www.terrarosa.com.

au

Feature:
BioTensegrity

Terra Rosa E-magazine, Issue No. 16, July 2015.

ontents
BioTensegrity
2

The shape of natureGraham Scarr

Biotensegrity, A Brief Historical PerspectiveJohn Sharkey

BioTensegrity, Powering the fabric of human anatomy

John Sharkey & Joanne Avison

14

The Elastic Body, Introducing Biotensegrity as a model of

Elastic Integrity in the moving bodyJoanne Avison

Cover reproduced with kind permission

from capacitor.org and the photographer
RJ Muna (rjmuna.com).

Clinical Study
25

A randomized clinical trial of Structural Integration as an

adjunct to outpatient rehabilitation for chronic low back
pain: A summary Eric Jacobson PhD, MPH

Practices & Techniques

31

The Price of Smart Phones: Ten common dysfunctional postures and injuries caused by smart phone useJoe Muscolino

40

Putting the Maximus Back into Gluteus Maximus John

Gibbons

Perspectives
45

CORE Structural Integration and Myofascial Therapy: A

lifetime of improving structure and function George P.
Kousaleos, LMT

48

Bringing Up Baby. Bodywork grows-up from infancy to

adolescent Art Riggs

Research
56

Research Highlights

Pro iles
60

6 Questions to Joanne Avison

61

6 Questions to John Sharkey

Report
62

Fascial Fitness Kati Cooper

Terra Rosa E-mag 1

The Shape of Nature

By Graham Scarr
The natural world is full of
shapes, from the smallest of crystals to the highest of mountains,
and from simple molecular helixes to the complex spiralling of
muscles and fascial sheets in the
human body (Figure 1). Natural
patterns and shapes have been
generating wonder since at least
the time of the ancient Greeks
and caused much speculation in
relation to living organisms, but
most explanations have been
(unfairly) relegated to the realm
of the esoteric and fanciful.
Modern anatomy has taken many
centuries to accumulate a body of
knowledge that is now unrivalled
in any other sphere. It has classiied structures according to the
thinking of the day and sought to
2 Terra Rosa E-mag

understand their functions using

the latest technologies, but established conventions have allowed
many inconsistencies to survive
long past their sell by dates. Orthodox views of human movement, for example, are based on
the mechanics of man-made machines described in the seventeenth century and have remained essentially unchanged
ever since; but biology is not constrained by the rules of classical
mechanics and there is now a better way of looking at functional
anatomy.
Whenever nature uses the same
principle in a variety of different
situations there is probably an
underlying energetic advantage
to its appearance, and biological

development and evolution will

automatically favour those patterns and shapes that are the
most ef icient in terms of stability, materials and mass. Even
though they can appear to be rather complicated, at the most
basic level all structures are the
result of interactions between
atomic forces, and the orderly
arrangements that they settle into are governed by some basic
rules of physics. Essentially, it is
the fundamental and interrelated principles of geodesic geometry, close-packing and minimal-energy that lead to the formation of crystals and molecules,
which thus become the physical
representations of the invisible
forces within them.

The Shape of Nature

Figure 1 Crystals and complex biological structures. a) luorite; b,c) iron pyrite; d) spinel; e) partial spirals
of muscles and fascia in the human body. Figures b-e reproduced from Scarr 2014 Handspring.

Nature always does things in the

simplest and most ef icient way
possible and a proper understanding of this simplicity now
provides a powerful means to
relate complex patterns and
shapes with functional anatomy.
Albert Einstein emphasized that
the laws of physics must be the
same in every place, which means
that even the most complex organism can be understood in
terms of the same basic rules of
construction. So, by simplifying
these inter-atomic forces into
those that attract and those that
repel, and applying the principles
described above, we now have a
simple means to understand biological complexity at every size
scale.

mechanical system that integrates them into a complete functional unit. It is a conceptual
model that is causing a paradigm
shift in biomechanical thinking
and changing the way that we
think about functional anatomy.
Biotensegrity recognizes that the
forces of attraction and repulsion
at the molecular scale are comparable with those of tension and
compression at higher size scales,
and are easily modelled using
cables and struts, respectively
( igure 2). It is a simple reevaluation of anatomy as a network of structures under tension
and others that are compressed;
parts that pull things together
and others that keep them apart;
basic physics!

Biotensegrity

Tensegrity con igurations are

similar to biological structures in
that they are strong, light in
weight and resilient to the effects
of damaging forces, yet can
change shape with the minimum

Biotensegrity is a structural design principle in biology that describes a relationship between

every part of an organism and the

of effort and return automatically

to the same position of stable
equilibrium. Their structural mechanics operate the same in any
position, irrespective of the direction of gravity, and they have similar non-linear visco-elastic type
properties that in luence movement. Each component part can
be constructed from smaller ones
within a hierarchy, with each level related to all the others so that
the entire structure becomes
united into a single functioning
unit.
The recognition of biotensegrity
as a unifying structural principle
in living organisms began in the
mid 1970s with Stephen Levin
(b. 1932), an orthopaedic surgeon who observed things at the
operating table that could not be
explained through orthodox biomechanical theory. He found that
tightening up certain ligaments in
the knee etc caused the bones to
move apart, and that normal
Terra Rosa E-mag 3

bones always had a slight spacing

between them, but there was no
known mechanism that could
make this space possible; it was
like the bones were loating in
the soft tissues. Further research
then uncovered a relatively little
known structural principle called
tensegrity and a likely explanation for these indings.
The term tensegrity is a combination of the words tension and
integrity and this structural system was irst recognized in 1948
by Kenneth Snelson (b. 1927), a
young sculptor who continues to Figure 2 A tensegrity structure consisting of compressed struts
loating within a network of tensioned cables. Reproduced from Scarr
produce impressive works that
he describes as ...unveil[ing] the 2014 Handspring.
exquisite beauty of structure itself. Tensegrity structures are
structures, but because certain
standings about functional anatoparticularly interesting because
aspects are not transferable, Stemy.
the struts remain isolated and do
phen Levin introduced the term
not compress each other at any
A biotensegrity view of life
biotensegrity to distinguish bepoint because they are suspended
sweeps away the man-made contween these two ields.
within the tension network. The
straints of classical mechanics
architect Buckminster Fuller
Biotensegrity models emulate
and re-establishes biology at its
(1895-1983) recognized them as biology in ways that were inconvery core. It is based on the laws
part of his theory of synergetics,
ceivable in the past but it has tak- of physics irst, rather than the
the study of natures coordinate
en some time for the concept to
arti icially contrived ones that
system that considers that all nat- become widely accepted because have dominated biomechanics for
ural structures are inherent disof its challenges to generally accenturies, and recognizes that the
plays of the forces within them;
cepted wisdom. Biotensegrity
structure and behaviour of each
and Donald Ingber, a cell bioloexplains how joints can remain
molecule, cell, tissue and organgist, has described the structural
completely stable without overism must result from those same
lattice (cytoskeleton) within cells stressing the soft tissues surrules. Both simple molecules and
as a tensegrity structure that reg- rounding them and demonstrates complex structures result from
ulates cell function. Mechanical
that the spine is essentially a tenthe interactions of pure energy
engineers also appreciate the dis- sioned structure that can function (forces), and although particular
tinctive properties of tensegrity
the same in any position, and
con igurations dominate, they are
structures and are producing rohow movement is controlled by
not especially chosen by nature
bots for use in the exploration of
the very structure itself. It is atbut because their simplicity, ef ispace etc. Both biologists and entracting the attention of biolociency and stability favours them.
gineers now recognize that the
gists and hands-on therapists beThe real beauty of nature is that it
simple principles of tensegrity
cause it provides a better means
does so much with so little.
can be applied to understanding
to visualize the mechanics of the

the behaviour of more complex
body in the light of new under4 Terra Rosa E-mag

The Shape of Nature

Graham Scarr is a chartered biologist and osteopath, and has been
researching the signi icance of
natural patterns and shapes over
many years. He has also developed
new models that progress our understanding of the structurefunction relationship in human
biology and published several papers on this subject in peerreviewed scienti ic journals. His
fully illustrated book entitled
Biotensegrity: the structural basis
of life now brings all these indings together for the irst time.
gscarr3@ntlworld.com
This article was originally published in the the e-magazine Bare
essentials 2014 issue 37 http://
bareessentialsmagazine.uber lip.com/i/437027/88 )
References
Fuller, RB. 1975 Synergetics: explorations in the geometry of
thinking. Macmillan.

Heartney, E. 2009 Kenneth Snelson: forces made visible. Hard

Press Editions.
Ingber, DE. 1998 The architecture
of life. Scienti ic American
(Jan), pp. 30-39.
Levin, SM.
www.biotensegrity.com

Scarr, G. 2014 Biotensegrity: the

structural basis of life. Handspring Publishing.

This book brings all aspects of tensegrity/

biotensegrity together for the first time, from
its discovery, the basic geometry, significance
and anatomy to its assimilation into current
biomechanical theory.
Available at
www.terrarosa.com.au

Terra Rosa E-mag 5

A Brief Historical Perspective

John Sharkey

Stephen Levin is the father of Biotensegrity. Dr

Levin trained as an Orthopaedic and Spine
Surgeon having formerly been a Clinical Associate Professor at Michigan State University
and Howard University, Washington, D.C. He
studied General Systems Theory with the distinguished biologist, Timothy Allen but is now
retired from clinical practice. Following years
of tirelessly working to seek appropriate focus
of the biotensegrity model, it is currently enjoying growing acceptance and widespread
academic approval.
Work on biotensegrity started in the mid 1970s,
when Levin, a young orthopaedic surgeon, was trying to understand what he was doing as a body
mechanic. Medical education and surgical training,
was to Levin the most anti-intellectual training experience outside of military combat training. Levin
was of the opinion that like combat situations, life
and limb are at stake and there is no room for learning from your mistakes, but only from the mistakes
of others. Being overloaded with facts, given little time to think, too much to do, and little time to do it
in original thought and experimentation was discouraged and usually punished rather than rewarded. It
was only afterward, after all exams were completed, could one begin to think for oneself.

6 Terra Rosa E-mag

BiotensegrityA historical Perspective

Having reached retirement from
a distinguished career in clinical
practice, Dr Levin finally had the
time to do some thinking of his
own. He hoped it was not too
late. He was interested in spine
mechanics and, after all, he
should know something about
spine mechanics since he spent
so many years operating on the
spine. What he had been taught
during his residency training, by
some of the top biomechanics
people at the time, was the application of first year college physics to biologic structures and particularly how it applied to the
human frame. This has been, and
continues to be, the accepted mechanics since first described by
Borelli, a mathematician and
renaissance man, in 1680. Since
that time little or nothing has
changed. Levin was to find that
the promotion of new ideas and
new models that run contrary to
the accepted way of thinking was
to be no bed of roses.
The accepted biomechanics for
living tissue was based on Newtonian mechanics such as would
be applied to a column or building built with rigid materials and standing in one place on solid ground. But Levin argued that humans,
and all biologic structures, are mobile, omnidirectional, gravity independent structures built of soft
matter, foams, colloids and emulsions, (Levin contended that bone and wood are stiff foams, structured
more like Styrofoam), and mechanical laws as applied to these structures would be different. Over time
Levin came to the conclusion that it is impossible to explain the mechanics of a dinosaurs neck using
standard Newtonian mechanics and so he walked a road less travelled. The road to the model of biotensegrity beckoned and became more compelling. Dr Levin lives outside of Washington, DC, and, in the
mid 1970s in his efforts to better understand living mechanics he went to study the dinosaurs at the
Smithsonians Natural History Museum. He could not accept the Borellian model, but could find no
other suitable model to explain how the dinosaurs could hold up their long neck and tail. There are no
tail prints in the sands of time, asserts Levin. Sitting on the mall in front of the museum, Levin looked
across and could see the Needle Tower, a Kenneth Snelson sculpture, right across the mall at the
Hirshhorn Museum. The forces that allowed the Snelson sculpture to exist, tension and compression,
provided the missing link for Levin and the model of biotensegrity began, slowly, to emerge.
Article (copyright Stephen Levin) and Images supplied with kind permission from Dr Stephen Levin.

Terra Rosa E-mag 7

Introduction

many different movement modalities can be at odds

with the basis of the anatomy, physiology and bioMassage therapy is recognised as the manual manip- mechanics in their training studio.
ulation of the soft tissues namely muscles, connecNewtonian-based mechanics, using a post and beam
tive tissue (fascia), tendons, ligaments and joints.
With a clinically oriented bias massage helps allevi- construct, has allowed mankind to build amazing
structures such as skyscrapers, bridges, airplanes
ate the discomfort associated with daily living
and automobiles. To provide stability and controlled
strains and overuse issues leading to pain condimotion in any man made structure a pin joint must
tions. To ensure high standards of education masbe employed to provide a rigid hinge (Fig. 1). This is
sage schools have long included a complementary
a lever system. In order for part A or B to move in a
medical approach. This has led to massage schools
syllabi content including modules on human anato- controlled manner a need exists for the addition of
my and Newtonian based biomechanics. All this was an engine as a source of kinetic energy providing a
in an effort to understand the mechanical structure- force to move one of the lever arms. This is how aufunction relationship. This lever based biomechanics tomobiles, trains and planes are constructed and it
and one muscle one-movement philosophy has long all works very well. Transferring this post and beam,
been at odds with what massage therapists intuitive- lever system to biological structures and cellular netly feel and clinically observe. The lever based biome- works (such as humans) seems to work, initially.
chanics model promotes the existence of individual However thorough investigation and appropriate
scrutiny reveals basic laws that call for new explaparts working independently under continuous
nations and new models. BioTensegrity is the new
gravitational compression.
model of living motion, or biomotional experience. It
In such a model the foot has little relation to the
provides clear and concise explanations based on
wrist, the sub occipital structures work autonomous- continuity, tension, compression and Mechnotransly with no concern for the sacrum and pain experiduction (Sharkey, 2008). These are congruent with
enced in the shoulder would require massaging the the human experience of natural motion.
shoulder and local soft tissues only. Many movement
practitioners are also educated under these laws of
biomechanics. As such the experience for teachers in
8 Terra Rosa E-mag

Image used courtesy of RJ Muna Pictures and Capacitor.

Powering the Fabric of Human Anatomy

John Sharkey
Joanne Avison

BiotensegrityPowering the Fabric of Human Anatomy

Fig 1. This is the upper limb represented as a lever system where joint space (at the elbow) would require a pin for point A
(shoulder) and point B ( ist) to move towards each other. There are no pin joints, or levers, in biologic forms. They can appear to
make lever-like motions, however this is not the basis or the limit of their structure. Copyright: Joanne Avison

Massage therapy and movement nourishing

our inner space
Massage therapists work directly with the cellular
network. So does the body in motion. Any movement
practice, be it exercise protocols or Martial Arts invites us to work at the gross and cellular level. The
cellular network is ubiquitous throughout nature
and can be represented by foams and froth. Foams
and froth can be seen everywhere. Take some water,
soap, mix by shaking and you will get lots of
bubbles making a wonderful froth. The froth on the
top of your morning cappuccino (Fig. 2) is another
great everyday example of a cellular network. It may
even explain the irst basic cell 3000 million years
ago. Look closely at the bubbles and you will notice
they have a distinct number of sides, an innate and
mobile geometry. Some will have three sides while
others may have up to eight sides (polygonal). This
arrangement can be seen everywhere in nature and
is an essential aspect of the hierarchical organization
of all biological organisms (Scarr, 2014, Avison.
2015)). It exists at the microscopic level such as
looking at the arrangement of connective tissue (Fig.
3) to the macro level of skin markings on animals
such as the Giraffe (Fig, 4). Molecules, cells, tissues, organs, and organisms are all constructed on
these tensegrity principles of enclosed geometric
structures within enclosed geometries.
All are in fact tensegrities within tensegrities working collaboratively on a biologically hierarchical ba-

Fig. 2. The froth on the top of your morning coffee is an everyday example of a cellular network. (Image: Authors own)

sis. Within these hierarchical biological tensegrity

systems (BioTensegrity), the individual cells, which
are self stressed (AKA Pre-stress), are poised and
ready to receive mechanical signals that are then
converted into biochemical expression, termed
mechanotransduction (Ingber, 2008). The geometric
patterns or organisations of the cellular network is
even used to explain the anatomy of space. Astrophysicists call the distribution of galaxies the cosmic
Terra Rosa E-mag 9

Fig. 3. Hierarchical organisation exists at the microscopic level such as looking at the arrangement of connective tissue (With
kind permission of Dr J.C.GUIMBERTEAU and EndovivoProductions)

Fig. 4. Hierarchical organisation also exists at the macro level of skin markings on animals such as the Giraffe. Image by Shane
McDermott Photography reproduced with his kind permission (www.wildearthilluminations.com)

10 Terra Rosa E-mag

BiotensegrityPowering the Fabric of Human Anatomy

foam demonstrating a common fabric from Nano to
Macro (smallest to biggest).
The fabric of our inner space is made up of a continuum of soft matter comprising specialist tissue variations, all designed around these natural principles
of biological structure. Variations range from blood
cells to bones, digestive cells to autoimmune structures, mesentery, muscle, nerves and everything in
between. In massage therapy we make contact with
that inner cellular network by touching the outermost reaches of the same cellular network, the skin.
In movement, we organise the outside via the inside
and vice versa.
While the topic of fascia in movement has been the
focus of anatomical study in the last number of
years the topic of continuity has taken second place.
Fascia is the primary fabric providing continuous
tension throughout the whole organism. Fascia is
one of the specialties of our connective tissues including the bones (providing compressional forces)
classically referred to as the skeletal system. A critical point to drive home at this juncture is that fascia
and bones are not separate tissues. They are specialties existing in a continuum. They have different
densities and speci ic organisations, however they
form and evolve together embryologically and
throughout life as a continuum. They may be distinct, offering different frequencies within the same
force transmission system. However, all bodies,
whether they are moving themselves or being
moved by the massage or movement therapist, are
changing and organising via these responsive and
intimately related tissues that do not arise separately from each other.
Tensegrity structures can include bridges and geodesic domes, which are non-living structures. (Fig.
5) BioTensegrity (Levin 1982) refers to living
things. A tensegrity has no breath, no conscious
driven electromagnetic activity, no original thought,
no imagination, no love for music or prose.
Tensegrity does not suffer pain. BioTensegrity can.
Living cells and tissues share a common structural
relationship with non-biological tensegrity structures. Each has two members namely tension and
compression existing to provide structural integrity
to the whole. Other differences include the fact that
in non-living tensegrity structures these tensional
and compressional members are connected. In BioTensegrity these members are not so much connected but are continuous. They change shape (and can
change roles) depending on the forces acting upon
them. They are shape shifting. In a tensegrity system, such as a bridge or a building, bolts, screws and

Fig. 5. This complex architecture forms a dome in the ancient

Ulm Munster in Germany. Unlike living organisms, this has the
attributes of a linear, non-biologic architecture which relies on
speci ic ixed arrangements of compression structures. Geodesic Domes follow the rules of tension-compression architecture; incorporating mutually interdependent forces. (Image:
Authors own)

pins are required to join the members and ensure

integrity. In biological tensegrities there is no need
for screws, bolts, beams or gravity. There is no friction, no sliding.
Tissues glide relative to one another, as there are no
layers. They all exist as specialties along the living
continuum. Tissues can resonate and respond to the
forces around them and share properties such as
the incorporation of polarity innate to the tensioncompression design. The wholeness and integrity of
that structural coherence relies upon the relationship and balance of these co-existing forces, united
to form the whole structure. In other words, without such specialties their integrity would be compromised. Thus there is a built-in mutual codependency from which comfort, ease and balanced
motion or stability arise.
When a client attends a massage clinic the focus for
the therapist is to restore what has been lost,
through pain or injury for example, when the balance of these forces has been compromised. In
Terra Rosa E-mag 11

many cases what has been lost is structural integrity

due to excessive tension and/or compression. A typical presentation seen in the clinic is rounded shoulders. In such a case it is obvious that excessive compression is being exerted anteriorly while excessive
tension is experienced posteriorly. (This will appear
as shortening at the front and overly long tissues
at the back). Joint space becomes compromised, fascia thickens to support the new posture and bones
and other soft tissues can drift out of alignment if
such a situation perpetuates without attention. We
might generally refer to such posture as a
compensatory pattern. Forces may not be dealt
with appropriately creating additional strain thus
creating a downward spiral throughout the entire
organism. The solution would be to restore balance
between the forces of tension and compression.
Treating the anterior chest and upper back may
seem to be the order of the day however treating the
person on the principles of BioTensegrity requires a
whole body, whole person approach. While the treatment of local body parts is required this approach
alone will seldom result in sustainable success. A
combination of local changes and global reinforcement, with movement education can bring
about a new soft tissue pattern that permits the
whole structure to gradually change and sustain a
more useful one; especially if it means less pain and
the possibility of reversing the downward spiral to
an upward one; bene iting the whole organism.
In the BioTensegrity model strains are evenly distributed throughout the structure. When good tissues go bad the client will experience pain and
changes in sensations at the weakest points in the
structure. These points may be some distance from
the source of the issue or the original insult. In the
BioTensegrity model the harder soft matter (the
skeletal tissues) act as spacers providing virtual
space but real distance between the bones. Bones
should never touch. In anatomy the ends of bone can
be described as articulating surfaces but the truth is
they are near frictionless. The upright human is not a
stack of bones resting on top of another, despite the
fact the spine, for example, is commonly described as
the Spinal Column. If it really behaved as a column,
then a small tilt would disrupt its structure and massage would destroy its structural integrity. Bones are
suspended internally, loating in the sea of connective tissues that provides the nutrient tension all
around them; emphasised by the surrounding skin.
Bones provide the compressive energy and together
with the fascia provide us with tensional integrity or
lift. This is the reason humans dont fall down or fall
apart when they lie down and get up again. These
are mutually co-dependent or inter-dependent forc12 Terra Rosa E-mag

es, giving rise to the ability to move around as humans and animals do; the way they do.
BioTensegrity is an essential model for massage
therapists and movement practitioners of every
stripe. Understanding this model will provide you
with the vocabulary and underlying logic of body
architecture that forms the context of therapeutic
bene its. BioTensegrity will add to your con idence
and ability to achieve those therapeutic goals. A new
era is dawning in our understanding of anatomy and
living movement. That new anatomy and understanding of whole body structure is BioTensegrity.

