyond my use of gravity. So all of the force is from my legs and I'm

working at way too oblique an angle to really contact her deeply here.

One of the things that I encounter in my teaching of deep tissue classes to

relatively new students is that they have a lot of trepidation about working

around the body in areas that they're not used to.

And I think it's extremely important to have a very firm anatomical knowledge of

the body and the areas that require caution.

But on the other side, you also need to be able to work around these areas

because they're often the center of a lot of the problems our clients have. So

let's spend a little time with Joel, my anatomically correct model, who also

keeps me very honest when I'm doing my work about not trying to force things or

muscle things because...

When you're working with very strong or large clients, it's a perfect time for

you to work on your biomechanics and learning how to work with tissue instead

of forcing tissue.

So let's move down to some of the areas in Joel's feet that I would be

exercising some caution on, okay?

One of the first areas is that you'll find people come in to your practice

with sprained ankles rather soon after spraining ankles.

And this is a great area to work on. We'll talk about this in the

troubleshooting and injuries tapes. But I do want to mention one particular area

for caution, which is the anterior talofibular ligament, which runs from

the talus bone up to the fibula here. And it's the main ligament that keeps

the foot.

from turning out and getting inversion sprains, which is the most common

sprain. So the only thing I'll mention about this is this is a great area to

work after the ankle has started healing and you're sure there's no serious

damage. But if a client has just sprained their ankle, one of the things

that can happen is this talofibular ligament can actually be pulled away

from the bone, either at the fibula or at the talus bone, and it needs to

reattach itself. So you're not going to be wanting to move this area.

or work really hard on that ligament. However, after the ankle is healed to a

certain extent and you've found out that there's no serious damage here, then

this is an excellent area to work because it will become very fibrosed.

The only other area that I want to talk about on the foot that...

is important is the second metatarsal particularly, but any metatarsals, there

can be a condition called neuromas.

And clients will sometimes come in, and they've been to the doctor, and they say

they have a neuroma. And basically, it's a nerve that gets compressed between the

metatarsal bones.

The most common area is over here in the second metatarsal. And one of the causes

of that is that the metatarsal bone actually just drops.

Now, we'll be talking throughout this tape about ways of mobile. mobilizing

bones and moving them. And this is one area, if somebody does have a neuroma or

a lot of pain here, you do want to mobilize so that these can move if

they're fixated, but you're not going to want to be forcing the metatarsals down

relative to the metatarsal to its left and right. So this is an area you just

want to be a little bit careful of.

Let's move up the leg to talk about some of the areas on the back of the leg that

require some caution.

The back of the leg offers another chance to talk about some areas that

require caution, but that also can really be worked on to alleviate some

symptoms your clients may be complaining of. One of the things that I find is

that there's a large, large difference between working carefully and with

confidence and working very timidly and hesitantly.

I, in the book, mention my example of walking into a dark room, and if it's

your own house and there's no lights on and you're familiar where the tables are

and the television and chairs, you can navigate your way very, very efficiently

but slowly and carefully around those obstacles.

However, if you're in an unfamiliar environment and there are no lights on,

you're going to be very, very unconfident and also probably have some

trouble navigating. So what's really important for you is to learn your

anatomy and not be afraid of these areas. Take classes, get your skill

level up so that you can work around these areas and do it with confidence.

Let's take a look at the back of the leg here and talk about a couple areas

around the knee.

The first area I want to talk about is right behind the fibular head.

is a branch called the perineal nerve, which is a branch off the sciatic nerve.

And this is an area right up... behind the head of the fibula that you want to

be very careful of. What you want to be able to do is to distinguish the feeling

in tissue between nerves, between blood vessels, between fascial restrictions or

adhesions. So this is an area that you can accomplish a lot on. We'll be

talking about this in the tape. But just be cautious right behind the head of the

fibula. This is another area that you're going to want to be watching.

Another area is behind the knee in what's called the popliteal area.

And this is an area that very often in early massage classes students are told

to keep away from.

And I think that's wise advice until you have distinguished between these

different feelings of nerves and veins and what healthy tissue feels like. But

it also is an area that carries great strain in the body and you want to be

able to work around.

So one of the things that I do in the back of the knee in the popliteal the

teal area, is I just bolster the leg to soften this. All these

tissues will be in less of a stretch, and I put on a fairly severe curve to

the knee here so that this area is much softer, and you'll be able to feel

what's going on in here.

You do have the popliteal artery and you have the popliteal nerve right in this

area. And arteries are always very easy to feel because you'll feel their pulse.

And we'll talk more about some other larger and more important arteries. But

what I do is when I'm working, I work very slowly. If I feel a pulse, I then

try to slow down and come closer to the pulse where I feel that it's a little

bit stronger.

Then I know that I'm getting closer and closer.

And as long as that pulse continues, to get stronger I know I'm honing in on

that artery and then I can move a quarter of an inch or a half an inch

away and know that I'm not actually putting pressure directly on that

artery.

So let's move up to the pelvis now.

Let's talk about the sciatic nerve and the gluteals.

A lot of people hold a lot of strain in their gluteals and in their rotators,

the muscles that rotate the leg into external rotation.

And the basic thing that you want to do is to be very careful about not pushing

straight. down at an angle like this into bone. There's a lot of play. The

muscles can move this direction and that direction, up and down, as long as

you're working at an oblique angle.

This is the important thing that you want to do. And you also really will

find that this is an extremely important area that more and more people are

becoming aware of, and you will be getting clients that come in for what's

called piriformis syndrome.

We'll be talking about that in detail later on. But the main thing is that you

must realize that the sciatic nerve, is going to run in different directions for

different people.

Some people it will run deep.

to the piriformis muscle.

