by Othon Molina, Ph.d.c, LMT, PhD.
After forty years of being a massage therapist and having worked my way up to working in a Physical Therapy Clinic. I have come to realize that massage, physical therapy, chiropractic and osteopathy are still lacking some very important facets to helping people with changing their bodies. Most of these therapies are very helpful in helping people get well. They are exceptionally good for acute conditions. In general with some exceptions I’m afraid they don’t help chronic and old injuries as well.
I personally have gotten all types of this work over the last forty years and I have had some relief from this body-work. In fact at times when I could hardly walk it helped me. Most pain and misalignment of the body unfortunately comes back. You may have had massage and it feels great, but next day or next week all the tense muscles and pain comes back.
Believe me I’m not trying to put any body-work down, and I certainly don’t have all the answers, there is too much to learn about the human body. I’m just looking at being better at what I do and help people better. I have never been satisfied with just doing massage, my goal has always been to be the best and to do my best. After the first few years of doing massage I realized there was more needed. It was not the answer, you can correct many of the symptoms with it, but for long term healing it takes the patient also working to achieve homeostasis. (Balance)
This has led me to put together a system that works to balance the body, structurally. This seems to help people with the basics of dealing with gravity and the imbalances that occur in our bodies due to posture, injuries or whatever causes our bodies to be out of alignment (Some say, mind, nutrition emotions or whatever). We know it’s all connected. I’ll just go into the physical and structural components in this paper.
As much as I have studied the muscles and that massage is primarily concerned with the muscles and soft tissue. Muscles don’t seem the avenue by which to achieve balance or correct structure in the body. At least not the only reason and certainly not for long term correction. We have all heard how the muscles pull the body out of balance. Yet the more I look at that, having studied Kinesiology, the less I see they are the main problem. For a time we worked with the theory that the opposing muscle was the problem (George Goodheart, or Walters Kinesiology) we would go around and around the body chasing the problem. At times the more we massaged the muscles the more they just come back and got tense and painful again.
When a muscle is out of balance or stressed the brain shuts it down, so it will not injure itself further. Our brain controls all these functions, through the proprioceptive nerve reflexes, that is a whole other interesting area of study. Are the muscles the cause or they the symptom?
This led me to look at the body with different eyes. If we want to change the structure to create balance, because the hips are rotated or the body has a short leg, or worse a disk injury or neck is twisted and painful. What can we do to change that ? Massage, Chiropractic, Osteopathy, whatever works is how we have approached it.
I’m sorry I have seen and worked with some of the best Chiropractors and Osteopaths in the country and what I saw was that it works great for some acute conditions, some locked facet conditions, but not so good to correct many chronic conditions. Long term pain and injuries are in a ballpark all by themselves. We would adjust many patients and before they were out the door they would be back out again. If they ever even moved.
If the body has been out for many years, the quick chiropractic move does not generally produce long lasting effects, nor does it keep the vertebras or bones in place. Which is one reason why they have you keep coming back over and over.
In the work of Dr. James Cyriax, he postulates that if you have to adjust an area more than ten times that’s not the problem, nor the solution. I have also seen patients that where over adjusted. They would not stay in, their ligaments over stretched (hyper-mobile). Sometimes in our P.T. clinic we would say we are not going to manipulate until we strengthen the weak muscles and ligaments. These patients did start to get better, it was a slower process. I found that they stayed in longer with the slower work (Low velocity, more Osteopathic), building up their strength, corrective exercises and deep corrective massage.
Let’s look at the most underlying structure that we deal with when we look at the body structure; The bones, vertebras and ligaments. These tissues are not very flexible and if you have been out of balance for five or ten years, a hard adjustment may even hurt, and may not correct the problem.
I have seen and felt this pain with an adjustment. Now don’t get me wrong I have also had relief from an adjustment. I have seen many people get better with proper low force adjustments. I have also had patients tell me that they have been getting adjusted for ten years and still have a back problem. If you get a quick adjustment, usually the body goes right back to where it was, if you even manage to move the bone, or vertebra there is no guarantee it will stay.
The ligaments are holding the body out of alignment, the body thinks it lives there. We try to force it to move and it resists, or using a gentler approach we try to persuade it to move or loosen it to try and align it (Osteopathy).
Ligaments do not respond well to quick movements, they go right back to where they were. If we are out of balance we are constantly having what I call “muscle tug of war” It’s a vicious cycle, tension, tight muscles, pain, tension, tug of war and so on. Even all those ligaments have to compensate. And because they are such hard structure, not flexible and don’t respond to hard quick movement.
How do we stop this cycle? One way I know is by balancing the body getting to the cause and not just working on the symptoms. It’s a start, at least working with the body structurally, of course I acknowledge there are other factors. For simplicity let’s stay with the body.