References
1. Levin, S. M., 1982. Continuous tension, discontinuous compression, a model for biomechanical support
of the body. Bulletin of Structural Integration, Rolf
Institute, Bolder:31-33.
2. Ingber DE. 2008. Tensegrity-based mechanosensing from macro to micro. Prog Biophys Mol Biol. 97(6
-3):163-179.
3. Scarr, G. M., 2014. Biotensegrity, The Structural
Basis of Life. Handspring Publishing Ltd. ISBN:
9781909141216.
4. Sharkey, J. 2008 Concise Book of Neuromuscular
Therapy. A Trigger Point Manual. Lotus Publishing
and North Atlantic Press.
5. Avison, J. 2015. YOGA Fascia, Anatomy and Movement. Handspring Publishing Ltd.

John Sharkey, Clinical Anatomist and Founder
European Neuromuscular Therapy. MSc., Department of Clinical Sciences, University of Chester/NTC,
Dublin , Ireland. E-mail address:
john.sharkey@ntc.ie www.johnsharkeyevents.com

Joanne Avison Professional Structural Integrator
and Advanced Yoga Teacher (E-RYT500) KMI, CTK,
IASI. Kinesis Myofascial Integration. E-mail address:
jo@joanneavison.com www.joanneavison.com

Read 6 Questions to John & Jo on page 60-61.

Maximise Oxygenation
A N AT O M Y F O R T H E 2 1 S T C E N T U RY

BIOTENSEGRITY
with John Sharkey
Sydney, June 2016
Myofascial Trigger Points (MtPs) Versus
Neuropathies
A unique integrated neuromuscular approach for the
treatment of unresolved pain due to MtPs or nerve
insults.
This is that one stop workshop that covers everything
you need to know about identifying and treating Myofascial Trigger Points and nerve injury. David G Simons
(Travel and Simons), the farther of Myofascial Trigger
Points was mentor to John Sharkey and wrote the forward to Johns first book (a trigger point manual). Differentiating between neural generated pain and Myofascial
Trigger Point pain is essential in providing the correct
soft tissue interventions for successful therapeutic outcomes.

The Final Frontier

Working within Endangerment sites, providing
Manual and Movement Techniques to stay mobile
and pain free.
This informative workshop provides therapists with the
necessary anatomical and palpatory excellence to expertly navigate the holy grails of the human body
(endangerment sites). Providing safe neuromuscular
techniques using digital applications guarantees effective therapeutic interventions for soft tissue based
chronic pain conditions. Through your newfound anatomical knowledge and unique hands-on clinical pearls
each learner will develop a greater appreciation of local
and global anatomical connections.

The Theory of EverythingBioTensegrity, anatomy for the 21st century

This workshop is ideally suited to the advanced manual and movement therapist with appropriate clinical experience
and a desire to take on fresh new ideas, new models and a new way of thinking. Therapists are warmly encouraged
to demonstrate their current screening, assessments and therapeutic applications with John while he will provide
feedback and suggestions offering a new vision supported by connective tissue techniques for successful manual
and movement interventions for all participants. This workshop provides you, the chronic pain soldier the effective full
body kinetic chain ammunition you need in the war on pain.
John Sharkey MSc is a world renowned presenter and authority in the areas of bodywork and
movement therapies. He is a Clinical Anatomist (BACA), Accredited Exercise Physiologist (BASES) and
Founder of European Neuromuscular Therapy with more than 30 years of experience gained throughout
his career working alongside his mentors and colleagues Leon Chaitow, David G. Simons, Stephen Levin MD, Prof. Kevin Sykes. John is recognised as a leading protagonist of BioTensegrity (providing new
models and paradigm shifts concerning living movement and anatomy promoting therapeutic interventions for the reduction of chronic pain.

Terra Rosa E-mag 13

For more information & Registration, visit www.terrarosa.com.au

The Elastic Body

Introducing BioTensegrity as a model of
Elastic Integrity in the moving body

Joanne Avison

Fig. 1. Image used for the First BioTensegrity Summit in Washington DC; September 18th 2015. [biotensegritysummit.events.] and
reproduced with kind permission from capacitor.org and the photographer RJ Muna (rjmuna.com).

Everyone has a motion pattern that we could call

a movement signature. Working in yoga, or any
movement modality, a teacher naturally develops a more re ined sense of peoples individual
styles and movement expressions. Considering
the fascial matrix as a dynamic, self-organising,
BioTensegrity architecture can transform our
ability to see how individuals develop their
unique movement signatures within the protocol
of a given class. Part of this includes recognising
different fascial types and the value of elastic integrity. In this article it is viewed as an asset to
14 Terra Rosa E-mag

optimising any individuals quality of movement.

As well as shifting more popular ideas on
stretching for its own sake, the BioTensegrity
model provides a valuable tool for recognising
optimum movement patterns at the speed of motion. This discussion emphasises the general
shift from seeing muscles as functional units, to
understanding the fascial matrix (including muscles and bones) as a whole body architecture of
soft tissues, morphologically unique to the selfmotivated individual moving it.

The Elastic Body

Fig. 2. The Elastic Body relies on different elements to ind Elastic Integrity for each individual movement signature; relating closely to
the fascial body type.

Body-writing in Our Own Hand

Flexibility and stretching tend to be held as the archetypal movement celebrities, particularly in yoga.
Those with naturally bendy bodies can get top marks
while the stiff people, who feel they cannot stretch
to twist and contort with ease, are often considered
not as good as their naturally lexible companions.

and overall tensional sogginess. This depends on the

fascial body type of an individual and the way they
load their tissues over time.1,2
Drawing from several different aspects of recent research, we might consider the two ends of a scale
from strength to stretchiness, in natural tendencies
of fascial body types. For example, a strong, Viking
type3 body may tend towards strength and stiffness
naturally. A bendy or sinewy, jungle type body may
err on the side of lexibility. Referring to the members of a movement classroom, the key is inding balance between the two extremes of the graph depending on their particular movement signature. The beneits of stretching or strengthening will be found in
relatively opposite ways for each of these types, if
the value of elastic integrity is to bring vitality to
their very different signatures.

There is, however, a much more valuable and powerful distinction available, once we appreciate the
myofascial body and its structure, as a whole dynamic anatomy of continuity. This distinction lies in recognising elasticity as paramount and understanding
that for some individuals it is enhanced by stretching
and for others it is the opposite. There are those that
will increase their natural elastic integrity by stiffening the tissues. This makes sense if the foundations of
BioTensegrity and the context it provides to describe
human movement are de ined. This is as the basis of Elasticity as an Asset
the collagen network of every human form: a matrix
Identifying authentic elasticity is extremely valuable
intimate to every tiny part of us, formed under tenas a teaching tool and an important kinaesthetic dicsion since we began to self-assemble as embryos.
tionary to expand and refer to. This is partly because of its global application in reading bodies accuEnergy Storage Capacity
rately and partly because it makes sense of structurElasticity is the source (and containment and replenal integrity of the whole animated form. Elasticity
ishment) of our energy storage capacity. Once we
really means resistance to deformation and implies
understand it and there are a lot of misconceptions
ef iciency of reformation. In other words; how do we
around it we have an immeasurably valuable rechange shape, respond appropriately and then resource for vitality. Really it comes down to an approstore optimum shape after doing so? The best way of
priate balance between overall tensional stiffness
obtaining structural integrity might include stretchTerra Rosa E-mag 15

ing and strengthening but such ef iciency and resilience (see Fig .1) is by no means limited to either.
Elasticity emerges as the paramount asset to ef icient movement and poise in stillness. It refers to
moment-by-moment changes locally and globally,
while nourishing structural integrity over time.
Exploring New Terms
It has been shown that fascial stiffness and elasticity
play a signi icant role in many ballistic movements of
the human body. First discovered by studies of the
calf tissues of kangaroos, antelopes and later of horses, modern ultrasound studies have revealed that fascial recoil plays in fact a similarly impressive role in
many of our human movements. How far you can
throw a stone, how high you can jump, how long you
can run, depends not only the contraction of your
muscle ibres; it also depends to a large degree on
how well the elastic recoil properties of your fascial
network are supporting these movements. Robert
Schleip4
Robert Schleip refers in this quote to the elastic recoil properties of fascia in ballistic movements.
However, if biotensegrity is the basis of the architecture of our collagen matrix, then it also has elas- Fig. 3. The Bendy Wendy body type, sketch reproduced with pertic integrity when we are still. We do not de late.
mission from the author.
The body bene its from the value of elasticity just as
much when sitting on a meditation cushion or run
ning a marathon: peak performance and peak preThe useful schematic in Fig.2 is deceptively simple.
formance are both animated by the same system.
Balance and access come from the centre: it is a
Understanding and recognising innate elasticity is
question of ensuring balance of suitable stiffness,
made more dif icult by the many different meanings which means suitable resistance to deformation and
we have for the word elasticity itself. There is a
ef icient reformation. This is unique for each indigeneral perception that it is associated with stretch- vidual. In fact, Bendy Wendy (see Fig. 3) may need
iness and lexibility (the archetypal heroes in most
more stiffness, not more stretching.
yoga-based movement classes). The enemies in that
The terminology needs some reframing and the idea
environment might be seen as tension, stiffness,
that yoga is synonymous with stretching might be a
strain or stress. In the definition of elasticity howevdisservice to the potential power of its contribution
er, it is the lack of suitable stiffness that can be a
to elastic integrity. Elastic energy is very low-cost
de icit to structural integrity. Despite the level to
metabolically: it is the essence of healthy, vital
which it is favoured in yoga teaching, stretching is
movement. On or off the mat, we seek a signature
just one aspect of a much broader picture: one that
becomes clear if BioTensegrity principles are appre- our body signs with vitality whatever movements
we are doing. Mixing modalities to bring this balciated.
ance may be the most useful way to work and foster
In order to see this as a general and global distincthis valuable asset of architectural integrity. In othtion for movement integrity and overall vitality
er words, a balance between stretching-type move(including at rest) we can include four main attribments and those based upon resistance may hold a
utes of elastic integrity (Fig. 2).
key to elastic integrity.
16 Terra Rosa E-mag

The Elastic Body

Elasticity can be considered asone side of a coin.
The other sideof that coin is stiffness. Stiffness is
the resistance to deformation of a material. Elasticity is the efficiency of reformation. The literal definition is stored energy capacity which is a function of
elasticity and stiffness in mutual balance. The
amount of stored energy capacity is relative to the
stiffness and elasticity of a material. On this basis,
steel has higher energy storage capacity (elasticity)
than rubber. A steel car spring has high stiffness,
while a Slinky toy has low stiffness. Both have elasticity. The car spring (higher stiffness and elasticity)
is better able to resist deformation and therefore to
be supportive.

is a time-dependent way of regulating elastic spring

-back. The internal tissues of the human body rely
on this to change from one movement to another.

Poroelasticity is a feature of geology that is also relevant to the extracellular matrix.5 The combination
of our tissues and contained fluids includes these
characteristics as essential ingredients of our architectural form, from embryo to elder. They change
constantly and yet remain in integrity, re-arranging
as we do, movement-by-movement and moment-bymoment; inwardly and outwardly. This is what defines us as living forms and is re-defined by understanding the geometries of biologic forms, such as
the full model of BioTensegrity represents on every
scale. We are made up of various chambers in and
Viscoelasticity. In liquids, this same principle is
measured in viscosity (thickness). Honey is more
around the Extra Cellular Matrix; holding together
viscous than water because it resists deformation
a variety of colloids, foams and emulsions of our inwhen you stir it. Water has relatively lower viscosity ternal chemistries and fluids. Thus a poroelastic asand is less resistant to deformation. Viscoelasticity
pect of our internal close packing systems may be a
acts as a damper (i.e. such as would be placed on a valuable aspect of the BioTensegrity model.
stiff car spring to modify the rate of elastic return). It

Fig. 4. Tensegritoys these tensegrity model toys were created by

the Manhattan Toy Company in consultation with Tom Flemons
of Intension Designs.6

Fig. 5. Suitable Stiffness: This tensegrity mast has no elasticated

components. Nevertheless, it demonstrates high elasticity, because it has suitable stiffness. Model designed by Bruce Hamilton and constructed by the author.9

Suitable Stiffness as an Attribute of Biotensegrity

nal struts and the density of the external tensional

elements that provides elasticity to the different
aspects of our overall form. This can be demonstrated with the models in (Figs. 4 and 5).

Confusion about elasticity is also created by the use

of elastic bands in building biotensegrity models.
The distinction is between elasticity as a property of
any material and elasticated bands. Biotensegrity
models are actually optimised using non-elasticated
materials, to demonstrate strength and accurate
examples of how collagen behaves in our body architecture. It is the sum of their combined tension
compression organisation combined in specific geometries, the balance between the length of the inter-

You may be able to see that the toy on the left is

soggy: it has very low tension, or stiffness. The one
on the right can bounce more. These are
Tensegritoys7(Fig. 4) with elasticated tension
members and compression shafts made of wood,
organised as one continuous structure. They are
identical in size but the left-hand toy has lost its tensile integrity and is more collapsed. It has comparatively low stiffness. This does not represent lexibility, rather it shows lack of suf icient tensile integrity

The Middle Way

Terra Rosa E-mag 17

to hold itself up.8

While the tissue itself has recoil properties, a common misunderstanding is that the balance of elasIn these models, the soggiest one (Fig.4) is the
tin and collagen within the fascial ibres gives rise
most stretched, which in this model makes it the
to our elasticity. Elastin ibres can elongate up to
weakest of the three. Stretching is an ingredient in
150% of their length and restore or reform. It is, in
the recipe for structural integrity but only in balfact, one of the suite of tissues the body calls upon
ance with suitable stiffness and depending, to some
in wound healing.10 Suitable tensile properties in
extent, on the movement signature of the individual. our tissues and their overall elastic integrity rely
The mast, with no elasticated fabric, retains its elas- upon the stiffness of the collagen matrix, which is
ticity when it is bounced, held out or up or hung upessentially low in deformation and relatively high
side down. It is independent of gravity in that sense. in resistance to it (i.e. stiffness). (It stretches up to
about 5% only.) This, in balance with our architecIt is the most balanced and resilient of the three
models because it has the highest tensional integrity ture, creates overall energy storage capacity. If we
were too elasticated we could not function: the
and stiffness: it is by far the stiffest of the three. In
this context, it is the guardian of the highest energy energy literally leaks. It can look like a soggy structure that needs strengthening, stiffening, or makstorage capacity.
ing taut. A marquee is not a tensegrity structure as
such, because it relies on being pinned by guy
The mast in Fig 5 is made of guitar strings and hol11
low steel arrow shafts. It is exceptionally light and wires to the ground (we do not, even though we
encloses a maximum of space with the fewest mate- are bound to return to it. We can move independently of gravity). However, a tent is a tensionrials. Any force applied to it can be seen and felt to
compression model of sorts. Imagine using elastic
be transmitted to varying amplitudes throughout
guy wires and bendy tent poles. They would not
the whole structure. This is a compelling model of
tension or stiffen the fabric of the marquee sufbiological dynamic architecture, seen throughout
iciently to take appropriate care of the internal
the dynamic anatomy of living forms and their high- space or the external forces acting upon it. They
ly ef icient ability to move around.12 It is a trianguwould have low resistance to deformation. This
is the basic and simple way to begin understandlated structure (which provides some relative stability) and reveals a host of properties that we have ing our innate dependency on the logic of BioTensegrity as a powerful model of the architecture of
throughout our tissues. It stands up, in all direcour living form.
tions, by itself and, as a whole, it can bounce. It is
also a model of a closed kinematic chain with multithreat to its structural integrity. In a cartwheel or a
bar linkage and no levers.13 (See also Fig. 1 on page
yoga pose with the spine parallel to the ground, the
9).
bones would break apart if the spine followed the
Whatever direction you pull or push this model in,
rules of a stacked linear structure. It cannot be usethe structure gives, but naturally resists deforfully analysed on the basis of Newtonian physics
mation which means it has high elasticity. Whether
and laws of compression-based, hard matter organiyou pull, push, bend or twist, the architectural gesation. Human bodies do not conform to that logic.
ometries naturally counter any movement by stiffOur various soft tissues (harder bones and softer
ening the whole structure in resistance to defortissues around them of varying densities are all soft
mation. It then reforms immediately from defortissues) conform to the very different laws of soft
mation (within its resilience range) maintaining the
matter. They are non-linear biologic structures.
right internal spatial relationships. This relates to
Once we place ourselves in a handstand, or pound
our ability to perform postures or athletic feats,
around a running track, bits of us dont fall off!! As a
without toppling body parts. If the human spinal
general rule, in healthy bodies, we restore our form
column really was a stacked vertical column, then
soon after making shape changes. This makes us
even a slight tilt, would destroy our structural integliving examples of how BioTensegrity principles
rity. Columns are compression structures, like
work as dynamic whole physiologies.
stacked bricks in a house wall. They conform to the
laws of hard matter and non-biological linear orWhat this suggests is, effectively, the muscles can
ganisation. If we change the angle of the ground or
act more like brakes, while the tendinous tissues
attempt to move the structure it poses a signi icant
lengthen and shorten like springs. In terms of ap18 Terra Rosa E-mag

The Elastic Body

Fig.6 Images of research by Kawakami and colleagues (see note 13), after Schleip, showing the cooperation of muscles and fascial
tissues. A is the classical view of the muscle moving with a relatively static tendon; B is the research result, showing the muscle acting
more like a brake, while the tendon lengthens and contracts, acting more like a spring.