Other people, it will run superficial to, and others, it will actually move

right through the muscle. So the main thing when you're working in this area

deeply and people have tension and they've been told by their doctor to

come in for treatment of piriformis syndrome is to just work slowly and tell

them that if you feel any sensations going down your lung, any numbness or

tingling, then you need to take a little bit different direction, maybe move a

half an inch away, but don't be afraid of working on the muscle.

They're just probably stretching that nerve a little bit. So don't be afraid

of those sensations, but do immediately stop working on that.

The next area where the sciatic nerve is vulnerable is right where the hamstrings

attach at the ischial tuberosity.

And it comes up fairly close to the surface. And you just want to be very

careful when you're working around there that you don't move too fast and that

you're not going to be rolling over.

That would be particularly important for somebody that's doing...

cross fiber work. So just feel free to work around this area, but work slowly

and inform your client to let you know if they have any tingling or numbness

going down the leg.

And then moving up the back, I think the basic areas that are important to

watch out for are the floating ribs.

Underneath the floating ribs, you do have the kidneys, so you want to be very

careful about pushing with big, broad strokes down that are going to be

displacing these ribs. If people have specific pain in their ribs or in the

tissue over that, this is an area that I normally work with fingers or knuckles

or something like that so that I can give very precise...

without disrupting a lot of tissue by having to press real hard because

obviously the broader your surface, the harder you're going to have to press.

The other thing we'll talk about at great length is...

A lot of early massage classes mention about staying totally away from the

spine. And I have checked this with physicians, with physical therapists,

and you do need to have caution working around the spine. But take a look at a

skeleton and notice where these dorsal nerve roots come out. They come out

anterior to the transverse processes of the vertebra. And you can do a lot of

good by working in this area between the spinous processes and the transverse.

transverse processes. There are hundreds upon hundreds of little muscles

connecting all of these bony segments and you'd really have to get in here to

work and we'll be talking about how to do that.

So don't be afraid of working in the spinal groove between the spinous

processes and the transverse processes and don't be afraid to actually put

pressure on the transverse processes.

It's not only something that you don't have to worry about, it's something

that's a very, very effective tool.

alleviating back pain for your patients and we'll talk about that the anterior

pelvis is another area that a lot of students with good cause are very very

hesitant to work around so you do need to know your anatomy here but again if

you're doing serious structural work it is going to be important for you to know

how to work in the area called the inguinal triangle which is this little

triangle that comes from the border of the inguinal ligament

which begins at the anterior superior iliac spine and then attaches below with

the pubic bone.

This triangle is bordered below by the inguinal ligament and in the medial

border by the rectus abdominis muscle and basically is a thin walled area that

requires slow cautious work.

You'll be able to feel pulses from the femoral artery.

Be sure to use broad pressure and be exercise sensitive to distinguishing

exactly what you were feeling, whether it's muscle, blood vessels, or organs.

It's important for you to know how to be able to work here because you're going

to be working on the psoas muscle. More and more clients are...

coming in for work on the psoas, which is one of the major hip flexors.

And so it's important that you get a very clear idea of what's happening in

here, where that psoas runs, and where some of the areas for caution are there.

So let's take a look at a model that will give a little clearer picture here.

So let's look at a three-dimensional model of the psoas muscle and some of

the surrounding organs and tissue.

Just to give you a few ideas on the landmarks, of course, here's the

anterior superior iliac spine, right and left, and here's the inguinal

ligament coming down to the pubic symphysis here.

My students, I find, have a lot of trepidation that's really unneeded when

working with the psoas. If you know what organs are around there, then you can

work safely and with confidence. So let's just point out very quickly, here,

of course, are the kidneys.

They're going to be way above where you're going to be working on the psoas

anyway, so they're not an issue.

And, of course, in the middle...

of the body. You've got to be a little bit careful of the vena cava and the

aorta, but we're not going to be working near them anyway.

And you notice they split off and go to the inside here. This is the area right

around the anterior superior spine, a little bit above and a little bit down

below that we're going to be working on the psoas muscle, which of course is

this muscle that goes right here.

And of course the iliacus or the iliacus muscle joins the psoas and then becomes

one where it attaches down to the lesser trochanter of the femur.

So the main thing I want to get across is that this is really a very safe area

for you to be working on this muscle. And we'll talk about how to do that

later, but I wanted you to get just a view of the area.

The only organs that are really around here that you have to be careful of

would be the ovaries. And you can see right here the two ovaries where they

lie. They're significantly toward the inside of the psoas muscle, and the

bladder is right down here. So we're going to be working right around here,

and there really isn't much danger in you approaching any organs or causing

any problems there.

So be confident. Know the terrain, and that will help the quality of your work.

Another area that you're going to need to exercise caution with will be your

older clients that come in and have had hip replacement surgery.

Again, this is a wonderful area that you can really create a lot of freedom of

movement and a lot of improvement with these clients, but both the clients and

you need to know what are the right movements to move this hip through.

Generally, the surgeon will have told them what areas to keep away from as far

as movement, but it is important for you to know where you do not want to move

the hip, what ranges of motion.

So let's talk about those. Keeping in mind, these are the movements that you

do not want to do. Joel's got a nice comfortable hip here, and I'm going to

be running through some movements that I would not be doing with people with a

hip replacement.

first area I want to talk about would be the movement of the leg past the

midline. Any adduction past the midline, you can see how this acts as a lever

that could pop this hip out of the joint. So you want to be very careful

about moving the leg into adduction past the midline. Just don't do that.

The other area you want to move in, generally the hip moves into external

rotation fairly easily.

So although you're not going to really be emphasizing rotation, you don't want

to be moving into internal rotation.