New Strategies: Elastic Integrity as a New Value

A useful example of the paradigm shift between more classical notions and that of BioTensegrity as a biomechanical model, is in research on the Achilles tendon. Classical kinesiological models suggest that in
jumping, for instance, the Achilles tendon is the strong, supportive, relatively less mobile binding, connecting the calf (gastrocnemius) muscle to the heel (calcaneus) at the back of the ankle joint. The
movement occurs at, or has been classically assigned to, the calf muscle (gastrocnemius), as it actively
contracts and releases (i.e. based on the action classically assigned to that particular muscle).
Using modern ultrasound equipment capable of measuring the muscles and the fascial tissues in vivo,
however, researchers were surprised to discover that in oscillatory movement, the muscle ibres contract,
or stiffen, almost isometrically (without changing length) and the Achilles tendon in fact acts like a strong
elastic spring (Fig. 6).14 This would mean the muscle can act more like a brake on the spring-loaded recoil
of the pre-tensioned Achilles, under such circumstances. This might suggest the muscles have a role in
modifying or regulating stiffness and elasticity in appropriate length to tensional balance.
plied BioTensegrity, the body-wide implications of
this have global effects on organisation of the structure as a whole. In other words, the muscle (which
of course is a myofascial component of a global network or matrix of soft tissues) acts more like (in Dr.
Stephen Levins words) a turnbuckle15 in the bodywide tensioned web. The internal compression
members (bones) globally tension the external soft
tissues surrounding them, which in turn compress
the bones, which in turn tension the tissues and so
on and on. Thus they are in a mutual balance that
allows forces to be appropriately transmitted
throughout the structure as a whole. This balance
also preserves internal spaces; such as at the
joints16 or through the neuro-vascular vessels. The
more we look, the more examples of elastic integrity
we ind in every aspect of the form and on every

scale.


What this research all suggests is that we rely on
elasticity perhaps more than we realise. The revelations about the fascial matrix are shifting the explanations we have for biomechanical function. They
also raise many new questions and begin to make
sense of why describing the experience of animating
yoga postures in terms of levers, for example, is so
awkward. According to Dr Levin there are no levers
in biologic systems. Anywhere.17


Terra Rosa E-mag 19

The Elastic Body

Joint Space
Levers
Levers are two-bar, open-chain linkage systems that
do not explain our multi-joint and multi-directional
abilities to move and balance. There are no pins at
the joints, such as would be necessary in a two-bar
(lever) open-chain system.
We maintain the joint space and its integrity
through the omni-directionality of our living tissues,
continuous from inger to toe, from side to side, front
to back and top to bottom. This moves us from linear
mechanics, hinge like joints and one muscle works at
a time mentality to a more global, continuous tensioned contractile fabric that facilitates closed chain
kinematic linkages. A three bar linkage system would
be too rigid and would not allow movement.
[suggesting that closed chain 4-bar and multi-bar
linkages are the minimum] John Sharkey18
How can this be applied?
We are invited by various research into the fascial
matrix19 to view the muscles (and any other components of our form) as part of the continuity of myofascial balance throughout the tensional web of our
architecture, in multiple dimensions. The tissues
clearly participate in the subtle translation and mediation of all types of movement. While this research focuses on different speci ic types of tendinous organisations, we must remember that the
body itself does not go about getting agreement
from each separate part. It organises and acts as an
instinctive whole and the fascial matrix may be the
uniting medium in which these specialisations occur.
Anatomy Trains 20 encourages us to see the musclesin-fascia in longitudinal bands of continuity. This
suggests both fascia (inclusive of tendons, ligaments
and tendinous sheets) and muscle (in which it is
profoundly invested) form integrating bands from
head to toe.21 Whether you agree with the anatomical content of individual lines, slings or layers, Myers takes us towards an anatomical view of the body
that endorses wholeness. He refers to the myofascial meridians as lines of pull, which is an important distinction in terms of elasticity. They are
pulled even when we are resting. The bones of our
BioTensegrity architecture maintain them under
tension. They have to have something to pull on!
20 Terra Rosa E-mag

Fig. 7. The so-called Super icial Back Line22 is a metaphor for continuity. It is not separate in the living body from the layer beneath
or those either side of it. In a movement class we do not have time
to assess muscle by muscle nor does the body move that way.23

Fig. 7 shows the Super icial Back Line of Anatomy

Trains (which includes the tissues of the foot, the
Achilles, the calf and all the way up the hamstrings,
erector spinae and over the back of the head to the
bridge of the nose) can be shown to form a continuous layer and band, under tension.
We have to expand our view to include the whole
body to get a sense of why the bones play such an
important role in creating suitable tensioning, or
stiffness, in our tensioncompression form. This is
the quantum leap, from muscles as levers to muscles as moderators of stiffness and stretch. We
might call them tighteners or modi iers in the
weave of our three-dimensional architecture.
When you tension an elastic band and stretch it, Fig.
8 you are sensing its resistance to deformation, that
is, its stiffness. When you release it you are demonstrating its elasticity, that is, its ability to return, or
reformation. Two important facts arise from doing
this exercise, which are:(1) You need suf icient re-

The Elastic Body

Fig. 9. This puppy is using its whole body, from tail tip to nose
tip to balance the overall structure. The BioTensegrity model
explains this as a whole body architecture; expressing emergent
properties to balance from moment to moment, as distinct from
the more classical lever mechanics. (Reproduced with kind permission from Shane McDermott,
www.wildearthilluminations.com)

Fig.8. An elastic band at non-tension (A), semi-tensioned or mid

-point (B) and fully stretched (max-point) (C) (Reproduced with
permission from the author)

sistance to deformation (stiffness), or the band is

loppy and pulled out of shape too readily. (2) By
fully releasing the band you do NOT demonstrate
resting tension in the human body. It is the halfway
point of the elastic band, the semi-tensioned stage B
that demonstrates resting tension in the human
body. We are pre-stiffened or pre-tensioned because we do not de late. We never experience the
state represented by the elastic band at rest. We
start at the second stage, the middle way, which is
our default elasticity at rest and in stillness.
Elasticity is an energy asset throughout many forms
of our internal and locomotive structure, and many
aspects of our architecture actually rely on it in
health.
the visco-resilient nerves are under a constant internal tension. The strength of these forces is seen in
ruptured nerves. Simply because of their tremendous
elasticity, the two severed nerve stumps shorten by
several millimeters. In repair procedures, the surgeon
has to use a considerable amount of strength to bring
the two nerve ends together again ... It is elasticity
that allows nerves to adjust to the movement of a
joint without loss of function.24

The research that is accumulating on the study of

biotensegrity is perhaps so compelling because in
some aspects it suggests a scale-free explanation of
our movements: from organelles within a cell, cells
within an organ, vessels throughout the body and so
on to include the whole organism. We recapitulate
at the cellular level the same micro-patterns as
whole bodies performing macro-movements, on a
larger scale. This is also re lected in our personal
evolution and development from embryo to elder.
It is invariably on an individual basis as each person
moves uniquely at any given moment in time: accumulating their own physical and emotional tendencies and gestures.
A recognised characteristic of connective tissue is its
impressive adaptability. When regularly put under
increasing physiological strain, it changes its architectural properties to meet the increasing demand.25
Whichever way we do movements, exercises, yoga
or other physical pursuits, we are looking for a
place of elastic integrity, wherever we are (at the
time) in terms of resting tension. While we are alive,
we do not get to abstain from this choice. The vote
for inertia sets up its own strain (or lack of strain)
patterns. The lack of strain allows for the sogginess
we observe in the weaker of the two models in Fig.
4. What is also crucial is the timing of how our
strain patterns are accumulated. The myo part of
Terra Rosa E-mag 21

the myofascia (tensioned as it is by the bones)

works in co-dependent relationship to modify stiffness and elasticity in balance. Each aspect can respond in different time frames.
Summary and new considerations
So how do we put all this together? Besides the
knowledge we have for training and exercise, we
uncover a body-wide explanation that includes using muscles for strength and tensioning, while beneiting from using tissues for stretch and lexibility. It
begins to explain motion in 360 degrees with a
whole range of variabilities. It also invites us to reconsider stretching or stiffening (e.g. through
resistance) as better or worse forms of training the
body. The relative value of either of these types of
movements, resides in whether or not they work for
the individual accumulating them in their tissues
and to what degree. That is, what value do they have
in the goal of optimising resilience and balance or
poise for their unique elastic body?
BioTensegrity raises many new questions as a model of human form and movement. It doesnt it easily
into the biomechanical models of disconnected
parts that might be described as acting independently of one another. It also invites new semantic distinctions and connotations for words like
stiffness, tension, resistance and strain and
stress. We are called to rede ine stretching, for example 26,27,28, and review the context in which it is
upheld and used in movement training.
One of many dif iculties encountered in explaining
the essential organisation of BioTensegrity, is the
need to reside in paradox: that which connects (the
fascial connective tissues) also disconnects (the
membranes thereof). That which tensions also compresses. That which is under compression is simultaneously tensioning. In essence, the ability to fully
appreciate the art of the Elastic Body is enhanced by
understanding the science behind dynamic models
such as BioTensegrity. It is a new science of Body
Architecture and one that may transform the ability
to learn, teach and express our movement signatures safely and with vitality.



22 Terra Rosa E-mag

Endnotes:
1 Schleip R. Schleip, D.G. Mu ller, Training Principles for
Fascial Connective Tissues: Scienti ic Foundation and
Suggested Practical Applications, Journal of Bodywork
and Movement Therapies 17: 103115; 2013 and Terra
Rosa e-magazine No. 7, March 2011.
2 Joanne S Avison, YOGA Fascia, Anatomy and Movement,

Handspring Publishing 2015, Chapter 8, The Elastic Body

3 Joanne Avison, YOGA Fascia, Anatomy and Movement,

Handspring Publishing 2015, Chapter 13, Posture Pro iling

4 Robert Schleip, Foreword, in Luigi Stecco and Carla
Stecco, Fascial Manipulation: Practical Part, English edition by Julie Ann Day, foreword by Robert Schleip, Piccin,
Padua, 2009.
5 Leonid Blyum (http://blyum.com/). Private presenta-

tion at the Biotensegrity Interest Group (B.I.G.) Europe,

Ghent, 2013

6 Tom Flemons made and sold toys designed on tensegri-

ty principles for many years. His Skwish toys were licensed to a local company to manufacture in 1987. Manhattan Toys subsequently bought that company and the
licensing rights in 1995.
7Ibid. See also, for further reading: http://

www.intensiondesigns.com/bones_of_tensegrity.html
8 Note: For an example of insuf icient stiffness, this reference links to a ilm about a condition called Swimmer
puppy syndrome : see YouTube references to Swimmer
Puppy Syndrome: http://www.wimp.com/
puppytherapy/ for video
9 Bruce Hamiltons designs can be seen at
www.tensiondesigns.com.
10Adjo Zorn and Kai Hodeck; In: Erik Daltons The Dy-

namic Body, Freedom from Pain Institute, Oklahoma,

2011.
11 Bruce Hamiltons designs can be seen at
www.tensiondesigns.com.
13 Graham Scarr, www.tensegrityinbiology.co.uk, article:

Geodesic. See also: Biotensegrity: The Structural Basis

of Life, Handspring Publishing Ltd., Pencaitland, 2014.
13 Joanne Avison, YOGA Fascia, Anatomy and Movement, Handspring Publishing 2015, Chapter 7.
14 Y. Kawakami, T. Muraoka, S. Ito, H. Kanehisa and T. Fukunaga,

In vivo Muscle Fibre Behaviour During Counter-Movement

Exercise in Humans Reveals a Signi icant Role for Tendon Elasticity, Journal of Physiology 540: 635646; 2002.
14 Stephen Levin, personal communication at the Bioten-

segrity Interest Group, Belgium, 2013; http://

www.biotensegrity.com/muscles_ at_rest.php; A.T. Masi
and J.C. Hannon, Human Resting Muscle Tone (HRMT):
Narrative Introduction and Modern Concepts, Journal of
Bodywork and Movement Therapies 12(4): 320332;
2008.

The Elastic Body

16John Sharkey, BioTensegrity. The fallacy of biomechan-

ics. Journal of Australian Association of Massage Therapists.Volume 14, issue 2 Winter 2015

theme see YOGA Fascia, Anatomy and Movement, Handspring Publishing 2015, Chapter 12, Yoga and Anatomy
Trains

17 Stephen Levin: www.biotensegrity.com: Home Page

and several articles under Papers: Tensegrity: The New
Biomechanics.

24Jean-Pierre Barral and Alain Croibier, Manual Therapy

for the Peripheral Nerves, Churchill Livingstone, Edinburgh, 2007.

18 John Sharkey, see article in this edition of Terra Rosa

magazine BioTensegrity page 6-10.

25 Robert Schleip, Thomas W. Findley, Leon Chaitow and

Peter A. Huijing, Fascia: The Tensional Network of the
Human Body, Churchill Livingstone/Elsevier, Edinburgh,
2012.

19 Robert Schleip, Thomas W. Findley, Leon Chaitow and

Peter A. Huijing, Fascia: The Tensional Network of the

Human Body, Churchill Livingstone/Elsevier, Edinburgh,
2012.
20 Thomas W. Myers, Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists, 2nd edition,
Churchill Livingstone, Edinburgh, 2009.
21Joanne Avison, YOGA Fascia, Anatomy and Movement,

Handspring Publishing 2015, Chapter 12, Yoga and Anatomy Trains

22 Thomas W. Myers, Anatomy Trains: Myofascial Meridi-

ans for Manual and Movement Therapists, 2nd edition,

Churchill Livingstone, Edinburgh, 2009. The Super icial
Back Line
23 For a more detailed explanation expanding on this

26 Luiz Fernando Bertolucci , Pandiculation: Natures

Way of Maintaining the Functional Integrity of the Myofascial System?, Journal of Bodywork and Movement
Therapies 15(3): 268280; 2011.
27 Doug Richards, University of Toronto, Assistant Profes-

sor, Medical Director, David L. MacIntosh Sport Medicine

Clinic. Also see www.youtube.com/watch?
v=7qYYhkfu_vc for a 45 minute presentation by Doug
Richards called Stretching: The Truth.
28For a more detailed explanation expanding on this
theme and further reading references see YOGA Fascia,
Anatomy and Movement, Handspring Publishing 2015,
Chapter 4, Biotensegrity Structures and Chapter 8, The
Elastic Body

YOGA: Fascia, Anatomy and Movement seeks to bridge

the divide between the application of classical anatomy
and real-life experiences of practicing and teaching
yoga.
Whatever your style of yoga, YOGA: Fascia, Anatomy
and Movement makes sense of the experience of the
moving body in and beyond the yoga classroom. It is a
groundbreaking and invaluable resource in the contemporary art and science of yoga.
The book is written in straightforward and accessible
language, and is divided into three parts:
Part 1 examines recent research and the paradigm
shift from the classical anatomy of the musculoskeletal
system to the new perspective the fascia provides.
Part 2 applies this perspective to the practice of yoga
with highly illustrated, clear descriptions of techniques
and exercises.
Part 3 considers the metaphysical aspect of yoga and
the hidden geometry of our biotensegrity architecture
as a metaphor for consciousness.
YOGA: Fascia, Anatomy and Movement is intended primarily for Yoga Teachers, but can be adapted for use
with Pilates and all other movement training programs.
It is also a resource for therapists working in the fields
of sport, dance, and movement therapy as well as manual practitioners.

Available at www.terrarosa.com.au
Terra Rosa E-mag 23

24 Terra Rosa E-mag

A randomized clinical trial of Structural

Integration as an adjunct to outpatient
rehabilitation for chronic low back
pain: A summary
By Eric Jacobson PhD, MPH
Introduction

acupuncturists.[13]

Chronic low back pain is among the most burdensome of

health problems in prevalence and cost of care.[1] It is the
leading cause of years lived with disability worldwide and the
most frequent cause of disability related loss in high-income
countries.[2,3] Much of this economic burden is expended on
costly surgical and rehabilitative services. Up to one third of
acute low back pain cases may become chronic and lead to
disability.[4] In a majority of chronic cases (estimated at 85
95%) a definitive diagnosis, that is, infection, neoplasm,
osteoporosis, arthritis, fracture, radiculopathy, or
inflammatory rheumatic processes, is ruled out, and these are
designated as chronic uncomplicated, mechanical, or
nonspecific low back pain (CNSLBP).[5] There is no
consensus on the optimal approach to the treatment of
CNSLBP. Management typically includes some combination
of analgesic or anti-inflammatory medication, directed
therapeutic exercise, manipulation, cognitive-behavioural
therapy, and patient education.[6] However, systematic
reviews have generally concluded that the benefits of these
approaches are limited and mostly short-lived. [7-11] A large
survey in the United States found that 54% of patients with
low back or neck pain used complementary therapies and
that approximately one third of all visits to alternative care
practices were for back or neck pain.[12] Low back pain has
been reported to be the primary complaint in 40% of all visits
to chiropractors, 20% to massage therapists, and 15% to

Structural Integration (SI) is increasingly turned to for the

treatment of chronic musculoskeletal pain and disability. A
few preliminary studies with small samples suggest possible
effectiveness for musculoskeletal pain, but aside from a single
case report, no clinical studies of SI for CNSLBP have
appeared to date.[14] Studies of SI for musculoskeletal pain,
and preliminary evidence regarding a number of
hypothesized therapeutic mechanisms have been reviewed
elsewhere.[15-17] SI treatment sometimes involves notable
discomfort which has led to a reputation of being excessively
painful and even to concerns as to its safety.[18] This has
been a barrier to a more widespread adoption by
conventional medical clinics, although SI was successfully
incorporated into at least one.[15,19] Despite these concerns,
published data on adverse events associated with SI are
limited to a single case and a small prospective case series.
[20,21]
This study was designed to collect preliminary data on the
feasibility, effectiveness, and adverse events associated with
SI as an adjunct to outpatient rehabilitation (OR) versus OR
alone for CNSLBP. The outcomes will inform our design of a
more adequately powered clinical trial. We hypothesized that
we could recruit and retain qualified participants who would
comply with treatment and data collection, that a course of SI
+ OR would improve low back related pain and disability

Terra Rosa E-mag 25

significantly more than OR alone, and that SI could be

delivered with acceptable levels of adverse events.
Methods
Institutional context: This study was conducted at the Motion
Analysis Laboratory, Spaulding Rehabilitation Hospital,
Partners HealthCare, LLC, Boston, and was approved by the
Spaulding institutional review board. The study was
registered with ClinicalTrials.gov (NCT01322399) prior to
beginning the recruitment of participants.
Design: Following screening, enrolment, and baseline data
collection, participants were randomized in a 1:1 ratio to
parallel treatment groups: OR alone versus SI + OR. Followup data were collected at 20 weeks after baseline.
Subjects: We included men and women aged 1865 living in
the greater Boston area, with CNSLBP of 6 months duration
which was not attributed to infection, neoplasm, severe
radiculopathy (assessed by frequent severe pain radiating
down a leg), fracture, or inflammatory rheumatic process,
with a patient rated bothersomeness of pain on average over
the preceding 6 months 3 on an 11-point ordinal verbal
response scale (0=none, 10=worst imaginable), i.e. moderate
to severe range. Prior arrangement to enter or having recently
entered treatment at any Boston area outpatient
rehabilitation clinic was also required.
We excluded candidates for i) impaired hearing, speech,
vision, or mobility; ii) current or anticipated receipt of
payments from Workers Compensation or other disability
insurance; iii) prior treatment with any type of SI; iv) plans to
initiate additional treatment for back pain other than
outpatient rehabilitation care during the period of the study;
v) exclusions for safety; vi) exclusions for anticipated lack of
therapeutic response; vii) conditions that might confound
measures of balance and movement; viii) conditions that
would confound data on inflammatory biomarkers; ix) any
other condition that would impair the patients ability to
complete the study.
Sample Size: Using data from a clinical trial of massage and a
meta-analysis of trials of balneotherapy, both for low back
pain, a sample size of 40 was estimated as adequate to detect
Minimal Clinically Important Differences (MCID) in pain and
disability.[22,23] The sample was later increased to 46 to
compensate for dropouts.
Treatment: All participants were required to attend a recently
arranged course of outpatient rehabilitation at any
rehabilitation clinic in the Boston area. Typical courses of
outpatient rehabilitation (OR) for CNSLBP employ varying
combinations of analgesic and anti-inflammatory medication,
joint manipulation, therapeutic exercise, cognitive
behavioural treatment, and education. Participants were
allowed 20 weeks to complete their course of OR. The
number and frequency of treatments were determined by
each participant and their therapist.
Ten sessions conforming to the Rolf Ten Series protocol were
provided free of charge to each participant assigned to the
SI+OR group. SI treatments were provided by five therapists
who met the criteria of graduation from the training

26 Terra Rosa E-mag

programs of the Rolf Institute of Structural Integration,[24]

the Guild for Structural Integration,[25] or Kinesis
Myofascial Integration (KMI)[26]; a minimum of 10 years
clinical practice of SI; and membership in the International
Association of Structural Integrators.[27] The KMI
graduates agreed to provide the Rolf Ten Series instead of the
twelve sessions taught by KMI, which include the Ten Series.
Outcomes: The primary outcome of the study was pre-defined
as a comparison across treatment groups of change between
baseline and 20-week follow-up on a patient-rated visual
analog scale (0100 mm) of bothersomeness of pain on
average over the preceding week (VAS Pain), anchored as
0=none, 100 mm=worst imaginable.[28] The secondary
outcome was a comparison of changes in the total of the
Roland-Morris Disability Questionnaire (RMDQ) over the
same period.[29,30] Pre-defined exploratory outcomes
included the Short Form 36 Health Survey (SF36),[31] the
sum of days and half days disabled over the past week, and
Global Satisfaction with Care. These questionnaires are all
patient-completed and have been recommended for use
together in low back pain trials.[32,33] All data were analysed
on an intent-to-treat basis, i.e. the last available data for each
dropout was substituted for their missing 20 week data.
Because of our small sample size, the Wilcoxon rank sum test
was specified to test the significance of between group
differences in change scores.
Adverse events were monitored through reports submitted by
study staff and a biweekly Patient Questionnaire. We also
recorded all elevations VAS Pain scores 30mm above
baseline as adverse events. In addition we collected feasibility
data on the demographic characteristics of unenrolled
compared to enrolled candidates, compliance with assigned
treatment, and dropouts.
Results
Recruitment, Enrollment, Treatment Compliance, and
Dropouts: The study was conducted between April, 2011 and
August, 2013. Enrolled compared to unenrolled candidates
were approximately equivalent in gender, age and race. The
demographic and prognostically relevant characteristics of
the treatment groups were also acceptably similar at baseline.
Attendance at OR treatments was unexpectedly low, but was
not significantly different between treatment groups. In the
SI+OR group, attendance at SI was almost perfect. The
overall rate of dropout was 11%, which is within the range
that has been recommended as a standard for assessing back
pain trials, and was not significantly different between
groups.[34]
Outcomes: The median reductions in VAS Pain, the primary
outcome, of 26 mm [Interquartile range 31.5, 3.0] in
SI+OR compared to 0 mm [24.5, 6.5] in OR alone were not
significantly different (Wilcoxon rank sum 2-sided test
p=0.075#) (Figure 1). However, the median reductions in
RMDQ, the secondary outcome, of 2 points [4.5, 1] in SI
+OR compared to 0 [2, 0] in OR alone, were significantly
different (p= 0.007) (Figure 2). The between group difference
in median change of two points is the smallest suggested
absolute MCID for the RMDQ [37].

RCT: SI on Chronic Low Back Pain

Figure 1: Change in VAS (Visual Analog Scale) Pain by treatment group.

Figure 2: Change in Roland-Morris Disability Questionnaire (RMDQ) Pain by treatment group.

n=sample size; squares and circles represent the change

score of individual subjects; Widest horizontal lines= median
values; narrower horizontal lines=interquartile ranges

n=sample size; squares and circles represent the change

score of individual subjects; Widest horizontal lines=median
values; narrower horizontal lines=interquartile ranges

Other pre-specified outcomes which were different between

treatment groups at a significance level of p<0.01 were the
SF36 subscale for Bodily Pain, and Global Satisfaction with
Care, each of which had greater improvement in SI+OR.[17]

related adverse events were not significantly different across

groups, nor were the proportions for participants with any
adverse event, whether study-related or not. The numbers of
adverse events per participant were also compared across
groups and found to be not significantly different. All studyrelated adverse events were rated as mild or moderate in
seriousness, none were rated as severe, and none required
medical treatment. The most endorsed types of study-related
adverse events in both groups were sharp, burning, and
aching pain, and the proportions of subjects with these were
not significantly different across groups. The proportions of
participants who endorsed the other most frequent types
were compared across groups, and were significantly
different only for a residual category of non-pain experiences
that included time-limited sensations of heat, sweating,
dizziness or spinning, reduced coordination or balance which
were more frequent in SI+OR.

In an exploratory analysis that was not initially planned, we

tabulated the number of participants with reductions in VAS
Pain at 20 weeks that were minimal (1020%), moderate (
30%), and substantial ( 50%) relative to the baseline values,
and also those with absolute reductions of 20 and 40 mm [52,
53]. We then compared the proportions of such responders
versus non-responders at each level across groups. SI+OR
had larger proportions of responders at the minimal and
moderate levels at a p<0.05 level of significance. Differences
all other levels were in favour of SI+OR but were nonsignificant. (Table 1)
In a further exploratory analysis we constructed a linear
mixed effects regression model of bi-weekly data on VAS Pain
that had been collected on the Patient's Questionnaire. A total
of 388 pain ratings were available with collection times
ranging from 0 to 184 days and an average time from baseline
to last observation of 137 days (19.6 weeks). The model that
best fit that data had significant main effects for baseline VAS
Pain, baseline RMDQ, between group difference at baseline ,
days since baseline, and the days-group interaction (i.e. the
between-group difference in the rate of change per day). The
days-group parameter, which represents the amount by
which the rate of change for SI + OR differs from the rate of
change for OR alone, was estimated as -0.14 mm/day, and
was highly significant (p=0.0039). The negative value of this
parameter indicates a greater rate of reduction in SI+OR
compared to OR alone. Figure 3 displays the estimated
marginal means and 95% confidence bands for the daysgroup interaction.

Two participants in SI+OR dropped out because of adverse

events. The first reported an episode of dread and worry
regarding their next treatment and subsequently dropped
out, citing intolerance of the discomfort of SI treatment and a
poor relationship with the SI therapist. The second dropped
out subsequent to enrolment but prior to receiving any studyrelated treatment due to an exacerbation of a pre-existing
medical condition.
Discussion
This was the first randomized trial to estimate the therapeutic
effect of SI as an adjunct to OR for CNSLBP, and only the
third clinical trial of SI for any medical condition.[35,36] It
was also the first systematic study of adverse events
associated with SI treatment, which were robustly monitored
by both staff and participant reports and identified and rated
using conservative criteria.

Adverse events: The proportions of subjects with study#p values referred to here and later quantify the probability that the between group difference detected does not reflect an actual difference
between similarly defined groups in the larger population from which the study sample was drawn. The generally observed convention is that
findings of between group difference with p<0.05 are "significant," but those was p>0.05 are non-significant. The threshold of 0.05 is arbitrary; and the validity of any particular p value depends on the assumption that the distribution of the data being tested in the larger population conforms to one of a few mathematically defined distributions, the most common of which is normal distribution.

Terra Rosa E-mag 27

Table 1: VAS Pain responder analysis: responder/non-responder ratios compared across treatment groups .
Pain Reduction

SI+UC (n=23)

UC alone (n=23)

RR (CI)

10-20%

17 (74%)

9 (39%)

1.89 (1.07-3.32)

0.036*

>30%

15 (65%)

7 (30%)

2.14 (1.08-4.26)

0.038*

>50%

12 (52%)

6 (26%)

2.00 (0.91-4.41)

0.130

>20 mm

12 (52%)

7 (30%)

1.71 (0.83-3.56)

0.231

>40 mm

5 (22%)

2 (9%)

2.50 (0.54-11.60)

0.414

n: sample size; RR: relative risk, the percentage for SI+UC divided by the percentage for UC alone;
CI: 95% confidence intervals# for RR; 1. Fisher's exact 2-sided p value; * significant difference at p<0.05.
Improvements in the primary outcome, VAS Pain, were not
significantly different between treatment groups, but
improvements in the secondary outcome, RMDQ, were
significantly greater in SI+OR than in OR alone, with the
difference between median change scores satisfying the
lowest recommended absolute MCID.[37] Among pre-defined
exploratory outcomes the SF36 subscale for Bodily Pain, and
Global Satisfaction with Care both improved more in SI+OR
than in OR alone.
With respect to feasibility, we successfully recruited and
enrolled a sample whose demographic characteristics did not
differ significantly from those unenrolled. Randomization
produced treatment groups that were acceptably equivalent
on prognostically significant variables. Compliance with SI
treatment was high, suggesting that any discomfort
associated with it did not dissuade the majority of
participants assigned to SI+OR from attending. Neither the
incidence nor the seriousness of adverse events was
significantly increased by the addition of SI to OR. Dropouts
were within acceptable limits, and we found no evidence of
crossover between treatment regimes. However, the length of
time to recruit the cohort was unexpectedly long, and
compliance with the requirement to receive OR treatment
was unexpectedly low. Both would need to be remediated in a
follow-up study.
Limitations: Because this study assessed the effect of SI as an
adjunct to OR compared to OR alone, its outcomes should not
be taken to indicate the effect that SI alone might have on
CNSLBP. The large number of exclusion criteria might have
resulted in the enrolment of a sample that was not
representative of the typical clinical population, and this
might limit the generalizability of these results. It was not
possible to blind participants or therapists to treatment
assignment because of obvious differences between the
experiences of SI and OR treatment. Effective maintenance of
the initial blinding of investigators proved to be impossible
due to limited administrative staffing, but the potentially
biasing effect of this was mitigated by the fact that all
outcomes were patient-rated. Compliance with the
requirement to receive OR was unexpectedly low and might
##95%

Figure 3: VAS Pain marginal means by treatment group

estimated by linear mixed model. Shaded areas are the
95% confidence intervals.
have contributed to the median change scores of zero for both
VAS Pain and RMDQ in the OR alone group. We did not
directly monitor SI treatment sessions for fidelity to protocol,
nor require the therapists to report their treatment
interventions in detail.
The additional 10 hours of hands-on treatment received in
SI+OR might have contributed to the more favourable
outcomes in that group compared to OR alone (Hawthorne
effect). A placebo effect might also have contributed, because
members of the SI+OR group were aware that they were
receiving the treatment that was the object of our
investigation (SI). The absence of follow-up at a longer
duration is an additional limitation.
Recommendations: A follow-up study should provide SI
according to a specific treatment protocol such as the Rolf
Ten Series, should use therapists who are adequately trained
and experienced in whatever protocol is used, and should
allow for the individualization of treatment strategies to
reflect actual practice. The collection of information on the
specific SI techniques employed in each treatment session
would enable closer monitoring of the treatment protocol. At

confidence intervals represent the range of values within which the estimated value might vary for 95% of all possible samples that
might be selected from the larger population. Like the p value, it assumes that the distribution of values in the larger population conforms to
one of a few mathematically defined models.

28 Terra Rosa E-mag

RCT: SI on Chronic Low Back Pain

least a three-month follow-up should be included. We
speculate that SI alone might be superior to outpatient
rehabilitation alone and note that a direct comparison of the
two could control for time, attention, and skin stimulation
across treatment groups. Our positive outcome for greater
reduction in disability in the SI+OR group suggests that
hypothesized mechanisms for mediating a therapeutic effect
of SI are also worthy of future investigation.
Conclusions
The outcomes of this study suggest that adding SI to
outpatient rehabilitation for CNSLBP should not be expected
to enhance reductions in patient-rated pain, but might
enhance reductions in low back pain related disability at least
for the short term and modestly increase patient satisfaction
without significantly increasing the rates of adverse events. If
these indications were confirmed by a more definitive study,
that might support the recommendation of SI as an effective
adjunct to outpatient rehabilitation for this condition. Data
on enrolment, retention, data collection, and compliance with
SI treatment suggest that a follow-up study is feasible.
However, the study design should increase the efficiency of
recruitment and improve compliance with OR.
A more detailed report of this study is given in Jacobson et al.
2015 J Evid Based Complment Altern Med. 813418, which is
publically available at www.hindawi.com/journals/ecam/
2015/813418

Acknowledgements
This study would not have been possible without the
generous collaboration of Alec Meleger, Paolo Bonato, Peter
Wayne, Helene Langevin, Ted Kaptchuk, and Roger Davis.
Major study expenses and Dr. Jacobsons effort were funded
by a career development award from the National Center for
Complementary and Integrative Health, National Institutes
of Health (NCCIH/NIH, K01AT004916). Dr. Kaptchuks
effort was supported by a mentorship award from NCCIH/
NIH (K24AT004095). Supplemental funding was provided
by the Ida P. Rolf Research Foundation, Harvard Medical
School, the Rolf Institute of Structural Integration, Dean
Rollings, and Hal and Sonya Milton. Administrative and
technical support was generously provided by the Motion
Analysis Laboratory, Spaulding Rehabilitation Hospital,
Partners Healthcare, LLC, and by Harvard Medical School.
We also thank the volunteers who served as independent
monitor and on the data safety monitoring committee, and
the SI practitioners: Lou Benson, Lisa Grey, Ellen Halpern,
Tim Roode, and Garret Whitney.

The Author
Eric Jacobson, PhD, MPH, investigates alternative
medicine at Harvard Medical School. He was trained by Ida
Rolf in 1974, completed advanced training with the Rolf
Institute in 2005, and has a private practice of Structural
Integration in Boston.

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The Price of Smart Phones

Ten Common Dysfunctional Postures and
Injuries caused by Smart Phone Use

By Joe Muscolino
The introduction of any new technology often comes with unexpected consequences. This is certainly true with widespread use
of the smart phone. Although it is
a wonderful marvel of communication that allows us to be connected with our loved ones,
friends, and business colleagues,
as well as connect us to the internet and therefore the world
around us, unfortunately it comes
at a price. That price is the physical stress that it can place on our
body. One only needs to go to a
public place and observe others
while using their smart phones.
The odds are that we will see
many dysfunctional postural patterns and future injuries in the
making. However, most of these
conditions can be avoided if we
pay attention to our biomechanics as we hold and use the smart
phone.

As therapists, it is important to be
aware of these common conditions so that we can be prepared
to assess for them, and if found,
provide the appropriate clinical
orthopedic work to ameliorate
the condition. Being aware of
these potential problems also
arms us with the knowledge
needed to be able to offer the client valuable postural advice
about how to properly hold and
use the smart phone so that the
development of these problems
can be avoided.

ter be described as repetitive

overuse conditions. These conditions are therefore less posture
related and more due to the
chronic repetitive use of smart
phones. However, even with repetitive overuse conditions, improving smart phone posture can
help to minimize or avoid their
onset. For these reasons, some
suggested postures for smart
phone use are offered at the end
of this article.

Following are ten of the most

common dysfunctional postural
patterns and injuries that may
occur with smart phone use.
Some of these conditions are
purely postural and can be avoided by improving the posture that
is employed when using a smart
phone. Other conditions may bet-

Golfers elbow, also known as medial epicondylitis or medial epicondylosis, is a condition in

which in lammation and/or degeneration of the common lexor
tendon occurs, usually accompanied by hypertonicity of the bellies of the associated muscles.
This condition is caused by over-

1. Golfers Elbow

Terra Rosa E-mag 31

use of the muscles of the common

lexor tendon that attaches to the
medial epicondyle of the humerus. These muscles are the three
muscles of the wrist lexor group
( lexor carpi radialis, palmaris
longus, and lexor carpi ulnaris),
the pronator teres, and the lexor
digitorum super icialis. As a
whole, these muscles do lexion
of the wrist joint and the ingers;
in other words, the joint actions
necessary to grip and hold any
object including a smart phone
(Figure 1). Holding the smart
Figure 1. Prolonged holding of a smart phone can lead to overuse, fatigue,
phone occasionally for a few
and dysfunction of the common flexor tendon. This condition is known as
minutes at a time is not a probgolfers elbow.
lem. The problem occurs with
overuse that requires prolonged
isometric contraction of the associated musculature, leading to
fatigue and eventual injury/
dysfunction of the common lexor
tendon. The development of this
condition is accelerated if the client grips the smart phone harder
than necessary, thereby increasing the contraction strength and
therefore stress upon the musculature and its common tendon.

2. Tennis Elbow
Tennis elbow, also known as lateral epicondylitis or lateral epicondylosis, is a condition in
which in lammation and/or degeneration of the common extensor tendon occurs, usually accompanied by hypertonicity of the
bellies of the associated muscles.
This condition is caused by overuse of the muscles of the common
extensor tendon that attaches to
the lateral epicondyle of the humerus. These muscles are the extensor carpi radialis brevis, extensor digitorum, extensor digiti
minimi, and the extensor carpi
ulnaris. As a group, these muscles
do extension of the wrist joint
and the ingers. It would seem
that these muscles do not need to
contract when gripping and holding a smart phone because this
32 Terra Rosa E-mag

Figure 2. Prolonged holding of a smart phone (or shown here as pen) can
lead to overuse, fatigue, and dysfunction of the common extensor tendon.
This condition is known as tennis elbow.

Figure 3. Crimping a smart phone between the shoulder and ear physically
stresses muscles of scapular elevation.

The Price of Smart Phones

activity requires contraction by lexion musculature,
not extensor musculature. However, extensor musculature is needed to contract isometrically to stabilize the wrist joint and prevent it from lexing when
the lexors digitorum super icialis and profundus
muscles contract to lex the ingers. Most often, it is
the extensor carpi radialis brevis that engages in
this scenario (Figure 2). Therefore, holding a smart
phone does physically stress musculature of the
common extensor tendon and can contribute to tennis elbow. Occasional use is not a problem; like
golfers elbow, tennis elbow is an overuse condition.
Gripping the phone more forcefully than necessary
will also increase the stress to the extensor musculature and therefore the likelihood that this condition will develop.