So in any position, you want to keep away from internal.

rotation of the leg and it is safe to move into external rotation if you do it

slowly and don't come anywhere close to their end range. A lot of people have so

much fear that they've really tightened up in this area and working in the hip

area in different movement patterns can really, really provide a lot of work. So

just be cautious that you don't internally rotate the leg and that when

you externally rotate you move very slowly.

and always be talking with your client to have them tell you if they don't feel

safe with that.

You can even, of course, work with the knee down fully extended with internal

and external rotation with quite a bit of safety.

The only other movement that you want to keep away from with an artificial hip

would be you don't want any hip flexion greater than 90 degrees from the body

here. So it is probably safe to move it up a bit more, but I usually keep away

from even approaching 90 degrees and probably stop at 80 degrees and then

work with movement. And this can be, we'll talk more about how to work with

the hips, of course, but this could be something that you could really, really

work with.

with a lot of benefit to people because this area gets very fibrosed from lack

of movement and from scar tissue.

So don't be afraid to work around artificial hips. Just know what your

limitations are.

Let's move up the body to the trunk area and just talk about some of the areas of

caution here.

The major one that you're going to want to think about is the liver lies right

underneath these bottom ribs.

the right side so I do a lot of work with abdominal muscles some people

really are tight in this area and they have breathing patterns that need to be

freed up but you're not going to be sinking straight into the liver or going

underneath the ribs too much here on the other side This is why it's important to

know what you can and can't do. You can give tremendous benefit to people by

working on the anterior part of their diaphragm when they have breathing

patterns that have a lot of stress.

So, again, learn how to work in this area. Just be cautious of the liver.

The xiphoid process right at the bottom of the sternum is another area you want

to be very careful about working around. I really don't see much benefit of doing

much work around the xiphoid process.

So just be cautious of this. You know, it's this little protrusion of bone

right down at the bottom of the sternum, and people feel very, very vulnerable

about this.

Let's move on up to the shoulder area, and we'll talk about...

the thoracic outlet area.

Right here where the clavicle comes together and meets the, it's called the

AC joint, right up here where the shoulder joint is, there can be

tremendous tension for people. People that are working computers can have a

thoracic outlet syndrome where all of this gets compressed and these nerves

here get compressed.

So let's take just a little break and look at an anatomical drawing so you can

see what that will look like in a drawing.

The thoracic outlet.

Notice how tightness near the clavicles and beneath the pectoralis minor can

cause impingement of both the nerves and blood vessels as they travel down the

arm. Also notice how raising the arm above the head can increase that

pressure.

So what you want to be careful of in this area is that you're not compressing

all of these nerves and veins that are traveling out underneath this clavicle

here. And you've seen from the drawing where they move. You want to keep the

arm in a fairly neutral position.

So if you're moving the arm up, you can see how that's going to be stretching

these nerves. So generally when I work in this area, I keep it in a softened,

unstretched position.

Just know where the nerves are, and we will be talking later about strategies

for working in this area.

Let's work our way down the arm.

The first area that I want to mention would be the axilla or the armpit area.

So I'm going to bring Joel's arm up.

And this is an area where there really aren't compelling reasons to work

around. And actually, some reasons to not work here.

I pretty much just stay clear of this area.

You have numerous lymph nodes, descending nerves, and just a feeling of

vulnerability with many clients.

A little posterior and inferior, however, it is really important to be

able to address the origin of the triceps and also the teres muscles.

So just stay away from the axilla. There's really probably the potential

benefits are outweighed by the potential dangers there, okay?

The inside of the arm in between the biceps and the triceps here is another

area that you have nerve access.

So although you can do an awful lot of work working on the arm, on the triceps

and on the biceps and do a lot of benefit, I do keep away from very deep

work in between the septum for the muscles here.

As long as we have the arm up, let's talk about shoulder instability.

Generally, your client is going to know if they have a shoulder that isn't

stable. The main thing you do is if somebody warns you that they have a

shoulder that comes out of joint, I generally work with the arm in a neutral

position. I certainly work on internal and external rotation of the humerus,

but I do it with the arm abducted fairly close to the body, and I don't abduct it

above the head.

location come with abduction which is bringing the arm up above the head and

external rotation so here's external rotation in this position above the head

is where the shoulder is most vulnerable this isn't as much of a danger with

internal rotation but you still need to be careful because it depends upon which

ligaments have been compromised let's

move down the arm

and talk about the ulnar nerve, which travels down the back of the arm and

comes up near the surface, right near the olecranon process here in the...

elbow area. So this is an area that you want to be very, very careful of working

on, but that can get very, very fibrosed. So again, don't just shy away

from areas that you need to have caution with. Learn what the area feels like so

that you can work safely. There's a lot of fibrosed area for people that lift

weights here or that are working with computers that you can give a lot of

relief with. So learn how to work around here, but realize that the ulnar nerve

is right down here.

The front of the neck is one area that is probably the most fear-inducing for

new massage students. A lot of early classes, I think with good cause, again,

tell students never to work on the front of the neck. But that's before these

students have developed their tactile skills and can differentiate between

tissue. So once you're fairly adept at your anatomy and...

You're ready for it. I think the front of the neck is a wonderful area to feel

confident in working, and it can also give you an awful lot of benefit for

people with neck pain because a lot of the muscles in the back of the neck that

are complaining are actually fighting against tight anterior muscles.

So one of the ways to really start becoming confident in that area is to

work on your own neck. So I very often take my hands when I'm lying down and

just take my thumbs and feel tissue and start learning.

What do the lymph nodes feel like? What do the salivary glands feel like? And

then work my way down and start feeling these different tissues after I've

studied the anatomy and get a sense by working on my own neck about how much

pressure feels safe and all of that. So one thing that you can tell, the carotid

artery is an area, of course, that requires an awful lot of care on your

part because particularly for older clients, it can be hard. holding plaque

that you can dislodge if you work on this and that could actually travel up

to the brain and cause a stroke.