3. Uptight Shoulders
Developing uptight elevated shoulders with a
smart phone occurs when the phone is crimped
(compressed) between the ear and shoulder, because this posture requires contraction of scapular
elevation musculature to bring the shoulder up to
hold the phone against the ear (Figure 3). Muscles
of scapular elevation that are used/overused and
likely to become fatigued, tight, and injured are the
upper trapezius and levator scapulae. Crimping a
phone also requires contraction of same-side lateral Figure 4. Holding the phone out in front of the body
lexion musculature of the neck to help press the ear can overly stress, fatigue, and injure musculature of the
anterior shoulder.
downward against the phone and shoulder. This
further requires contraction of, and therefore physically stresses, the upper trapezius and levator scapulae, as well as other muscles of lateral lexion. This
anterior deltoid strain as well as strain of the upper
problem is not new with smart phones. It was and
trapezius and levator scapulae.
still is common for people to crimp landline phones
too. However, because smart phones are much

smaller, the amount of muscular effort necessary to
crimp a smart phone is greater than to crimp a land- 5. Rotator Cuff Strain/Tendinitis
line phone.
Holding a phone out in front of the body with humeral lexion can also stress and injure the rotator
4. Anterior Shoulder Strain
cuff musculature. Whenever the arm is lifted upIt is common for people using a smart phone to hold ward in the air, whether it is up into lexion, extenthe phone in the air out in front of their body. The
sion, abduction, or adduction, it is necessary for the
dif iculty with this posture is that it requires isomet- rotator cuff musculature to contract to stabilize and
ric contraction of the musculature of humeral lexhold the (proximal) head of the humerus down into
ion at the glenohumeral joint to hold the arm out in the glenoid fossa as the distal end of the humerus
the air. Foremost among these muscles is the anteri- raises (Figure 5). Overuse of this posture can, over
or deltoid (Figure 4). Holding the arm out in lexion time, contribute to fatigue, tightening, and strain of
also requires stabilization of the scapula, which rethe rotator cuff musculature, as well as tendinitis of
quires contraction of and therefore stress to the up- the rotator cuff muscles.
per trapezius. And if the person also adds in eleva
tion of the shoulder girdle to hold the phone up
higher, it places even greater stress on the upper
trapezius, as well as the levator scapulae. Therefore,
excessive engagement of this posture can lead to
Terra Rosa E-mag 33

6. Rounded Shoulders
Rounded shoulders is a postural distortion pattern in which the scapulae are protracted and the humeri
are medially rotated. Therefore the
shoulder girdles and arms are
rounded in, hence the name. The
client with rounded shoulders has
scapular protractors (pectoralis minor and major) and humeral medial
rotators (subscapularis, pectoralis
major and teres major) that are
locked short and tight, accompanied
by scapular retractors (middle and
lower trapezius and rhomboids) and
humeral lateral rotators (teres minor and infraspinatus) that are weak
and also likely locked long and tight.
Using a smart phone often predisposes the client to this condition
because so many people hold the
Figure 5. Holding the arm out in front of the body can also physically
smart phone down low in front of
them (Figure 6). As with other over- stress, fatigue, and injure musculature of the rotator cuff group.
use conditions, occasional rounded
posture with a smart phone is not
detrimental, but when this posture is
assumed for long periods of time, the
effects can become very chronic and
severe.

7. Rounded Upper Back

Rounded upper back is de ined as
hyperkyphosis of the thoracic spine
and almost always accompanies
rounded shoulders. As the clients
shoulder girdles and arms round and
collapse forward and down, their
thoracic spine also rounds and collapses into lexion, in other words,
hyperkyphosis. As with rounded
shoulders, rounded upper back is
caused and/or exacerbated by prolonged use of the smart phone down
in front of the body (see Figure 6).

8. Forward Neck
Also accompanying rounded shoulder girdles and rounded upper back
is forward head. When the thoracic
spine is hyperkyphotic, the neck naturally projects forward with a hypolordotic lower cervical spine. The
upper cervical spine then becomes
hyperlordotic as a compensation to
34 Terra Rosa E-mag

Figure 6. Holding the smart phone down low in front predisposes the
client to rounded shoulders characterized by protracted scapulae and medially rotated humeri, as well as rounded upper back, forward head, and
rounded lower back.

The Price of Smart Phones

The 27 kg head
Having the center of weight of the head forward of the trunk requires constant isometric contraction of
the posterior cervical extensor musculature. How forceful the posterior cervical musculature must work
is dependent upon the leverage force of the weight of the head.
The average head weighs approximately 4-5 kg (10-12 pounds). However, as the head and neck are further lexed, the center of weight of the head moves increasingly anterior, increasing the leverage force of
the weight of the head against which the cervical extensor musculature must work. It has been estimated
that when the neck is lexed to 45 degrees, the head weighs the equivalent of 20 kg (45 pounds). And if
the neck is lexed 60 degrees, the head weighs the equivalent of 27 kg (60 pounds)!

bring the eyes and ears back to

level (see Figure 6). The posture
of the head ends up being forward (protracted) with its center
of weight anterior to the trunk
and imbalanced over thin air;
therefore, it should fall with gravity into lexion until the chin hits
the chest. The only reason it does
not is that the posterior cervical
extensor musculature isometrically contracts to hold the head in
this postural distortion pattern
against the lexion force of gravity (Figure 7). Due to the prolonged isometric contraction of
the posterior cervical musculature, it often fatigues, tightens,
and becomes strained/injured
and painful. Long-term chronic
tightness of this musculature can
also cause a tension pulling force
(enthesopathy) upon its cranial
attachments on the scalp, possibly resulting in tension headaches.

smart phone down low in front of

the body, often in the lap. Over
time, the assumption of this posture, as with all chronic postures,
will result in locked short and
locked long musculature, as well
as fascial adhesions that will effectively glue the tissues to become stuck in this posture. The

collapsed posture of rounded

lower back usually couples with
the collapsed postures of rounded upper back and rounded
shoulders, as well as forward
head posture (see Figure 6).

9. Rounded Lower Back

Rounded lower back is becoming
increasingly common as a postural distortion pattern. It involves
excessive posterior tilt of the pelvis and either hypolordosis of the
lumbar spine or an actual reversal of the lumbar spine into kyphosis. This condition is caused
by collapsing the entire trunk forward, and in the context of smart
phone use, occurs when using the

Figure 7. Forward head posture results in the centre of weight of the head
being anterior to the trunk. This imbalance is compensated for by constant
contraction of the posterior cervical extensor musculature.

Terra Rosa E-mag 35

10. Texting Thumb

Texting thumb is the name given to
irritation/in lammation/injury to
the tendons of the thumb due to
repetitive overuse when texting or
otherwise using a smart phone. The
strain to the thumb comes less from
the pressing of the thumb against
the phone that it does from the
traveling of the thumb that is necessary to move from one area of the
screen to another; although pressing harder would add to the physical stress. The muscles of the thumb
can be divided into intrinsic and
extrinsic groups. Intrinsic thumb
muscles are wholly located within
the hand; in other words they originate within the hand and insert onto the thumb. Extrinsic thumb muscles have their proximal attachment
(origin) in the arm or forearm and
then attach onto the thumb. The
Figure 8. Texting thumb often involves overuse and injury to the tendons of the
intrinsic thumb muscles are the ab- abductor pollicis longus and extensor pollicis brevis.
ductor pollicis brevis, lexor pollicis
brevis, opponens pollicis (all of the
thenar group), and the adductor
pollicis. The extrinsic muscles are
the lexor pollicis longus, abductor
pollicis longus, extensor pollicis
brevis, and extensor pollicis longus.
Although the tendons of any of the
muscles of the thumb can be involved, the tendons, or more precisely the synovial sheathes of the
tendons, of the abductor pollicis
longus and extensor pollicis brevis
are most commonly involved because the use of these muscles causes their tendons to rub against the
styloid process of the radius (Figure
8). Tenosynovitis of these tendons
is also known as de Quervains disease (or de Quervains stenosing
tenosynovitis).

Suggested Smart Phone Postures

Following are a few tips for posture
when using a smart phone. Certainly, any static posture that is assumed for prolonged periods of
time, even an ideal posture, can result in stiffness and excessive stress
36 Terra Rosa E-mag

The Price of Smart Phones

Locked Short and Locked Long

There is an old saying that goes There is no such thing as a bad posture, as long as you dont get stuck in
it. This describes the idea that functionally being able to move in and out of any posture is ine. However,
when a person continually/chronically assumes the same posture, the bodys tissues do tend to get stuck
in it. Getting stuck can involve increased muscle baseline tone via the sliding ilament mechanism (termed
adaptive shortening) as well as the formation of fascial adhesions. With any given posture, the myofascial
soft tissues on one side of the joint are shortened and the myofascial soft tissues on the other side of the
joint are lengthened. Therefore, we can describe the tissues on the short side of the posture as locked
short, and the tissues on the long side as locked long. And because the length tension relationship curve
(that describes the strength of a muscle at its various lengths) shows that both shorter and longer muscles tend to become weaker, the result is that we have tight and weak muscles on both sides of the joint,
regardless of whether they are short or long.

Upper Crossed Syndrome

The sum postural distortion pattern
of rounded shoulders along with
rounded upper back and forward
head is often termed as the upper
crossed syndrome. This name is
used to describe the characteristic
crossed pattern of overly facilitated / tight / locked short muscles
with the overly inhibited / weak /
locked long muscles.

Terra Rosa E-mag 37

to the body. For this reason, it is wise

to take a break from your smart
phone every few minutes so that you
can move and change your posture.

Tips for smart phone posture

1. Try to work with the phone at, or
as close to eye level as possible; but
it is important for your arm(s) to be
supported (Figure 9A).
2. If present, perhaps you can lean
your elbows on an armrest to support your arms. This might not quite
bring the phone to eye level, but it
will allow both hands to be free
when writing/typing (Figure 9B).
3. Alternately, one elbow can be supported on an armrest with the other
arm supported by your trunk. This
will allow the phone to be held
slightly higher and closer to eye level, but may cause you to lean your
trunk toward the side of the armrest
(Figure 9C).
4. If no armrest is present, then try
to support your arms against your
trunk (Figure 9D). This might slightly round the shoulders, but it does
support the arms and it brings the
phone up higher.
5. If one forearm can be held across
your abdomen, then the other elbow
can rest on it and this will bring the
smart phone even higher and up to
eye level. This is the best posture for
your upper body. But because only
one hand is free, this posture might
not be best when typing but is recommended when reading (see Figure 9A).
6. Alternately, your elbows can be
supported on your knees (Figures
9D and E).
7. Hold the phone gently.
8. When typing, tap the phone lightly.

Figure 9. Suggested postures for smart phone use.

This article was originally published in Massage Therapy Journal, Spring 2015 issue, reprinted with permission from American Massage Therapy Association.

38 Terra Rosa E-mag

Clinical Orthopedic
Manual Therapy
with Dr. Joe Muscolino
Sydney, November 2015

This workshop covers the major clinical orthopedic assessment and treatment techniques for
the thoracic spine and ribcage.
31 Oct, 1 Nov 2015, Sydney

This workshop covers motion palpation and

joint mobilisation of the entire spine (cervical,
thoracic, and lumbar) as well as the sacroiliac
joint and rib cage.
2 & 3 November 2015, Sydney

ATMS, AMT, Approved CPE/CEU

Points
Dont miss this unique experience to
train with Dr. Joe Muscolino.

Terra Rosa e-magazine, No. 11

"Joe Muscolino is a master of his profession! His broad

knowledge on the human body and extensive experience
made the workshops interesting and engaging. I would
highly recommend his workshops to any body-worker. I,
myself, can't wait for the next one!" Zuzana G, North SydTerra Rosa E-mag 39
(Decemberney.
2012)

Putting the Maximus

Back into
Gluteus Maximus
By John Gibbons
Physical therapists are what I call detectives: they
possess some clues (patients history and symptoms), but they then have to take the patient
through an elimination process (via a physical assessment) to hopefully ind out and identify the actual underlying cause of the symptoms. The purpose
of this chapter is to brie ly explain about a patient
who presented with pain in the left shoulder area,
and to demonstrate that the possible cause of the
problem can originate in an area that one might not
consider in view of the patients presenting symptoms.
This article hopefully demonstrates what Dr. Ida
Rolf statesWhere you think the pain is, the problem is not. I want to illustrate this statement from
Dr. Rolf with a case study taken from my own physical therapy clinic at the University of Oxford. As I
become more experienced, not only in lecturing
physical therapy courses but also as a practicing
sports osteopath in my own clinic, I am convinced
that many issues which patients and athletes present with are purely symptoms rather than actual
causes.
The case study below is just a small snippet of the
information that I provide in the Vital Glutes book.
The information contained within the study is taken
from a real case study patient who came to my clinic
for a consultation.

40 Terra Rosa E-mag

Case Study
The patient in question was a woman of 34 and a
physical trainer for the Royal Air Force. She presented to the clinic with pain near the superior aspect of her left scapula ( igure 1.1). The pain would
come on four miles into a run, forcing her to stop
because it was so intense. The discomfort would
then subside, but quickly return if she attempted to
start running again. Running was the only activity
that caused the pain. Her complaint had been ongoing for eight months, had worsened over the past
three, and was starting to affect her work. There
was no previous history or related trauma to trigger
the complaint.
After seeing different practitioners, who all focused
their treatment on the upper trapezius, she visited
an osteopath who treated her cervical spine and rib
area. The treatments she had received were biased
toward the application of soft tissue techniques to
the affected area, namely the trapezius, levator
scapulae, sternocleidomastoid (SCM), scalenes, and
so on. The osteopath had also used manipulative
techniques on the facet joints of her cervical spine
C4/5 and C5/6. Muscle energy techniques and trigger point releases were used in a localized area,
which offered relief at the time but made no difference when she attempted to run more than four
miles. She had not undergone any scans (e.g. MRI or
x-ray).

The Vital Glutes

Once a subjective history has been conducted, the
physical therapist then proceeds to an objective assessment: this is where the therapist uses specialized techniques to assess the musculoskeletal system to come up with a thorough diagnosis. One of
the speci ic techniques employed by the therapist
can be simple range of motion (ROM) tests that are
initially performed by the patient; these are known
as active range of motion (AROM) tests. This assessment is generally followed by a series of passive
range of motion (PROM) tests; these tests are normally performed on the patient by the therapist, and
are commonly used to check the integrity of the affected joint. Resisted testing comes next: this type of
speci ic movement tests the power and involvement
of the contractile tissues, i.e. muscles and tendons.
The physical therapist also uses palpatory awareness through their ingertips to decide on the condition of the affected tissues, and will generally include
special tests to complement the diagnosis.
The potential causes of my patients presenting pain
are:
Referral pain from cervical facet C4/5 or C5/6.
Figure 1. Diagram of painful area of the patientleft
superior scapula.

Protective spasm/strain of upper trapezius or

levator scapulae.
Dysfunction of the glenohumeral joint or even

the acromioclavicular joint (ACJ) or sternoclavicular joint (SCJ).

Assessment
During a consultation (subjective history) the physical therapist will ask speci ic questions relating to
the patients presenting pain so that a picture can be
formed in their mind. This is a normal process in order for the physical therapist to come up with a hypothesis; this type of initial diagnosis will then help
the therapist decide on what tissue(s) might be responsible for causing the clients presenting pain/
symptoms. For the patient in question, the potential
tissues responsible for the pain to her superior scapula are:

Upper trapezius

Levator scapulae

Scalenes

Thoracic rib

Cervical rib (extra rib forming from the transverse process of C7)

Intervertebral disc bulge of C4/5 or C5/6.

Elevated irst rib.
Cervical rib (extra rib from the transverse pro-

cess of C7).
Relative shortness/tightness of the scalenes.
Positionaldue to upper crossed syndrome re-

lated to a forward head posture and rounded

shoulders caused by tight pectorals and SCM, and
possibly weak rhomboids and serratus anterior.
Upper lobe of left lung, referring to the trapezius.
Diaphragmthis is innervated by the phrenic

nerve, which originates from the level of C35

from the cervical spine; the dermatome from C3
5 can cause a referred pattern of pain that can
radiate to the area of the shoulder (dermatome is
an area of skin that is supplied from a single
nerve root).

Terra Rosa E-mag 41

Figure 2. Form closure and force closure.

As you can see, there are many possible causes of the

patients presenting pain. This list is not exhaustive
and highlights just some of the many avenues to con-
sider when confronted with a common complaint of
shoulder/trapezius pain.

How does a weakness of the Gmax on the right

side cause pain in the left trapezius?

What can be done to correct the issue?

Taking a Holistic Approach

What has happened to cause it in the irst

place?

Lets now assess the case study patient globally rather than locally, remembering that the pain only
comes on after running four miles.

Is there a link between the Gmax and the trapezius, and if so, how is this possible?

To answer these questions, we need to look at the

functional anatomy of the Gmax, and the relationship
of the Gmax to other anatomical structures, as deWhen I see a new patient for the irst time, no matter tailed in later chapters.
what the presenting pain is, I normally assess the
pelvis for position and movement, as I consider this
area of the body in particular to be the foundation

for everything that connects to it. I often ind in clinic
that when I correct a dysfunctional pelvis, my clients presenting symptoms tend to settle down.
However, when I assessed this particular patient, I
found her pelvis was level and moving correctly. I
then went on to test the iring patterns of the gluteus maximus (referred to as the Gmax for the remainder of this book), which I often do with patients and athletes who participate in regular sporting activities. However, I only test the iring pattern
sequence once I feel that the pelvis is in its correct
position; the logic here is that you often get a positive result of the muscle mis iring when the pelvis
is slightly out of position.
With the patient in question, I found a bilateral
weakness/mis iring of the Gmax, but the iring on
the right side seemed a bit slower. As I had not
found any dysfunction in the pelvis, I pursued this
line of approach a little further.
Before we continue I would like to pose a few questions for you to think about:
42 Terra Rosa E-mag

Figure 3Ligaments of force closure.

The Vital Glutes

irst need to consider two conceptsform closure
and force closurewhich are both associated with
stability of the SIJ (see Figures 2 & 3).
The shape of the sacrumalong with its ridges and
grooves, and the fact that it is wedged between the
iliahelps to bring natural stability to the SIJ. This is
known as form closure (Figure 3). If the articular
surfaces of the sacrum and the ilia itted together
with perfect form closure, mobility would be practically nonexistent. However, form closure of the SIJ is
not perfect and movement is possible, which means
stabilization during loading is required. This is
achieved by increasing compression across the joint
at the moment of loading; the surrounding ligaments, muscles, and fascia are responsible for this.
The mechanism of compression of the SIJ by these
additional forces is called force closure.
When the body is working ef iciently, the forces between the innominates and the sacrum are adequately controlled, and loads can be transferred between the trunk, pelvis, and legs. So how do we link
this to the patients complaint? In one of my previous
articles (Gibbons 2008), about training the Oxford
rowing team, I wrote about the posterior oblique
sling. This structure directly links the right Gmax
to the left latissimus dorsi via the thoracolumbar fascia (Figures 4 & 5). The latissimus dorsi has its insertion on the inner part of the humerus, and one of the
functions of this muscle is to keep the scapula
against the thoracic cage and aid in depression of the
scapula.
Piecing It All Together
So what do we know? We know that the right side of
the patients Gmax is slightly slower in terms of its
iring pattern and that this muscle plays a role in the
Figure 4. Muscle activation sequence.
force closure process of the SIJ. This tells us that if
the Gmax cannot perform this function of stabilizing
Gmax Function
the SIJ, then something else will assist in stabilizing
The Gmax operates mainly as a powerful hip exten- the joint. The left latissimus dorsi is the synergist
that helps stabilize the right Gmax and, more imsor and a lateral rotator, but it also plays a part in
portantly, the SIJ. As the patient participates in runstabilizing the sacroiliac joint (SIJ) by helping it to
ning, every time her right leg contacts the ground
force close while going through the gait cycle.
and goes through the gait cycle, the left latissimus
Some of the Gmax muscular ibres attach to the
dorsi is over-contracting. This causes the left scapula
sacrotuberous ligament, which runs from the sacrum to depress, and the muscles that resist the downto the ischial tuberosity. This ligament has been
ward depressive pull will be the upper trapezius and
termed the key ligament in helping to stabilize the
the levator scapulae. Subsequently, these muscles
SIJ. To gain a better understanding of this action, we start to fatigue; for the patient in question, this ocTerra Rosa E-mag 43

Prognosis and Conclusion

I advised the patient to abstain from running and to
get her partner to assist in lengthening the iliopsoas,
rectus femoris, and adductors twice a day. Strength
exercises were also advised twice daily until the follow-on treatment (these exercises are discussed in
later chapters). I reassessed her 10 days later and
found normal iring of the Gmax on the hip extension
iring pattern test, and a reduction in the tightness of
the associated iliopsoas, rectus femoris, and adductors. Because of these positive results, I advised her
to run as far as felt comfortable. I was not sure if my
treatment was going to correct the problem, but she
reported that she had no pain during or after a sixmile run. The patient is still pain free and continues
to regularly use the Gmax strengthening exercises
and the lengthening techniques for the tight muscles.
This case study demonstrates that very often the underlying cause of a condition or problem may not be
local to where the symptoms/pain presents, which
means that all avenues need to be fully considered. I
hope that the information from this study has intrigued you enough to continue reading, as the information presented is just a taster of what is to come
in the following chapters. Remember, this book is
what I call a jigsaw puzzle journeyif you stick with
it, the picture will eventually become a lot clearer.
Figure 5. Posterior oblique sling.

This article is an extract from The Vital Glutes by

John Gibbons. Reproduced here courtesy of Lotus
curs at approximately four miles, at which point she Publishing.
feels pain in her left superior scapula.

Treatment
JOHN GIBBONS is a quali ied and registered osteopath
You might think the easy way to treat the weakness with the British General Osteopathic Council, specialising in the assessment, treatment, and rehabilitation of
in the Gmax is to simply prescribe strength-based
exercises. However, in practice this is not always the sport-related injuries. Having lectured in the ields of
correct solution, as sometimes the tighter antagonis- sports medicine and physical therapy for over twelve
tic muscle is responsible for the apparent weakness. years, John delivers advanced therapy training to
The muscle in this case is the iliopsoas (hip lexor), quali ied professionals within a variety of sports.
and shortening of this can result in a weakness inhibition of the Gmax. My answer to this puzzle was to
stretch the patients right iliopsoas muscle to see if it
promoted the iring activation of the Gmax, while at
the same time introducing strength exercises for the
Gmax. All this will be explained in more detail in The
Vital Glutes book, chapter .

44 Terra Rosa E-mag

CORE Structural Integration and

Myofascial Therapy:
A Lifetime of Improving Structure
and Function
By George P. Kousaleos, LMT
It is interesting that a cervical injury during a college
rugby match lead me to my irst Swedish massage.
After four weeks of treatment the massage therapist
sent me to my irst Iyengar Hatha Yoga class, where I
experienced more discomfort during exercise than I
had ever felt in my lifetime. Six weeks later the
Iyengar teacher gave me an article on Rol ing, and in
a few short weeks I received my irst session of
Structural Integration. Each step of the way I experienced signi icant improvement in decreasing my
pain levels, improving my overall lexibility, and becoming more aware of my optimal physical alignment and balance. It took three years to realize that I
was ready to change my life even further and started
my training as a professional massage therapist and
Structural Integration practitioner.

From the early 1980s I worked in New York City

with leading ballet dancers, opera singers and classical musicians. They quickly appreciated the performance bene its of this precise work and cherished
the added level of skill mastery they acquired
through regular clinical treatment.

Later that decade I practiced and taught in Germany,

applying this work to patients at a holistic centre for
homeopathic medicine and psychiatry. Through various seminars I taught Myofascial Therapy to European massage therapists and physiotherapists in 13th
Century Bavarian castles, on the Greek island of Santorini, in the oldest yoga school in Vienna, Austria
and at the healing warm springs of Passau. I appreciated even more the effects of slow, powerful, and
carefully orchestrated pressure that changed the pliFrom the earliest days of my study of the disciplines ability of even the densest tissues, the most hardened of bodies.
of Structural Integration and Myofascial Therapy I
was fascinated with the importance of recognizing
After opening the CORE Institute in Tallahassee,
the foundational relationships between structure
Florida in 1990, and creating an entry level profesand function. Indeed, over many years and decades
sional massage therapy program that included strucof practicing and teaching this incredible work, I
tural and myofascial education, I looked for opportunever lost sight of those relationships that not only
nities to help prepare my students for the day that
improve structure and function, but increase neuroeach of them would embark on their professional
somatic awareness and restore a sense of physical
journey. I was thrilled when the British Olympic Asand mental con idence.
sociation decided to hold their warm-weather prepaTerra Rosa E-mag 45

ration camps at Florida State University to prepare

their athletes for the 1996 Atlanta Olympics. British
Olympians from 13 sports received regular treatments from CORE students during three weeks of
strenuous two-a-day practice sessions during the
summers of 95 and 96.
The Atlanta Olympics lead to my involvement as a Co
-Director of the International Sports Massage Team
of the 2004 Athens Olympics & Paralympics. One
hundred and eighty therapists were chosen from 18
countries to provide therapeutic massage to over
15,000 athletes and coaches. Many athletes had never experienced massage therapy in their home country and relished at the improvement to form and
function at the most meaningful time of their life. An
Italian gymnast, who came to the clinic daily, won
the gold medal in the horizontal bar in one the biggest upsets of the Athens Olympiad. The next day he
came to the clinic to take photographs with the therapists who helped him prepare for his lifetime moment.

Last Fall I was honoured to travel to Sydney, Australia and teach leading sports therapists from all across
Australia and New Zealand. Many of these therapists
work in allied medical ields, including physiotherapy, podiatry and acupuncture. On the ninth and inal
day of the intensive seminar we invited current and
former professional and Olympic athletes to a special
clinic. Each athlete responded favorably to their
Later that decade I began teaching in England, Scot- sense of improvement from a 90-minute full body
land and the Republic of Ireland from 2009 to 2011. session, with several emailing us later in the week
with amazing stories of how their training had imMany of those students from London, Manchester,
proved. The common theme we heard was I feel
Chelsea, Bath, York, Edinburgh, Aberdeen, Galway
and Dublin assisted their Olympic teams at the 2012 more awareness of my body and how integrated my
movements have become.
London Games. Each of them took their place with
those who preceded them in offering a sports and
I am more than satis ied that during the past four
performance therapy that increased balance, respondecades I have represented one of the inest apsiveness, ease of movement, and kinaesthetic agility.
proaches to structural and functional improvement
At the same time I was engaged in creating Myofas- from the disciplines I studied 37 years ago. Each year
cial Therapy protocols for the leading athletes of the I look forward to introducing this work to curious
Florida State University Football Team. From 2011 and dedicated therapists who are searching for the
to this day these athletes receive twice a week treat- keys to providing long-lasting health and wellness to
those they serve each day. Each day I enjoy my cliniment from 10 CORE Institute graduates during the
regular season as well as during all spring and sum- cal sessions with professional and amateur athletes
mer training camps. During this time, soft-tissue in- who want to maintain elite athletic levels, with clients rehabbing from serious injuries and disease,
juries decreased by 75% and FSU won three ACC
and with those who simply yearn for a deeper sense
Championships and the 2013 National Championship. Over 30 of these athletes are now playing in the of self. Each day I ind happiness.
NFL, with many of them continuing their commitment to regular myofascial therapy.

46 Terra Rosa E-mag

Maximise Oxygenation

CORE MYOFASCIAL THERAPY

with George Kousaleos
Sydney, Brisbane Sept-Oct 2015
"George Kousaleos was one of the most influential people in the manual therapy profession on my career and my
success. His amazing CORE Myofascial Therapy training should be the foundation of every manual therapist's
practice. His incredible knowledge of the human body, his compassion, and his kind heart, make him one of my
greatest mentors in the manual therapy - James Waslaski LMT; Author & International Lecturer Integrated
Manual Therapy & Orthopedic Massage CPT-

CORE Myofascial Therapy Certification

CORE Myofascial Therapy for the Back & Neck

Sydney (Venue: 5 Forbes St, Newtown)

Sydney 3, 4 October 2015

CORE Myofascial Therapy 1: 25, 26,27 September 2015

CORE Myofascial Therapy 2: 28, 29,30 September 2015
An intermediate to advanced, six-day workshop designed to
give practicing massage therapists in-depth knowledge and
hands-on experience in full-body myofascial treatment protocols. With this knowledge and skill, you will be able to improve your clients structural body alignment and increase
their physical performance.

Getting the basic Myofascial Spreading done on

my first day resulted in a dramatic improvement
of my body alignment Mic, Townsville

This 2-day seminar will focus on CORE myofascial treatment

Back Specific and Chest Neck & Head protocols.

CORE Sports and Performance Bodywork

Brisbane 9,10,11 October 2015 (venue 41 Anzac Av.
Redcliffe)
This 3-day seminar will examine the basic styles of performance inherent in all athletic disciplines. Utilizing structural
integration and myofascial therapy theories and techniques
that are appropriate for each style of performance, we will
focus on developing training and event protocols for endurance, sprint, power, and multi-skilled athletes.

George Kousaleos, LMT is the founder and director of the Core Institute, a school of massage therapy and structural bodywork in Tallahassee, FL. He is a graduate of Harvard University, and has
practiced and taught Structural Integration, Myofascial Therapy and Sports Bodywork for the past
30 years. George has served as a member of the Florida Board of Massage Therapy and was CoDirector of the International Sports Massage Team for the 2004 Athens Olympics.

Terra Rosa
Your Source for Massage Information
AMT , ATMS, IRMA, MAA Approved CEs.

For more information & Registration

Terra Rosa E-mag 47

Visit www.terrarosa.com.au

Bringing Up Baby.
Bodywork Grows-up from
Infancy to Adolescent

By Art Riggs

A few months ago, some of us old-timers were reminiscing about the good, and not-quite-so-good, old
days of massage and bodywork, and how the profession has evolved. I decided to contact three longtime bodywork luminaries to get a broad picture of
how things were, where we are now, and where
they think we are heading.
Rick Garbowski is the co-owner of Georgia Massage School. He has trained more than 150 massage
instructors, has been closely involved in the education of many thousands of students, and was a
member of the Entry Level Analysis Project (ELAP)
to provide a blueprint for consistent standards of
training excellence.
Tracy Walton is one of the foremost teachers of
oncology massage and, among other contributions,
author of Medical Conditions and Massage Therapy.
I love that her background in the trenches of massage in both private practice and a spa setting bridges the sometimes-divisive dichotomy between
therapeutic and relaxation massage.
Thomas Myers is a world-renowned anatomist,
writer, educator, and philosopher who describes
himself as an expert in spatial medicine, as seen in
his theories of organizing and integrating the body
along fascial meridians in his modality Anatomy
Trains and subsequent books and videos.
48 Terra Rosa E-mag

To some of the newer and (and perhaps younger)

therapists out there, it may be dif icult to imagine
that back in the Neanderthal 1980s, one could receive a diploma with slightly more than 100 hours
of (often surprisingly good) training, using Anatomy
Colouring Book as the gold textbook standard, and
classes conducted without PowerPoint or threedimensional anatomical videos. Since the Internet
was not in existence, to have a successful practice, a
lot of work was needed in word-of-mouth promotion, lyers, and beating the pavement, sometimes
offering free massage. Private business of ices were
a rarity, and most depended upon a home or apartment with a less professional ambiance, sometimes
offering such new age accoutrements as a lava lamp,
incense burning in front of a bubbling fountain, and
a boom box to play sitar music in the background.
That said, there was excellent work being done, as
evidenced by so many long-time experts who were
drawn to the profession after experiencing massage.
All of our experts agree that we have come a long
way from the infancy of massage and that most of
the changes could be considered an extremely beneicial evolution. However, few things in life are free,
and along with all the progress, many of the changes
have come at a cost, both to consumers and therapists.

The Growth of Bodywork

Probably the biggest change in massage is the respect bodywork now has as an extremely worthwhile part of a healthy life for our clients, and as a
full- ledged profession rather than a fun hobby.
When Myers changed his career path to massage,
his family was disappointed and bemoaned all that
education wasted. He feels the general perception
was that massage was something old ladies did, or
was for entertainment, titillation, or an expression
of the alternative scene.
With my own background in graduate study in both
literature and exercise physiology, my abrupt march
to the beat of a different drummer in my career path
caused similar well-meaning concern for my wellbeing, if not my sanity, and reactions in the form of
what Walton describes as raised eyebrows. Like Myers, however, when friends and family saw the happiness and ful ilmentas well as the inancial rewardsI got from my work, and the bene its to my
clients, they quickly changed their views.
Thirty- ive years ago, not only was the public unaware of the therapeutic and medicinal bene its of
massage (partly because of the misperceptions that
Myers mentions), but bodywork also faced downright hostility from ill-informed local governments
and other therapeutic modalities who either feared
competition or possibly felt it their duty to protect

the publics health and morality. It was not easy to

establish an above-board practice through of icial
channels.
Garbowski recounts that in Georgia the stiffest resistance came not from local of icials or concern
over sexual massage, but from physical therapist
organizations. In formulating licensing requirements in California, the chiropractic lobby attempted to prohibit massage therapists from ever moving
limbs past the active range of motionsomething
that would have made it very dif icult for me to
work on a favourite paraplegic client. Early in her
practice, Walton was called to testify in support of
allowing massage therapists to practice without a
physicians ordertypical of the quagmire of local,
state, and national licensing and regulation that is
still not resolved today. Some therapists today are
hesitant to provide massage to medically complex
populations, such as people with cancer, without
physician approval. Walton teaches MTs how to do
the work safely and well, relying on their own reasoning rather than shifting responsibility to the clients physician. She devotes a whole chapter of her
book to effective communication with physicians
when their involvement becomes necessary.
In spite of the obstacles, it is dif icult to suppress a
good thing for long, and public awareness moved
Terra Rosa E-mag 49

massage to mainstream acceptance for both relaxation and therapeutic bene its. Now, of course, spas
abound, massage is increasingly seen in hospital settings, and chiropractors regularly employ massage
therapists in their of ices. Even physical therapists
are now having massage therapists perform manual
therapy on their patients.
Massage is now considered a legitimate career. Just
look at the name of an association in the USA:
Associated Bodywork & Massage Professionals.
Interestingly, as bodywork becomes mainstream,
Myers notices a difference in the nature of todays
therapists. When he began, someone pursuing a career in massage had to be a bit of a rebel making an
actual cultural choice. He feels most therapists had
to be very strong in their commitment and willing to
confront a somewhat condescending or adverse public opinion, but that many therapists today dont
have the same verve and drive to excel. Looking at
massage as more of a trade rather than a craft or art,
some are content to work for the security of meagre
wages and poor working conditions that may cause
injury and burnout. Rather than expressing their excellence, some therapists are hampered by assembly
-line routines or rigid, unimaginative protocols of
generic massage that shackle creativity and feelings
of ful ilment. Many new therapists I speak with are
unaware of their potential for inancial and emotional ful ilment if they challenge themselves and learn
more sophisticated techniques.
The success of our profession is much more than a
word-of-mouth grass roots movement. Unlike in its
infancy, massage now has an abundance of welldocumented studies demonstrating its therapeutic
value. All of our experts agree this is good, but that
many more studies need to be conducted. Myers especially mentions the increasing connection between
physical therapy and bodywork and that as the two
ields grow closer together, we will need more studies and veri ication.

formation in our work. She feels we need a

systematic parsing of some of the old myths concerning massage and endorphins, cortisol, cancer,
and immunity. She is preparing an eBook on this
subject for the Massage Therapy Foundation. It will
be offered along with other free resources for massage therapists on
www.massagetherapyfoundation.org.

Effect of the Internet

Our experts agree that the Internet may be the biggest in luence on the explosion of popularity of bodywork with the masses, both for marketing of private practice and also on continuing education training. In the 1970s and 80s, the major marketing tools
were word of mouth, lyers tacked on telephone
poles or left at cafe s, and ads in local weekly counterculture newspapers. It generally was accepted that
one had to work for three years to establish a full
practice, so many supplemented their massage profession with other work, often relegating bodywork
to an avocation and never making the leap to fulltime work.
Now Yelp, LinkedIn, and other social media are a tremendous help and almost a necessity for a ledgling
bodywork practice to hope to thrive. However, it
takes more than an attractive website to be successful; Myers and Garbowski agree that many therapists
inish school without suf icient training in marketing
or running a business and dont even consider the
great rewards of a private practice.

In the old days, the slow progression of practice

building not only allowed time to re ine biomechanics and tactile skills, but also gradually allowed the
body to adapt to the physical stresses as ones practice evolved. Nowadays, with the growing numbers
of people looking to massage, one can get a job immediately out of school working ive days a week in
a spaessentially being thrown into a marathon
race without a proper build-up of training. Every spa
that brings me in for in-service trainings places injuConversely, Walton points out that many of our
widely accepted claims about the effects of massage ry prevention as a high priority, and I see a large and
unfortunate increase in massage injuries and burnare either not supported or are contradicted by research. We must come to accept newer, sturdier in- out.
50 Terra Rosa E-mag

The Growth of Bodywork

The Internet has also revolutionized teaching. Before the advent of online training and the explosion
of commercial video trainings, the only way to improve our skills was to take classes at schools. This
was a huge obstacle to the progress of therapists
living in out-of-the-way locations, depriving them of
the excitement and ful ilment of growth. Now, with
webinars, online continuing education trainings,
and video instructional materials, fantastic information is available to virtually everyone, and our
profession has greatly bene itted.
Myers points out another advantage of video training that is helpful in his classes. Different folks learn
at different rates, and being able to play back video
demonstrations for clarity allows students to learn
at a more profound level, or conversely, skip over
material they are skilled in or which is not of interest. He often has students watch recorded lectures
of anatomical or philosophical discourse on one of
his favourite topics: evolution. This leaves more
time in class for training in manual skills and more
table supervision.
A downside of this proliferation is that not all teaching is of the highest quality, and some therapists
choose the most inexpensive and least challenging
material simply to ful il yearly requirements for
continuing education without the verve Myers
speaks of to constantly improve in a profession they
love.
No matter how good the quality of distance instruction, there is no substitute for attending a class and
seeing work performed in real time with a chance
for questions and the all-important bene it of feeling the work in ones own body and performing
with personal supervision of the teacher. The Internet makes it easy to forego this important experience, and I highly recommend at least one hands-on
class a year to jump-start your enthusiasm and
broaden your horizons.