So you certainly should know what the carotid pulse feels like and one of the

best ways to work on that is on yourself. So just take your hand and

reach across your neck to the opposite side and use nice soft fingers and

slowly push in and feel this carotid pulse realizing that if you push too

hard you're going to make the pulse disappear because you're going to be

cutting off flow in that artery.

So then when you have a sense of that, then you can be moving to working on

your clients.

So the other areas in the neck that you want to be careful of

I do a lot of work on the sternocleidomastoid muscle, and we'll be

talking about this later, but the jugular vein does run superficial to

that. So just get a sense, feel for veins, and be very, very cautious in

this area as well, but don't be afraid of working on that sternocleidomastoid

muscle. It's a very important muscle to work on.

Moving down a little bit, again, as we've talked about, The thoracic outlet

area here, you do have the nerve plexus here that

you're going to want to be cautious of. But right underneath the clavicle

is the subclavian artery.

And it is beneficial to work in this area. The subclavius muscle can get very

tight. But just feel for that.

pulse and realize when you're right near that artery and move your hand away.

I mentioned this earlier, but the same thing with the carotid pulse. If you

feel the carotid pulse, instead of shying away, very, very cautiously move

closer to that pulse so you can tell exactly where that artery is. And then

if you move a quarter to a half an inch away, you know you're not going to be

pushing on that artery.

You do, of course, have lymph nodes coming all the way up the neck and up to

the skull here. So just get a feel for what those lymph nodes feel like and

just realize that you're going to be moving slowly and you'll feel that sort

of slippery, different type feel of the lymph nodes and you're going to move

slightly so you're not putting pressure on those.

Let's take a look at the head.

and talk about some of the areas on the skull and in the back of the neck here.

The head and the occipital area back here are worthy of

a few mentions, but although there's really not a whole lot of area that you

need to be extremely careful of. Right beneath the occipital ridge here, a lot

of people do a lot of work about providing traction and taking your hands

and pulling the neck.

Right below the occiput in the foramen magnum is the basilar artery.

And what you want to be careful of is just using two sharp fingers and really

pushing up too much.

You want to be careful of moving the head back into extension too much. That

can compress this artery.

In the side of the neck, right up.

through the transverse processes only closer to the body of the vertebra

is the vertebral artery.

And this area you can do a lot of very, very beneficial work on the neck.

but you want to just be a little careful that you're not compressing that artery.

And one of the ways you can do that would be by doing too much side bending,

which could sort of put a kink in that. If you have the head in a neutral

position and work unilaterally, you can be pretty safe working on the side of

the neck, and it's also very important to be able to do that. So just don't

work bilaterally on the side of the neck, and don't put too much movement in

side bending in that area.

Moving up to the skull, one area that's mentioned if you look at a skull or an

anatomy book, you can certainly See the styloid process back here.

The reason I'm mentioning this is not so much that you need to exercise great

caution here as that this is really, really covered by a lot of muscle and a

lot of tissue. And I've never heard of anyone actually doing damage to the

styloid process.

You should be aware of that. You don't want to push directly in against it with

sharing force.

But don't let that...

that you see in the skull frighten you from keeping away from this mastoid

process right here, which is such an important area to work that we'll talk

about later.

Then we come into right in front of the ear, right near where the jaw comes

together, is an important nerve that you do want to be careful of. And I have

heard of therapists injuring their clients. And this is a trigeminal nerve.

And you want to be very careful of the trigeminal nerve. If you push too hard

in here, you can create a condition called Bell's palsy, which is a very

serious condition.

Bell's palsy can be very painful and debilitating. It can cause paralysis of

the facial muscles of expression.

The face and lips can sag around the mouth.

So be very cautious right in this area working.

with cross-fiber strokes or deeply or too fast, this is a vulnerable area.

The trigeminal nerve then travels deep and then comes back down right about

here in the chin area, and that's another area that you want to work

fairly carefully around.

And that there's not a lot of good reason to work in this area. There

certainly is on the masseter and all these muscles of mastication, but this

is not an area that you're going to want to work deeply on anyway.

I've mentioned earlier you have the submandibular salivary glands. This is

an area you also want to be careful of.

The last area that I will mention is a bone called the sphenoid bone. And go to

your anatomy books and look at this, but basically it's right where the eyebrows

come out and a little bit behind and a little bit lower is the sphenoid bone.

And this is a very delicate bone, and you can disrupt it if you apply a lot of

force. So I generally tell my students, as good as it feels to work in the

temples, to know where the sphenoid bone is so that you can do this important

work. I pretty much keep away from working on this phenoid bone, even

lightly, because craniosacral work, and I strongly recommend taking a

craniosacral class sometime, works with this, and it doesn't take much pressure

to be manipulating this phenoid bone.

So these are the major areas that I would like to have you exercise caution

around, but also feel confident to work around.

This is not all inclusive. I'm making the assumption that you've always been

trained in your safety.

And the final warning I would give is if you don't feel safe working around an

area, do not work around it. It may be required for you to just take a class,

ask a teacher.

or something so that you can gain the knowledge to feel safe. But if you don't

feel safe, that's going to be reflected in your touch, and it's going to have a

timid sort of tentative feeling, and you're probably not going to be

accomplishing much anyway.

Now that we've covered some of the basic issues about touch and about

biomechanics, I'd like to start talking about the tools that you have at your

disposal. What we will be doing is moving from fingers to knuckles to fists

to forearms and to elbows.

The basic theory that I have behind this is that when each one is for the most

part, increasingly more powerful and therefore easier for you to use.

So most of us feel very comfortable using our fingers, but we get to a point

where we find ourselves straining. At that time, you would move to using

knuckles, and when your knuckles are not working for you, you may move to the

fist, you may move to the elbow or forearm, whatever is most appropriate

for you to contact the muscle at the depth you're working at.