The Big Business of Bodywork

Myers and Garbowski concur on the huge effect of
corporate takeover of the bodywork business. Both
agree that this phenomenon is a natural economic

reality for something as bene icial and successful as

massage. Garbowski bemoans the effects on education, while Myers regrets what he considers the inevitable massage industry and franchising drawing a different kind of individual and different working conditions now.
The popularization of massage and large spas making massage available to the masses has been a phenomenal bene it in many ways. Large numbers of
therapists who may not have the experience or interest in a private practice can ind rewarding employment; the downside is limited maximum income, often giving 5070 percent of a reduced competitive spa marketplace fee to their employers. I
hear of frequent injuries and burnout, and complaints from consumers that they ind it dif icult to
get quality therapeutic work as some spas seem satis ied to offer cookie-cutter routines. Often, because
of restrictions from corporate lawyers fearing litigation, some therapists shy away from needed work in
areas such as the chest and anterior neck, abdomen,
gluteals, adductors, and other important areas, or
refrain from extremely useful side-lying work because theyre not comfortable with overly restrictive employer draping protocols.
Garbowski points out that the single largest complaint from consumers in general is that their therapist didnt listen to requests for speci ic areas needing work. When all of our experts and I began, there
was a sort of Darwinian survival of the ittest for a
successful practice. Of course, that still holds true,
especially in private practice, but also in spa work
one therapist told me of always being booked more
than two weeks in advance at a large corporate spa
because she listens to clients and gives them what
they want rather than just performing routines.
However, I hear countless complaints about the inconsistency of spa massage and the perception that
many therapists are satis ied just getting by with
performing essentially the same massage on all clients. The popularity pendulum may be swinging
back toward private bodywork practices, as I recently heard from three different therapists in private practice that new clients complained they
didnt want a spa massage.
Terra Rosa E-mag 51

Garbowski is happy that massage franchises have

driven the cost of massage services down dramatically, making massage affordable for the middleincome family. But this also has made it more dif icult for the small businessperson operating a private practice to compete. Walton points out that
comparing hourly wages of corporate employment
to hourly rates in private practice can be misleading. There are a lot of non-paying promotional
hours necessary for independent therapists, especially in building a ledgling practice. Maintaining a
website (pretty much a necessity today), paying
rent, doing laundry, and other expenses must be
taken into consideration. Firm numbers on income,
expenses, hours, bene its, and taxes in all massage
settings are badly needed. These will enhance the
dialogue in our profession about the viability, sustainability, and real work of massage therapy.
Garbowski pulls no punches in saying that the explosive growth and increased pro its have led to a
proliferation of large schools led by investors with
no experience in the industry (who) recognized the
potential for pro it in the burgeoning massage market and stepped into a profession that had been led
by individuals who cared more about their students,
their clients, and the profession itself than their return on investment degrading the overall quality
of training and leading to an increase in the overall
turnover rate in our profession.
I speak with educators offering advanced continuing education classes who comment that many of
the newer students have no idea of their potential,
having had unimaginative routines stressed in their
trainings, sometimes just to qualify them to pass
tests, or to prepare them for generic spa massage,
even if that generalization may be unwarranted
excellent spa massage is, of course, available.
Of course, there are excellent large school programs
turning out highly skilled therapists, but I must
agree with Garbowski on many of his points. Even
the much-needed licensing requirements have a
downside. Myers says, Teaching to pass licensing
tests is a very poor way to get across knowledge.

52 Terra Rosa E-mag

The Great News with Education

To me, the explosion of knowledge and teaching of
more advanced therapeutic techniques is the most
exciting and bene icial progress. In the 70s and
80s, most training was relaxation based, often for
non-professionals. Myers is happy that there is
much more diversity and clarity today, but still feels
there is confusion between sensuality and sexuality
that should be clari ied. I would add that excellent
therapeutic work for serious conditions need not
con lict with a comforting, even sensuous, experience. One of the nicest compliments Ive received
was from a woman with serious low-back pain that
I was working deeply on who commented, You
have such a kind touch. For someone in constant
pain, a warm and nurturing touch can stimulate the
parasympathetic nervous system for serious therapy.
It is so good that we, for the most part, have escaped from the sexual stereotypes of the past; but
as many therapists emphasize the therapeutic and
medicinal bene its, I feel there can be an overreaction to the sexual stereotyping, which removes the
very crucial nurturing aspects of touch. Some therapists become so clinical that they appear to mimic
the cold and dispassionate demeanour that is so often a criticism of doctors or physical therapists ofices. I love that Walton teaches advanced clinical
skills, but also emphasizes the personal warmth
that distinguishes massage therapists from some of
the stereotypes of strictly medical approaches. She
adds, I dont like the dichotomy, especially the denigration of relaxation work from lots of experts doing serious work.
That said, the incredible gifts of therapeutic strategies from practitioners such as Ben Benjamin, Erik
Dalton, Whitney Lowe, Til Luchau, Myers, Walton,
and countless others were simply not in existence
40 years ago. There is no doubt that high-quality
educational opportunities in many different modalities are exponentially more available in continuing
education classes, videos, and webinars; and many
more therapists today are more highly skilled than
in the past, particularly in therapeutic bodywork.

The Growth of Bodywork

Thankfully, the misinformed small local policing of
our profession that Walton and Garbowski have
commented on has diminished, and we are moving
toward state and national certi ication, often based
on our own professional licensing groups.
Still, a multitude of problems remain with competing accreditation groups, con licting rules, spotty
acceptance of continuing education classes, and
online study, thus making it dif icult for therapists
to begin practice or relocate. Some states, instead of
examining therapeutic specialization, simply continue to require more and more hours, both in initial
trainings and continuing education. For example, in
California, a therapists rating is automatically upgraded from practitioner to therapist based on
the number of educational hours, without consideration of what classes have been studied.
Myers points out that more speci ic categories need
to be delineated so consumers can choose appropriate treatment. Garbowski feels a tiered system
would be helpful. There are pros and cons to a
tiered system too complex to examine in detail in
this article, but Walton feels that is not the answer.
Certainly more study can imply greater skill, but not
necessarily, and arbitrary boundaries that imply
superior skill based solely on hours of study may be
misleading. A problem with policing inside our profession is that some large schools, vying for more
students and higher tuition fees, lobby certi ication
groups to simply continue to require more hours.
Many excellent smaller schools without a large population base to draw from have had to close.
Already, many potentially excellent therapists are
prevented from entry to our profession by massive
hour requirements and expense. Much of the skill of
any therapist is not quanti iable or measured simply
by hours of study. Several famous teachers admit
that they would probably not have entered the ield
30 years ago with such daunting requirements.
Many argue that real skill can best be achieved by
getting out and working with fewer initial hours;
that practice on the public combined with continuing education workshops are a better answer, both
for getting experience and to ind passion for areas

to specialize in.
Great progress has been made since the accreditation chaos of 30 years ago, and it is hoped that Garbowski's and others work with ELAP will solve
many of these issues and make life easier for both
therapists and clients. The great news is that massage and bodywork has had phenomenal success in
the last few decades and will continue to grow. As
some problems are solved, new ones will undoubtedly spring up. For instance, will massage begin to
be covered by health insurance? Myers feels this
would expand the availability to a wide range of clientele. This plan works well in Canada, where all
citizens are granted a certain number of massages
per year with a minimum of red tape, simply having
to submit a receipt from the sessions.
With his interest in evolution, Myers has noticed
changes in the structure of clients over the years
just from the environmental changes in posture as
we spend more time hunched over computers and
commuting. I ind an increasing need for bodywork
for the it generation who spend large amounts of
time exercising in many forms, sometimes causing
injuries from over-exerciseespecially in the burgeoning market of extreme exercise classes with
minimal supervision. For success in whatever venue
we work, in the future, we need to adapt to the
changing environment of new technology, business
models, and evolving needs of our clientele, including an aging population.

The Tangibles
Having the bene it of our longtime experts advice, I
asked them what suggestions they would have for
therapists.
For his suggestions, I see a connection in Myerss
comments about the early confusion de ining massage and his desire for clarity in present-day therapists self-perception and self-de inition. One needs
to decide just where ones niche lies in the continuum of an art, a craft, a science, or a skill. Myers feels
the divisiveness between different modalities is
counterproductive. As a profession with so many
different approaches, we need to make allies, not
Terra Rosa E-mag 53

competitive separations.
Walton emphasizes good body mechanics and to
keep moving, relaxed, and breathing, and to explore
different forms of movement training including
dance and sports to shake things up and keep the
body from resting on habit.
Garbowski is in agreement, suggesting getting into
the habit of stretching, strengthening, and continually perfecting your mechanics: I have yet to meet a
healthy massage therapist who does not enjoy what
they do for a living. Most importantly, he says,
Listen intently to your clients. Massage therapy is a
customer service industry driven by repeat business and referrals from existing clients.
I would agree with all of our experts, particularly
the suggestions to stay healthy in our physically demanding work with lexibility, strength, and using
gravity and core energy rather than muscling. However, I would emphasize the mental and emotional
aspects of our work to stay focused, interested, and
passionate. Rather than resting on my laurels, I ind

I am learning and improving at bodywork as much

now as in my early years. Make each client an experiment in learning and giving.
Whether your stay in the bodywork profession is a
transitory chapter or a lifelong profession, I urge
you to make your work a creative art form. Be curious and continue to aspire to improve, and the work
will always be exciting, fun, and rewarding.
Art Riggs is a Certi ied Advanced Rolfer and massage
therapist whos been practicing bodywork since 1988.
He sells myofascial release videos and manuals, and
teaches continuing education courses worldwide.
Riggs is the recipient of the 2012 Lifetime Achievement Award from the American Massage Conference.
For more information about his work, visit
www.deeptissuemassagemanual.com.
This article was published in the March/April 2015 issue of
Massage & Bodywork magazine and is reprinted here courtesy
of Associated Bodywork & Massage Professionals (ABMP). You
can also access it online at
www.massageandbodyworkdigital.com/i/465652-march-april2015/76

Art Riggs Deep Tissue Massage :

An Integrated Full Body Approach
Coordinating Deep Tissue and Myofascial Release into a Fluid
Bodywork Session
This extensive new set (seven DVDs totalling over 9 hours) was created by
Art Riggs after countless requests from therapists who loved the first set,
Deep Tissue Massage and Myofascial Release but were having trouble working the therapeutic philosophy and techniques into a fluid deep tissue massage, especially in a spa setting. Rather than discreet sections, we move from
A to Z, covering the whole body in a common sequence of beginning in prone,
moving to supine with a whole segment devoted to the important side-lying
position.
Available at www.terrarosa.com.au

54 Terra Rosa E-mag

Functional Fascial Taping

with Ron Alexander

Evidence-Based Pain Relief

This workshop teaches a fast and simple way for clinicians to reduce
pain, improve function, encourage normal movement patterns and
rehabilitation of musculoskeletal pathologies in a pain-free environment.
FFT has been shown to have a significant effect on Non-Specific
Low Back Pain in a randomised double-blind PhD study. FFT is a
non-invasive, immediate, functional and an objective way to decrease musculoskeletal pain.

Presenter:
Ron Alexander

A great way to encourage

treatments

STT [Musculoskeletal],
FFT Founder and Teacher

Gold Coast, 14-15 Nov 2015

Sydney, 21-22 Nov 2015
Adelaide, 28-29 Nov 2015
Register Now at:
www.terrarosa.com.au

Terra Rosa E-mag 55

Research Highlights
Compiled By Jeff Tan
Isometric contraction reduce tendon pain
Researchers from Adelaide investigated heavy isometric quadriceps muscle contractions for their ability to
induce immediate analgesia in 6 athletes with patellar
tendon pain and used transcranial magnetic stimulation to look at the possible motor activation changes.
First of all, they found that people with patellar tendon
pain had HUGE amounts of cortical inhibition (as if
their motor cortex was trying to limit the use of the
quads). However, a single bout of heavy (70% MVC)
isometrics reduced tendon pain pretty much instantly
(and lasted at least 45 minutes), it also reduced the associated muscle inhibition, resulting in an increase in
muscle strength. It wasnt just about heavy load though
as this cross over study also examined isotonic
(concentric / eccentric) contractions and found no effect on inhibition, and that isometrics were superior for
pain relief.
Some key points: Tendons dislike compression so any
isometric load should avoid compression, e.g. avoid
compression of the Achilles insertion at the calcaneus
in ankle dorsiflexion. Time under tension and load (i.e.
weight) both seem to be important (based on pre-study
pilot testing). Some people may need to start with below body weight loads (e.g. seated calf raise machine
for an unloaded Achilles tendon) but the elite football
player with Achilles pain will tolerate much greater
load and will need greater than body weight. Time for
the holds in the study was 45 seconds (five times) but
may need some clinical tweaking if the muscle is shaking too much. Make sure the muscle is given complete
recovery between holds when using isometrics for tendon analgesia we used two minutes.
This is an extract from an article by Ebonie Rio published in BodyinMind
Practice and research in Australian massage
therapy
Massage is the largest complementary medicine profession in Australia, in terms of public utilisation, practitioner distribution, and number of practitioners, and is
being increasingly integrated into the Australian health
care system. A research was taken to identify practice,
research, and education characteristics among the Australian massage therapist workforce.
301 randomly selected members of the Association of
Massage Therapists (Australia) completed a 15-item,
cross-sectional telephone survey.
The results showed that most respondents (73.8%)
worked 20 hours per week or less practising massage,

56 Terra Rosa E-mag

nearly half of all respondents (46.8%) treated fewer

than 10 massage clients per week, and over threequarters (81.7%) of respondents were self-employed.
Massage therapy was the sole source of income for just
over half (55.0%) of the study respondents. Only 5.7%
of respondents earned over the average wage
($50,000) through their massage activities. Nearly half
of all respondents (43.3%) reported regularly exceeding
their continuing professional education (CPE) quota
mandated by their professional association. However,
21.1% reported struggling to achieve their CPE quota
each year. Over one-third of respondents (35.6%) were
not interested in acquiring further CPE points beyond
minimum requirements. Respondents were significantly more likely to have an active approach to research if
they had higher income ( p = .015). Multivariate analysis showed factors associated with access to CPE to be
the only significant predictors for increased CPE.
In conclusion, the massage profession in Australia remains largely part-time and practitioners earn less than
the average Australian wage. The factors that underlie
research and education involvement appear to be highly individualised and, therefore, policies targeting specific groups may be arbitrary and ineffective.
The Full article is available here
Prevalence of gluteus medius weakness in people with chronic low back pain
Clinical observation suggests that hip abductor weakness is common in patients with low back pain (LBP). A
study from University of Iowa compared the prevalence
of hip abductor weakness in a clinical population with
chronic non-specific LBP and a matched sample without LBP.
One hundred fifty subjects with chronic non-specific
LBP and a matched cohort of 75 control subjects were
recruited. A standardized back and hip physical exam
was performed. Specifically tensor fascia lata, gluteus
medius, and gluteus maximus strength were assessed
with manual muscle testing. Functional assessment of
the hip abductors was performed with assessment for
the presence of the Trendelenburg sign. Palpation examination of the back, gluteal and hip region was performed to try and reproduce the subject's pain complaint.
The results showed that Gluteus medius is weaker in
people with LBP compared to controls or the unaffected side. The Trendelenburg sign is more prevalent in
subjects with LBP than controls. Furthermore there is
more palpation tenderness over the gluteals, greater
trochanter, and paraspinals in people with low back

Research Highlights
pain compared to controls.
The authors concluded that Gluteus medius weakness
and gluteal muscle tenderness are common symptoms
in people with chronic non-specific LBP. The research
is published in European Journal of Spine
Massage May Initiate Tendon Structural Changes
Physical exercise is now a widely known and studied
factor of the proper functioning of living organisms.
Many questions remain unanswered concerning various aspects of the changes in the morphology of structures subjected to chronic physical exercise.
To study the effect of massage on collagen fibres in tendon, scientists from Poland conduced an experiment on
rats.
This study was conducted on fifty Buffalo strain rats,
randomly divided into two equal (experimental and
control) groups. All animals were subjected to physical
training on a running track for 10 weeks, whereas only
in the experimental group, massage was additionally
applied five-times per week.

40) over four weeks.

MEASUREMENTS:
The primary outcome was improvement in pain measured on a 100 mm visual analogue scale one week after
cessation of treatment. Secondary outcomes were disability, active flexion, abduction and hand-behind-back
range of motion. Measures were taken at baseline, one
week after cessation of treatment and 12 weeks after
cessation of treatment.
RESULTS:
The between groups difference in pain scores from the
initial measures to 12 weeks after cessation of treatment demonstrated a small significant difference in
favor of the exercise only group (mean difference 14.7
mm, p=0.042). There were no significant differences
between groups for any other variable.
LIMITATIONS:
It was not possible to blind therapists or participants to
group allocation. Diagnostic tests were not used on participants to determine specific shoulder pathology.

The results showed an increase in the percentage of

collagen fibers in tendons with the smallest diameter
(100 nm) was observed only in the experimental
group in week 3, followed by a decrease in weeks 5 and
7. A subsequent repeated increase was observed in
week 10 of the study. No significant differences were
observed for either study group in the number of collagen fibers based on fiber diameter (101-200 nm, 201300 nm and 301-400 nm).

CONCLUSIONS:

The results of this preliminary study showed that longterm massage performed during running training may
initiate for small structural changes in the rat tendon.
The study was published in the journal in Vivo.

Gluteal Trigger Points Found in Most Lumbosacral Radiculopathy Cases

Effectiveness of Soft Tissue Massage for Nonspecific Shoulder Pain?

BACKGROUND:
Soft tissue massage and exercise are commonly used to
treat episodes of shoulder pain.
OBJECTIVE:
To investigate the effects of soft tissue massage and
exercise compared to exercise alone on pain, disability,
and range of motion in patients with non-specific
shoulder pain.
DESIGN:
Randomized controlled trial.
SETTING:
Public hospital physiotherapy clinics, Sydney, Australia.
PATIENTS:
Eighty participants aged 62.6 1.4 yrs (mean SE)
referred to physical therapy for non-specific shoulder
pain.

The addition of soft tissue massage to an exercise program for the shoulder confers no additional benefit in
pain, disability or range of motion or disability in patients with non-specific shoulder pain.
Reference

Most patients with lumbosacral radiculopathy have

gluteal trigger points (GTrP), according to new findings.The findings raise the possibility that treating
these trigger points could help ease pain in these patients.
Lumbosacral radiculopathy, or pain in the low back
and legs due to damage to the intravertebral discs, is a
frequent cause of lower back pain, Dr. Adelmanesh and
his colleagues note in their report. Painful GTrP due to
lumbosacral myofascial pain syndrome can mimic this
type of pain, they add, and distinguishing between the
two can be difficult.
While Dr. Adelmanesh and his team note that they often observe GTrP in patients with lumbosacral radiculopathy, GTrP is not routinely evaluated in these patients. To better understand the relationship between
these two pathologies, the researchers compared the
prevalence of GTrP in patients with clinical, electromyographic, and magnetic resonance findings indicating
lumbosacral radiculopathy with healthy controls.
They screened 441 patients, 271 of whom met the
study's inclusion criteria. Two-hundred seven (76.4%)
had GTrP, versus three of the 152 healthy volunteers
(1.9%). Among patients with one-sided pain, 74.6% had
ipsilateral GTrP.

INTERVENTIONS:

The findings were published March 12 in the American

Journal of Physical Medicine & Rehabilitation.

Participants were randomly assigned to either a group

that received soft tissue massage around the shoulder
and exercises (n = 40) or an exercise only group (n =

The investigators also found that just one of the 14 patients with no pain, but leg weakness and parasthesias,
had a positive GTrP, versus 82.5% of patients with right

Terra Rosa E-mag 57

Research Highlights
-sided pain and 79.5% of those with left-sided pain.

suboccipital area on the flexibility of the hamstring.