So I'm going to start by talking a little bit about the fingers.

The biggest problem I see with people on fingers is that they have their fingers

hyperextended and they push directly down into tissue.

So they're working too hard, and this is going to have sort of a pokey feeling

that it's not going to feel good.

So the main thing is to have your fingers slightly curved and work at an

oblique angle.

The lower rib cage is an area that I see a lot of early massage students not even

contacting when it's such an important area to talk about for getting the ribs

moving.

So it's very important to work on this, and the main thing is you're going to

sink to the level you're working and then use these fingers to open that

area. What I'm doing is I'm grabbing tight muscles, tight fascia.

I'd be contacting serratus anterior here, and as I went farther down, I

might even be talking to the lateral aspect of latissimus dorsi.

This work feels wonderful to clients, and very often people come to me, and

the first time I start working on here,

They've never had work like this before.

And this is what you want to do in your practice. You want to be able to do work

that is new to your clients, that's going to expand the way they look at

their body rather than just squeezing tissue.

The fingers are an excellent tool for working on the lower part of the rib

cage where the diaphragm attaches.

A lot of people are very constricted here, and particularly people that do

many, many sit-ups and abdominal crunches. And all you need to do is,

with nice soft hands, just slide right down to the ribs, being careful, of

course, that the liver is right down here. You're not going to be going too

deep. And just start working with the breath.

We'll go into much more detail in working with the breath and abdomen in

later tapes.

But for now, you can certainly start practicing by following along this

costal arch here and giving some length so that when people breathe, their ribs

can move up.

I'm now going to move to the top part of the rib cage around the clavicle, and

we'll talk about some other ways to work with postural issues there.

The fingers working around the clavicle and the upper chest are another example

of the snow plowing and the importance of spreading tissue.

I think this is just wonderful work. So often people do a little bit of kneading

work and they consider that the chest work. So if you can picture somebody, a

lot of my clients that come in complain of feeling like their stooped shoulder,

like their shoulders are pulled forward like this. So you can do all the work

you want to rubbing tissue, but unless you open up this tissue and spread it.

they're going to walk out the same way. So this is just work. Be very playful.

I work in different layers here. Initially, I just work on superficial

fascia that has been pulled toward the sternum, and I just spread this.

Just give them a cue to drop those shoulders and let them fall back.

Nothing fancy. It's just very intuitive work.

You often will feel emotions coming up here with your clients. You'll find them

sort of tensing or watching for signs of their eyes blinking or

maybe even some tears or something like this. This is a real holding area, and

it feels excellent to just open this up.

After I've worked on the superficial area, then I'm going to use my fingers

in a little more specific way to get in on the pectoralis major and the

pectoralis minor right here by the coracoid process.

Pectoralis major.

Notice the difference in fiber direction between the clavicular and sternal

attachments of the pectoralis major.

Although these different aspects of the muscle both attach at the humerus,

positioning of the arm will depend upon which fibers you wish to stretch to

effect a more effective release and lengthening of the muscles while

working.

Pectoralis Minor Notice the attachment of the pectoralis minor on the third

through the fifth ribs and on the coracoid process of the scapula. A

short, tight pectoralis minor can pull the scapula forward and give a stoop

-shouldered appearance.

And wherever you feel tension here, you just sink in, you wait, and start

stretching that tissue.

You can see these strain patterns that I'm opening up here.

Just work gently and slowly here.

If you have too much lotion on your body here, you're not going to be able to

grab that tissue. You're just going to be sliding over it.

After you've worked on the outer fascia, after you've worked on the major muscle

groups, I even move a little bit deeper and start thinking about ribs. So I'm

sinking right through all this tissue here, standing up and getting my own

body weight, and just seeing how the ribs move.

Move to the end range.

Weight. Do whatever is needed to get freedom and movement in the chest.

The elbow is another area that the fingers really can get a lot of good

work done on. I think of all the spots on the body that are fairly accessible

in early massage training, the elbow is the most underworked.

Incredible tension can be held in the elbow which transmits up to the shoulder

and to the neck. So I'll do a bit of work with my fingers to demonstrate the

idea of working with specific muscles or with broad fascial sheets to improve the

function of a joint.

To work with rotation, to decompress the joint.

So I'm just going to start with the biceps.

You can see the broad hold I have and I just lengthen and stretch the biceps.

We'll talk about lengthening and other types of strokes later, but what I'm

doing is anchoring her biceps and then extending her arm away from that anchor

to get some length in the biceps.

I can find strain patterns wherever I find them and just anchor and stretch in

different directions.

In class, we often demonstrate this and have the students stand up, the model

stand up after the example, and it's extremely obvious. The whole shoulder

will let down, and there'll be a tremendous feeling of relaxation on the

whole right side after doing some work on just one side.

Here I'm using my fingers a little different way. I'm bending them, and

they're very strong this way, and I'm working on the triceps.

And if I want to stretch the triceps, then I can just flex the arm and

lengthen that muscle as I'm working. Any place where I feel tension, I just sink

into that level slowly and easily, let my hands contact that, and then I can

start working in any pattern I want to to try to alleviate that stress pattern.

This is so much more functional than just squeezing tissue.

Let me talk a little bit about hyperextending fingers again because

this is one area that you really have to be careful that you don't injure

yourself.

The fingers are such a good tool, but when you see your hand with the fingers

hyperextending, and mine are not all that flexible, but I see some people

that are like my little finger here that go like this, then basically you don't

want to be using your fingers for deep work. That's why you move upstream to

using your knuckles, your fist, your forearm, or your elbow.

But they are a wonderful tool, particularly for an area that's very

sensitive like the IT band here.

All runners, tennis players, most athletes are going to need a lot of work

on their IT band, and the fingers are the great way to do it. You can move it

around. You can rotate it around that femur. You can stretch it one way or

another. So the fingers are a great tool there, but do not hyperextend them. One

of the things you can do when your fingers start hyperextending, you should

have them at a nicely even curve here, not too much where they're going to feel

sharp. but about like this. And when they start going, all you need to do is

go back to that neutral position and take your other hand and put it on top.

And then between both hands, you should be able to have a nice soft touch. You

can have that bend of the fingers and it'll be much easier and more accessible

and you can get a lot more work done.

One other use of the fingers involves not such oblique strokes, and that is

when you're working in very precise areas, such as the area between the

spinous processes and the transverse processes of the back.

Introvertebral muscles.

When people complain of back pain, most often the short crisscrossing muscles

that connect individual vertebrae are the cause.

Spasmed and short intervertebral muscles may fixate vertebrae or cause rotational

problems. Be sure to palpate and work through large superficial muscles in

this area between the spinous and transverse processes of the vertebrae.

So on this one, I'm actually coming in at a pretty straight angle, but not so

straight that my fingernails are going to be a factor.

So I've got about 15 degrees off a total vertical, which would be like this.

and I'm still on the pads of my fingers, but I can do very, very precise work up

the spine.

And this is very, very good work because all of the broad strokes that we use

cover the large muscle groups. And an awful lot of the problems that people

feel with their spine involve these very small muscles that move from a spinous

process of one vertebra to the...

the transverse process of the next vertebra, from the spinous process of

one to the spinous process of the one above.

So these are these small little muscles that go into spasm, and you need to be

very, very precise.

And you don't want to disrupt the vertebra too much by using a broad

stroke that would be applying too much force.

So this is just an excellent stroke. Just keep practicing until your fingers

get strong enough. If they too much hyperextend, then you're going to have

to slow down and possibly reinforce with your other hand.

The key on this is that everyone's middle finger is going to be longer than

their other fingers.

So you want to be working at an angle so that you can probably use two fingers.

It's going to be a little bit too much to be pushing with one finger here. It's

going to be a little bit too much for that finger. So you want to spread the

work out between two fingers. You're never going to be able to use three

because this middle one, unless you were to bend it like that, which loses all

the power, is not going to work. So just practice this stroke.

Later on we'll be talking about knuckles and you may want to replace it and work

this way.

But you aren't going to be able to get as precise work with that knuckle as you

are with the fingers.

So just keep working on this. Your fingers will get strong and this will be

an effective stroke for you.

Before progressing on from the fingers up to the knuckles, fist, elbow, and

forearm, I'd like to talk a little bit about the thumbs.

One of the saddest things I've seen in my massage teaching are people that have

to change professions because they've worn their thumbs out. They've gotten

arthritis or severe tendonitis.

The thumbs are a wonderful tool for all this kneading that we do. They're very,

very sensitive. They have a nice, soft, fleshy surface, and they're a wonderful

tool. But on the other side, if you use those for deep work, you're risking...

changing your career. I really have seen over the years about five or six people

that have actually had to get out of massage work that they love because

their thumbs gave out on them. So when you're working with your thumbs for very

deep work, let me show some of the problems you're going to encounter.

I've seen a lot of people really digging in and snow plowing or forcing with

them. You can see the strain here.

Basically the thumb is sticking out from my hand and the force that I'm

generating and it actually

is shearing in the joint like this. It may not hurt, but what you're doing is

wearing away the articular cartilage in that very, very shallow joint in which

the thumb articulates.

So if you're doing it like this, you're worrying about wearing out that thumb

joint plus having a whole lot of tension on the inside of your thumb flexors

here because they're going to have to hold to keep it from going too far.

So this may feel real good for a while to you, but it's going to catch up to

you probably.

So this doesn't work. So what you can do to eliminate that shearing force is to

turn your thumb so that it's an extension of your forearm all the way

down. Then your force is coming all the way through your body and out to that

thumb, and it's pushing right into the joint without that shearing force.

Now the only problem with that is...

If you look at both hands here, you can see that my wrists are then compromised,

which is the second most common problem I see with people coming in with overuse

injuries from massage.

So you basically have to choose one or the other. You either put shearing force

this way or you put strain on your wrist this way.

That's why we will talk about whenever you're feeling like deep work is needed,

you can move to any other tool at your disposal to save these thumbs so that

you can use it for all that wonderful effleurage work. You can see if I'm

straining with this thumb here how much easier it is for me to simply shift to a

knuckle.

I have much more force. I have a nice flat surface of these knuckles, and

we'll talk about that coming right up.

And your thumbs will be there for another day.

The next tool we will cover upstream from the fingers is the knuckles.

And they are a wonderful tool to save your thumbs.

So I want to talk a little bit about how you can use the knuckles in areas that

you would be using your thumbs.

The main point I want to get across with the knuckles is that they are an

extension of your metacarpal bones.

As soon as you start bending your hand into a fist shape, you lose all your

power. So the important thing with the knuckles is to keep them in a straight

line, and you can do anything with them that you could do with fingers or with

your thumbs.

They're a very versatile tool. You can use the bony part to do very, very

specific work.

Or you can use the nice flat area to get a little larger surface area and it

feels much more nurturing.

So it just depends what you're trying to accomplish.

If you were to use your knuckles instead of thumbs, just on the hands and feet,

you would probably cut your thumb use by 50%. So it works excellently to

just take your knuckles.

And do anything you'd be working with a thumb, but instead of doing kneading

work, you're actually stretching tissue here. You can start feeling, where is

this tissue thick? Where is it restricted?

Does this calcaneus bone need a little bit of freeing on the front part?