"Taken together, these findings support the clinical observation of the authors of this study that GTrPs are
common among patients with radicular pain and that
they are directly associated with this pain condition,"
Dr. Adelmanesh and his colleagues write.

Fifty persons with short hamstrings participated in this

research. According to the results of the finger-floor distance (FFD) test, the subjects were allocated to SMI and
SMFR groups of 25 subjects each.

The effect of stretching the plantar fascia on the

flexibility of hamstring and lumbar spine

The SMI and SMFR techniques were applied to the

groups. For the analysis, they used the FFD test and the
straight leg raise (SLR) test for the flexibility of hamstring. The evaluator was blindfolded.

In the era of evidence-based, everything needs to be

tested before it is proven. The superficial back line of
Anatomy Trains suggested that muscles along this line
is "connected". Last month we reported a study that
"proves" myofascial release of the suboccipital muscle
increases the flexibility of hamstring. And now another
study needs to "prove" what is usually taught in a myofascial course, stretching the plantar fascia increase
flexibility and range of movement along the superficial
back line. The researchers deemed it is necessary to do
an experiment as "To date there is no evidence to support the effect of bilateral self myofascial release on the
plantar aspect of the feet to increase hamstring and
lumbar spine flexibility."
Twenty four healthy volunteers (8 men, 16 women;
mean age 28 years 11.13). underwent screening to exclude hypermobility and were randomly allocated to an
intervention (self myofascial release SMR) or control
group (no therapy). Baseline and post intervention flexibility was assessed by a sit-and-reach test (SRT).

The results showed that In the SMI group, FFD, SLR,

and PA were significantly changed after the intervention, and in the SMFR group, there was a significant
change in SLR after the intervention. In a comparison
between the groups, FFD was found to be significantly
increased in the SMI group.
The authors concluded that the application of the SMI
and SMFR to persons with short hamstrings resulted in
immediate increases in flexibility of the hamstring.
However, the SMI technique was more effective.
The full article can be accessed here
Performance-enhancing Placebos

Performance-enhancing drugs can improve a runners

best time even when they havent taken them. A study
examining the placebo effect found that endurance runners who thought they were injecting a fictional perforThe results showed that there was a significant increase in the intervention SRT outcome measurements mance-boosting drug called OxyRBX improved their
race time even though they had taken only sacompared to the control group, with a large effect size.
And thus concluded that "An immediate clinical benefit line.Investigators from the University of Glasgow told 15
of SMR on the flexibility of the hamstrings and lumbar endurance-trained club-level runners that they were
spine was indicated" Therefore we can now say research being given a new performance enhancing drug called
OxyRBX which was said to improve oxygen delivery to
has proven it! This study was published in Journal of
the muscles in a similar way to a hormone called recomBodywork and Movement Therapies
binant human erythropoietin (r-HuEPO).
The runners, who all had personal best times over 10km
of 39.3 minutes on average, self-injected the saline placebo, thinking it to be OxyRBX, over seven days and
3km running performances in head-toShortening of the hamstring has a negative impact on
head competitions were assessed.The runners improved
the posture of the pelvic region. As Tom Mytheir race time by an average of 1.2% a small but sigers superficial back line implies the hamstrings and
nificant margin after taking the placebo.Participants
suboccipital muscles are connected.
reported reductions in physical effort, increased potenThe study investigated if the flexibility of the hamstring tial motivation and improved recovery after running
can be increased by targeting the suboccipital muscles. following the saline injections.Dr Jason Gill of
the Institute of Cardiovascular & Medical Sciences, said:
The suboccipital muscle inhibition (SMI) technique is a The change in performance was of clear sporting relemethod of relaxing the tension in the four muscles locat- vance, albeit smaller than the improvement that would
be produced by r-HuEPO.The placebo may work by
ed between the occiput and axis, which regulates the
reducing perception of effort and increasing potential
upper cervical vertebra (rectus capitis posterior major,
rectus capitis posterior minor, obliquus capitis inferior, motivation in line with a psychological expectation of
performance. The study is published on the jourand obliquus capitis superior) ; these muscles are
known to be associated with regulating body posture as nal Medicine and Science in Sports and Exercise.
well as rotation of the head. When the tone of suboccipital muscles falls, it has been reported that the tone of
Duration and magnitude of myofascial release
knee flexors such as the hamstrings also decreases due
in 3-dimensional bioengineered tendons: effects
to relaxation of the myofascia.
on wound healing.
The purpose of this study was to research the effect of
To investigate the mechanism behind the effectiveness
performing the suboccipital muscle inhibition (SMI)
of myofascial release (MFR), researchers from the Deand self-myofascial release (SMFR) techniques in the
partment of Basic Medical Sciences at the University of
The immediate effects of application of the suboccipital muscle inhibition on short hamstring.

58 Terra Rosa E-mag

Research Highlights
Arizona College of Medicine in Phoenix led by Paul
Standley evaluated effects of duration and magnitude of The rats were divided into the following three groups;
MFR strain on wound healing in bioengineered tendons (1) normal controls, (2) rats with LC application (LC
(BETs) in laboratory.
group), and (3) rats undergoing MT after LC (LC + MT
group).
The bioengineered tendons (BETs) were cultured on a
deformable matrix and then wounded with a steel cutAccording to the CE-TOFMS analysis, a total of 171 meting tip. Using vacuum pressure, they were then
strained with a modelled MFR paradigm. The duration tabolites were detected among the three groups, and 19
of these metabolites were significant among the groups.
of MFR dose consisted of a slow-loading strain that
stretched the BETs 6% beyond their resting length, held Furthermore, the concentrations of eight metabolites,
including branched-chain amino acids, carnitine, and
them for 0, 1, 2, 3, 4, or 5 minutes, and then slowly remalic acid, were significantly different between the LC +
leased them back to baseline. To assess the effects of
MT and LC groups.
MFR magnitude, the BETs were stretched to 0%, 3%,
6%, 9%, or 12% beyond resting length, held for 90 secThe results suggest that manual therapy (MT) signifionds, and then released back to baseline. Repeated
cantly altered metabolite profiles in DOMS. According
measures of BET width and the wound's area, shape,
to the findings and previous data regarding metabolites
and major and minor axes were quantified using miin mitochondrial metabolism, the ameliorative effects of
croscopy over a 48-hour period.
MT might be mediated partly through alterations in meThe results showed that an 11% and 12% reduction in
tabolites associated with mitochondrial respiration.
BET width were observed in groups with a 9% and
Full article is available here
12% strain, respectively. In the 3% strain group, a statistically significant decrease in wound size was observed at 24 hours compared with 48 hours in the non- Role of psychosocial factors in the development
strain, 6% strain, and 9% strain groups. Longer duration of multisite pain
of MFR resulted in rapid decreases in wound size, which The November 2014 issue of Journal of Pain published
were observed as early as 3 hours after strain.
a research study on the role of psychosocial factors in
the development of multisite pain. The researchers used
The authors concluded that Wound healing is highly
experimentally induced Delayed Onset Muscle Soreness
dependent on the duration and magnitude of MFR
(DOMS) to investigate the possibility that pre-existing
strain, with a lower magnitude and longer duration
psychosocial status could predict the likelihood that
leading to the most improvement. The rapid change in
wound area observed 3 hours after strain suggests that someone would develop multisite pain.
this phenomenon is likely a result of the modification of
119 healthy university students completed questionthe existing matrix protein architecture. These data sug- naires to assess depression, fear of pain and catagest that MFR's effect on the extracellular matrix can
strophic thinking, and then reported on their experience
potentially promote wound healing. The implication of
of pain on lifting a heavy canister. They reported pain
this research suggest that 3 hours after a wound ocintensity on a numerical rating scale, and pain sites by
curred, application of 6% stretch on the area for 90 sec- shading a body chart. They then performed a set of exeronds could enhance healing.
cises designed to induce DOMS, and went home. The
The study was published in The Journal of the American next day, they came back and repeated the lifting test
Osteopathic Association
and pain reports.
The researchers investigated possible influences of genManual therapy ameliorates delayed-onset mus- der, depression, fear of pain and catastrophising on (a)
cle soreness and alters muscle metabolites (in
pain intensity and (b) number of pain sites. They found
rats).
that depression influenced neither pain outcome. Pain
Delayed-onset muscle soreness (DOMS) can be induced intensity was affected by gender: women reported more
pain sites than men (both before and after DOMS inducby lengthening contraction (LC); it can be characterized
tion), and women had a greater increase in pain after
by tenderness and movement-related pain in the exercised muscle. Manual therapy (MT), including compres- DOMS induction than men had. Pain intensity after
DOMS induction was correlated with catastrophising
sion of exercised muscles, is widely used as physical rescore. Fear of pain did not appear to modulate pain inhabilitation to reduce pain and promote functional recovery. Although MT is beneficial for reducing musculo- tensity.
skeletal pain (i.e. DOMS), the physiological mechanisms The number of painful sites was greater after DOMS
of MT remain unclear. There is still a debate whether
induction in both men and women, and both fear of
manual therapy can help with DOMS.
pain and catastrophising appeared to separately influence the number of painful sites after DOMS induction.
To study the physiological mechanism, researches from This study makes a notable contribution to what we
Japan studied the effect of manual therapy in DOMS on know about psychosocial influences on multisite pain: it
rats.
tells us that fear of pain and catastrophic thinking patLC was applied to the rat gastrocnemius muscle under
terns that exist before pain begins may predict how far
anesthesia, which induced mechanical hyperalgesia 2-4 that pain will spread, but that depression may not play
days after LC. MT (manual compression) ameliorated
the same role.
mechanical hyperalgesia. Then, they used capillary electrophoresis time-of-flight mass spectroscopy (CEFrom Body in Mind
TOFMS) to investigate early effects of MT on the metabolite profiles of the muscle experiencing DOMS.

Terra Rosa E-mag 59

6 Questions to John Sharkey

1. When and how did you decide to become a
bodyworker?
In the 1970s I was very interested in the life's work
of Bernarr Macfadden (August 16, 1868 October
12, 1955). Macfadden was teacher of Stanley
Lief, the person who coined the term
neuromuscular techniques and he was uncle to
Leon Chaitow, one of my mentors. I was fascinated
by Macfadden as he combined physical activity and
soft tissue manipulation in an effort to reduce pain
and return homeostasis. I did every course available
to me in those halcyon days (and I am still a student). I met Leon Chaitow in the mid eighties (as
a young boy I could never have imagined I would
end up working with Leon and create a new link in
such an historical chain) and the rest is history
crowned with the development of our masters degree in Neuromuscular Therapy.
2. What do you ind most exciting about bodywork therapy?
For me there is no black or white in bodywork.
There is at times a touch of grey but it is mostly colourful. It works. It is simplistic in its application. It
requires touching and to be touched. There is a
famine of touch in the world. It has the potential to
change lives. It changes lives.
3. What is your favourite bodywork book?
I am forever reading books. Not the latest Tom
Clancy or Paula Hawkins but anatomy, physiology
and bodywork topics. The irst book my mother
bought for me was an anatomy text book. I have a
handful of prized possessions including the original Macfadden's Encyclopaedia of Physical Culture.
Macfadden was the father of health related physical
itness and he combined soft tissue manipulation
with exercise. I was truly taken with that idea. How
I came to own Macfaddens Encyclopedia is a story
in itself and if I was not the person I am such amazing occurrences in life could make me believe in
destiny.
4. What is the most challenging part of your
work?
60 Terra Rosa E-mag

From an educational and clinical point of view a

challenging aspect for me has been to develop
my vocabulary to ensure that I stay true to scienti ic
facts without dumbing it down, which in my view
would be a grave insult to everyone patients and
students. My responsibilities include that I stay true
to the science but avoid complicating the issues for
therapists and patients alike. I need to have the ability to speak to and teach a wide variety of learners
while facilitating a great educational experience.
That involves translating the theory and models into clinical take-away applications. I need my patients to buy into the therapeutic interventions I
provide and in that regard education and understanding is empowering and healing for them.
5. What advise you can give to fresh manual
therapists who wish to make a career out of it?
Make sure the people you choose as your tutors are
accepted and recognised experts in education.
These people need to know your scope of practice
and must be up to date with all legal implications of
the work you are doing. I appreciate that therapists
can be frustrated with having to always provide evidence based, research supported therapeutic interventions. Keep in mind that if you ever had the misfortune to end up in a court of law the judge needs
to know you are professional in your approach, that
you follow accepted standards and guidelines and
above all that you took reasonable care. Lastly realise that you will be a student for life.
6. How do you see the future of manual therapy?
Populous Fads will come and go but most people
will always appreciate hands-on applications when
compared to the use of machine based modalities.
Never underestimate the power of endocannabinoids. The endocannabinoid system helps to balance sympathetic tone and imparts anti-emetic and
antihypertensive bene its, and favourably modulates stress in the HPA axis and all due to manual
therapies. Manual therapy has a great future.

6 Questions to Joanne Avison

1. When and how did you decide to become a
bodyworker?

I became a Yoga Teacher after a back injury that
meant I had dif iculty carrying my new-born son. I
couldnt understand why the so-called anatomy &
biomechanics I was learning, (and the postures)
appeared to show up uniquely in each person I
taught. As an artist, I had been trained in life drawing to see form in a way that didnt lend itself to
being broken down into muscles and joints, as if the
structure underneath a body at rest, or in motion,
was a robotic, mechanical form. I met Tom Myers in
1998 (before he had completed Anatomy Trains),
as a Yoga Teacher, and become fascinated by the
idea of anatomical continuity. The inclusion of the
fascial matrix in the suite of tissues that hold us together was a paradigm shift for me. I wanted to
learn how to sense these forms through my hands
and make sense of movement. It transformed my
notions of adjustment too.
2. What do you ind most exciting about bodywork therapy?

Discovering the language of bodies through touch.
It awoke a level of sensory perception and communication between me and the person I was working
with, that just seems to become more eloquent and
articulate as time goes on. It is as if people speak
or write their body story and its history in their
tissues; the hands can be a medium of translation
that eventually becomes luent enough to communicate in individual dialects. Every encounter is
a new conversation for different possibilities; I love
that. My hands become translators in a way.
3. What is your favourite bodywork book?

The book that has given me the most inspiration
and wisdom is The Unknown Leonardo, (Leonardo
da Vinci) which is full of his exquisite drawings and
insights into form and Sacred Geometry. The man
was a genius, way ahead of his time. Every time I
look into it, it gives me a view of human motion that
teaches or inspires me. If you want something more
obviously about body work, then Jobs Body, by

Dean Juhan and Awakening the Spine by Vanda

Scaravelli. I know thats three altogether; but they
are each very important works to me. There are
many others, my book shelves take up a huge
amount of space in my home
4. What is the most challenging part of your
work?
Taking care of myself as well as my clients!
5. What advise you can give to fresh manual therapists who wish to make a career out of it?

Practice, practice and practice on everyone you can,
while you take care of yourself doing so; and work
gently and thoughtfully, even if you are doing some
of the stronger therapies. It takes years to really
let yourself work instinctively and you need to be
patient with the time it takes for you to really dance
with the modality you choose. Listen to yourself
and dont make a guru of your teachers. That
doesnt mean ignore them or deny them credit for
your learning facility. However it does mean gathering all that you are taught and making it your
own. Whats in your heart?
6. How do you see the future of manual therapy?

I see it expanding into new paradigms as we begin
to recognise how entirely essential appropriate
touch is in everyones life. My prayer is that we are
kind to ourselves and realise that very gentle treatment can be as valuable as strong treatment. I
would also love to see more manual therapy options in Orthopaedic training. I think it would be
extremely valuable if more Orthopaedic Surgeons
recognise the value of manual interventions before
surgery, wherever possible. I think that is a lost aspect that too few recognise, but maybe the tides are
turning. Surgery can be exceptionally valuable of
course; it saves lives. However there are many intelligent options in the broader reach of manual
therapies that can prevent the need for surgeries in
many cases; preserving the wholeness of the body.
That could perhaps be given a higher value as manual therapy becomes more articulate and new models emerge.
Terra Rosa E-mag 61

Report

Fascial Fitness Workshop

with Daniela Meinl, Sydney Feb 2015
By Kati Cooper
Fascial Fitness, the original connective tissue conditioning
program, has been growing for several years. An ever increasing number of high profile sporting, fitness and therapeutic
organizations are now using and incorporating the Fascial
Fitness conditioning techniques into their assessment, movement and training regimes. Amongst these are the World Cup
winning German Soccer Team and the Canadian Olympic Athletic team. The success of Fascial Fitness is largely based upon
its ability to translate the latest scientific research and insights
regarding the nature of fascia, into practical, safe, complementary and enjoyable training techniques. When the techniques
are taught correctly, they help to enhance the elasticity,
strength and performance of connective tissue and those collahydration; myofascial stretch and fascia as a sensory organ, in
genous structures most prone to injury.
more depth. She demonstrated and explained how the techThe cutting edge and complementary approach of the Fascial
niques associated with each principle can help remodel and
Fitness training program always attracts a wide range of very
condition our fascia. Workshop participants were given time
enthusiastic health and fitness professionals leading the way
to listen, watch, ask questions, practice and play with the techin their fields, as well as individuals seeking personal fascial
niques and feel how best to work their tissue.
enlightenment. Attending the Introductory and Trainer workThis play took us outdoors to rediscover how our inner child
shops with Dani in Sydney were pilates and yoga specialists,
had explored and experimented with movement. Leaving
fitness, martial art and dance instructors, physiotherapists
adult inhibitions behind we hopped, wiggled, jumped,
and chiropractors as well as remedial, somatic, bowen and
skipped, swung, leapt, climbed, crab-walked, monkeyed, balstretch therapists of every description. Its great that such a
anced, danced, somersaulted and cartwheeled our way
diversity of skills and life experiences can connect with each
through the beautiful gardens surrounding our venue. The
other and their fascia, in this exploratory learning environsuccess of the Introductory program was such that those who
ment.
had attended did not want to leave and were wishing they had
Early this year, Daniela Meinl. Master Trainer from Augsburg, signed up for the Trainer course.
Germany travelled to Sydney and teach how to safely and efThe Trainer course revisited but expanded significantly on the
fectively train our fabulous fascial network. Along with Dr
Robert Schleip and Divo Mueller, who have previously taught scientific research underlying the four main Fascial Fitness
in Australia, Dani is a highly experienced core member of the training principles. The potential trainers were given time to
Fascial Fitness Organization, travelling Europe and the world revisit and clarify their understanding of these principles and
then given instruction as to how to go about teaching the basic
to share her knowledge and expertise.
techniques for each of them. Additional techniques for each of
After a brief history and review of the evolution of our under- the principles were demonstrated and practiced and particistanding of fascia, Dani gave us an introduction to the scienpants were encouraged to focus on how they would adapt
tific research upon which the Fascial Fitness principles and
these for themselves and others individual needs and capabilitechniques are based. Whilst energy, enthusiasm and concen- ties. We were also lucky enough to have Dr Robert Schleip
tration were at their peak Dani demonstrated, talked, walked, beam in for a Tele-Lecture on the latest research news and to
warmed, bounced and stretched us through a sample Fascial
answer any questions. It was both a fascia changing and career
Fitness routine. Everyone was encouraged to participate
enhancing process for the participants.
adapting the techniques to suit their ability as they tuned in
and took care to listen to what their individual fascial network Kati Cooper, Assuage Fascial Release Therapy, Fascial
Freedom Advanced Fascial Fitness Trainer
was telling them.
Over the next two days, Dani then revisited each of the Fascial
Fitness theoretical principles: elastic rebound; release and

62 Terra Rosa E-mag