It's a great tool.

One thing I will mention is that until people are used to using their knuckles,

they can get sore for the first day or two. So be cautious about overusing your

knuckles too much at first.

Don't try to power through them.

They're a wonderful tool.

The knuckles are just about the perfect tool to use for the palm of the hand.

It's easy to see that with me standing fairly far above here, all of my effort

and energy is coming just from gravity. I'm putting next to no effort into this

and I can work very, very deeply.

I can take my thumb and use my fingers as a fulcrum on the other side, and I

can open her hand.

Most of these hand muscles that you are working with are used to close the hand

into a position like this. They're really not ever stretched this way. So

you can just go through and work on any area you feel tightness and stretch. You

can hold it here, take the other side, and open up the hand this way.

This would be somewhat similar to the old trick that most people learn in

beginning massage classes of taking your hands here and opening this, but you can

see how much strain there is in the thumbs here and that your wrists are not

in a perfectly neutral position.

So you can do just the same thing this way and accomplish a lot more.

Ankle retinaculum.

Throughout this series, I will demonstrate working with the ankle

retinaculum. It is important to work with this ribbon-like band to facilitate

smooth movement of the ankle.

In the supine position, The knuckles are also very useful in working on the front

of the ankle, the retinaculum, which wraps around the ankle, and on the

tibialis anterior.

We'll be going into much more detail later about this, but I want to

demonstrate a little bit about mechanics here.

So all you need to do is use the soft part of your knuckles, because this is a

fairly bony area here, and you can do many things to just free this ankle up.

I can work on plantar flexion here.

Most people have sprained their ankle sometime in their life and have a lot of

holding patterns here. You can test to see how the foot moves out, how it moves

in from inversion and eversion, plantar flexion and dorsiflexion. And whenever

you feel restrictions, just use a nice soft knuckle. Use a flat, soft, fleshy

area there and free those adhesions.

It's a great tool to work up the tibia.

Tibialis anterior here can get very, very tight and you just work your way

up. We'll go into more detail about this later, but you can do anything you would

be using with thumbs. You can turn, get a kneading stroke.

Now I'd like to work on the plantar surface of the foot to show a little bit

about proper use of your energy and your weight.

knuckles are also an excellent tool to use on the bottom of the foot when your

client is in the supine position one of the errors that I see people doing is

they get their elbow out and it's all muscular they're using their shoulder

and their elbow and this is just not going to feel like it has any power to

your client so all you need to do is bring your elbow into your body you may

want to push your body back a little bit and you keep the proper curve in your

back And then all the force is coming from just leaning forward.

So I'm applying 50 or 60 pounds of pressure with my body by leaning

forward, and my real job is to not apply too much pressure so that this will be

too tender for her. So I just have my elbow braced against my lower ribs here,

and then I just lean into this, and I can apply as much force as I want.

This is a great way to stretch the plantar fascia. You can just grab the

toes,

Pull them back this way so this tissue is on a stretch.

Again, this is much, much more effective than taking your thumbs and just

squeezing tissue.

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

spinous processes of the spine, is a great place to show proper use of the

knuckles. As you can see in this position, my knuckles, I can either

choose a nice flat surface.

like this or I can turn and go have a fairly sharp knuckle here. The main

point is that you'll notice there's a straight line going all the way up

through the elbow. All of my weight is coming down. I'm not forcing anything

and I can slide down this way.

This is so much better to be using than say the thumbs.

you're not going to necessarily always going to want to be working with your

thumbs on each side of the spine. You can get a lot more movement with the

ribs. You can take your other hand and move the shoulder down and move the

ribs. So working unilaterally is often a good idea.

I want to show a couple of the ways that I see people misusing the knuckles, and

that is that they...

Instead of turning your palm out toward the outside where everything's in a

straight line, I'll see people turning their hand this way with the palm up,

almost like what you'd be doing with the fist. When you use the fist, it's very

stable to have the palm up here. But when you get up to the knuckles, your

hand is going to collapse, and your wrist is very vulnerable. So I'll see

people with their knuckles like this, and their wrist is very vulnerable, and

it's going to collapse here. So you just don't have any power. So just try to

remember to turn your hand out.

When you're working with your right knuckles, you're going to be turning it

outside toward the right side and walk down that way. If you're going to be

using the left, you just turn your hand this way and move this way.

The other error that I see people using with the knuckles is they'll get two

knuckles here and then they'll collapse again.

So they'll lose the angle right here between the fingers and the metacarpal

bones. and they'll give way here, and there's a lot of strain right here. So

you want to be sure when you're working with the knuckles that you've got it

straight so everything's going in a line.

Suboccipital muscles.

Notice the many layers of the small suboccipital muscles.

They can affect the rotational dysfunction of the vertebrae and also

prevent the proper movement of the skull upon the atlas. It is crucial when

creating balance in the neck and head to be able to work through superficial

large muscle layers to address these muscles.

The knuckles are a very effective tool to be using on the occipital ridge. You

can go from the mastoid process all the way down to clear up all this tissue,

which has a tendency to get bunched, particularly for people that sort of

hold their head in a shortened position with their chin up. So what I do is I

try to stretch this tissue by tilting the head down, and be sure to use the

soft part of your knuckles, not the joint itself, and I just slide down that

occipital ridge.

You can even do some rotating strokes as you get in here. You can sort of turn

your knuckle.

One other thing to do is to take short strokes here. You don't want to be

sliding over the hair and pulling the hair. So I make the hair and the outer

skin layer part of my knuckle and just direct my attention below there so that

I'm not sliding over that surface.

The knuckles are a much more effective and useful tool than a lot of people

realize.

Actually, it feels very, very good to work on the muscles where people frown

or squint. This area can get very restricted.

Muscles and fascia of the skull.

Notice both the muscles and fascia of the skull.

These muscles can be overworked just like any other muscle and can cause

headaches or other symptoms of tension.

Being able to stretch this tissue with slow patient work will be greatly

appreciated by your clients.

Of course, using your fingers can work, but you can actually sink in very well

right above the eyebrow, sink into that layer, and then move all in a horizontal

position and spread this tissue.

This actually feels very, very good. In classes, students are always surprised

to find out how good this feels.

The fist is the next tool we will talk about that is upstream from the

knuckles. It can provide a lot more force than the knuckles, but it also has

more square inches of area to be working with. So it's not just an issue of your

knuckles being tired and moving upstream to the fist.

Basically, the back is the perfect place to show you how to start working with

the fist and the proper mechanics of the hand.

Actually, the fist is the first four knuckles where the fingers join the

metacarpal bones.

So all you want to do is to keep your hand relaxed, your fingers loose, and

your thumb relaxed.

And this will give a nice, soft feeling that you can lean into and provide a lot

of force, but over a broad surface that will feel excellent.

I'm going to show my other hand to show you what it looks like from the other

side.

So here, basically the palm is always going to be up, and you can see what it

looks like from this side.

In reality, the fist is a bit of a misnomer. You would certainly not want

to be gripping your hands tight and your thumb like this.

You'll have a very hard feeling. It's just not going to feel good to your

client. So the difference is that this is going to give a lot of shock

absorption when your hand's soft like this. So here it shows it from this

side. This would not be what you would want. You can see the strain in my

forearm, and there's just going to be no give anywhere here.

You could take strokes with the fist as far down as you want on the back. If you

move your feet to keep your gravity over your fist,

you could cross the pelvis and actually continue your stroke down to the

gluteals.

The fist is a wonderful tool to use on the shoulder girdle.

You can use it to skirt along the medial border of the scapula, and it's an

excellent way to work on the rotator cuff.

Depending on how you have the arm moved, as you move the elbow up into abduction,

the humerus is going to rotate into internal rotation, which will stretch

the rotator cuff, basically those being external rotators. So all you do on this

one is have your palm right towards your body and just use your own body weight

and do strokes.

You can carry this all the way down the triceps.

Posterior deltoid.

And you can manipulate the arm as you're working.

We'll be going into a lot more detail about how to manipulate the arm to

effect freedom of the shoulder joint in later tapes. But for now, we're just

working on how to properly use the fist.

On any fleshy area, I could certainly be pushing away from my body by working on

her triceps this way.

Notice I'm anchoring with my left hand here.

The fist is...

An excellent tool to use anywhere where you have large muscle masses and you

want to have just a nice soft feeling.

Sometimes directly over ribs or bones, the fist can seem a little bit too

harsh, but on the gluteals, on the thighs, on the calves, anywhere where

you have large muscles, the fist is an excellent tool.

You'll notice right now, this table is a little low to demonstrate this, but

you'll notice that sometimes if the table is too high, I'm using the force

from my shoulder. I'm actually pushing down with my shoulder muscles to try to

work here with the fist, where when I find myself doing that, sometimes just a

quick little climb up on the table, and you notice now I'm reaching down, and

I'm basically just leaning, and it's just a body weight.

My weight is what's providing all the force, and there's very little muscular

effort because my shoulder is locked in a downward position.

And then you can just do a raking stroke.

Anything you want to do along here.

You could work in the direction of the gluteals this way.

Notice if I go this way, my wrist is going to collapse. So on this, I would

turn my palm away from me and move down.

You can move it this way, back and forth, for a bit of a kneading feeling.

Use that fist.

It's a great tool.

The broad surface of the fist is also an excellent tool to be using on the IT

band or other areas that are fairly sensitive.

So I want to show a little bit of work with the fist on the IT band, beginning

by showing how I would not like to use the fist. This is one of the most common

errors I see with students using the fist on the IT band, is they break their

elbow in a bend at the elbow and start using all of their power from their

shoulder. So you can see that my shoulder is doing all the work. I have

to make my arm very tight because of the bend in my elbow. So we have two basic

solutions to this.

Number one, all I need to do is step back a little ways so that my shoulder

is extended, my elbow is extended, and I can just lean into this. Notice that my

fist is nice and soft, my fingers are relaxed, and I can do repeat

strokes.

The other solution that works a little better because you have a shorter lever

arm is to move closer, put your elbow against your pelvis, and then work this

way.

You can take your other hand to manipulate the femur, to rotate it, or

do anything you want to to try to deal with the strain patterns you see. Some

people whose wrists are not particularly strong can then grab their...

wrist with the other hand to hold that stable.

As I've shown earlier the fist is a great tool to be using on the shoulder

but it's very important that I show you a couple ways that I see students

misusing the fist.

Properly done, your hand should be relaxed, your palm should be up. So

looking from this side, it would be looking like this. Using my right side,

my hand is in a relaxed position, my fingers are loose, and everything is in

a straight line here. The problems I see when people misuse the fist have to do

basically with abusing the wrist.

I see two basic errors that people make. The most common is that they start

working with the fist in this position so that the wrist bends into a flexed

position. If you keep it from a flexed position, you're going to have to be

really tightening the extensor muscles. So when people start doing this, there's

a lot of strain involved.

You can see how much easier it is when you're doing it the right way.

The other area I see is that people are basically using the palm of the hand, so

this is really not a fist stroke anyway, and they're bending the wrist here. This

is something you really want to keep away from because this is involved with

carpal tunnel issues and all of that. So this is not a stroke. If you're going to

have to work this way and you want a nice soft surface like the palm of your

hand, just put your hand out, step farther back so that you have a little

bit more angle away.

and then work this way. But you definitely want to keep your wrist into

a neutral position.