If the most deep level of structure is the bones and ligaments then that’s a place where we can make some long lasting change. The muscles will follow the bones, as long as you also work on the actual adhesions in the muscle tissues as well. The way to stretch or change the ligaments is through corrective stretches and specific exercises. We have known in physical therapy that often strengthening the muscles, doing certain postural corrective exercises, can affect change in the body, many times giving relief to the pain as well. We also know in sports medicine that in training, laying a base is critical. We need to strengthen the muscles, the joints, ligaments and bones before we put excessive strain on them with competition, or we can get injured.
It takes longer to strengthen ligaments, as well as stretch them because of their structure, lack of blood flow and rigid cell makeup. So it has to be slow and easy to stretch and move ligaments. Not only that, it takes consistency and accuracy in the knowledge of the structure that you are trying to make a change in order to get measurable results. As I have said to many a student. The level of knowledge and diagnostics ability gives you the level of duplicable results you can get to help your clients. The more years you have seeing patients in a clinic day after day you start to learn a little about the body and it’s ability to change or not change, to heal or not. Therapy to me, no matter what type it is, is still about 70% of the equation to helping people change and heal their bodies. The other 30% is doing corrective exercises to change the body from within as well as breaking bad postural habits.
The last twenty years I have accomplished results in my therapy that I just touched on in the first twenty years. Many times I heard from patients that I really helped them, even in the early days. But I didn’t know what part I did that worked and for many years I could not duplicate the same results over and over. Many of us are still working in the dark. I always knew that if I focused on balancing the body at whatever skill level I had, that the symptoms or problems would go away or at least improve. It’s still a good approach, the key is what techniques we have, also determines the level of success we can accomplish.
I would rather work on prevention of problems or injuries as well as with athletes and dancers that want to perform at a higher level. But let’s face it, most patients come to get a massage or therapy because they have a problem or pain of some sort.
The way I work on the body is with deep massage (for adhesions), DTF (deep transverse friction), trigger points, for increased flexibility, tone and relief. Then I use positional release techniques holding the area in a stretch, mobilization, either with a torque on the whole spine, neck or any joint that I want to work on relaxing. It’s a modified version of Orthobionomy (Osteopathy) that works on the release of the proprioceptive nerve reflexes. This allows the body to release and self align. The body has a memory, sometimes using Feldenkris, Polarity or Traggering can break up some of the holding patterns in the neurology but my experience doesn’t show that they are long lasting corrections of the body structure.
Lets start with the neck, most people have some type of trouble with the neck. Many have been in car accidents, many sleep with large pillows and both end up with an improper curve in the neck. Many can get this by weak neck flexors as well, regardless of how someone ends up with a poor curve or a twist in the neck the therapist can palpate this condition. Traditional massage helps, chiropractic helps in the acute state, and many times in the chronic state it gives relief, the point is even aspirin will help with neck pain that can turn into headaches. To correct the cause means we have to align the neck, as well as remove any adhesions in the muscles or ligaments that have been created by the trauma.
By creating a torque in the neck or spine for instance, we are persuading the vertebras and muscles to want to work as a team or as a unit. If we have one vertebra or muscle that is not cooperating or out of alignment, it will crate a chronic condition sometimes displayed as scar tissue and pain. Using deep transvers friction DTF is one of the most effective ways to loosen ligaments and the vertebra holding. By using a directed force put on the area of resistance we can achieve great results in mobilizing the area. I put direct pressure towards the direction it’s being pulled first and then after the body relaxes, I gently move it in the direction it should be for proper alignment. Holding for a few minutes and having the patient breathing deeply, allows the body to integrate the proper alignment, and I find more accepted than an adjustment.
With deep breathing we use the mechanism of breath, moving the ribs, undulation of the spine, movement in the pelvis and the sacrum. These movements are microscopic, yet they do create movement in the ligaments and joints. Using all of these factors you can stretch the specific ligament tissue very slowly and gently to achieve restoration and alignment in any joint or vertebra. We are still working with soft tissue, we are not adjusting bones, this is within the massage license. It’s all very slow, precise and deliberate movement, thus more effective in my opinion.
I have found that by using this system I am able to help people with pain in hip, low back or neck problems. This system of massage is all within our license. I am not talking about doing any type of adjustment, nor am I suggesting that we are working with the bones. We are working with soft tissue and using mobilizations and stretches all at very low level force. By giving the clients stretches that help relieve tension and work towards self alignment we get the body to change.
The most important part for proper function and alignment of the whole body is the pelvis. For I feel the pelvis is the foundation of the body and if not balanced everything compensates and gets thrown out; the legs the spine and the neck.
With most people working at desks or computers all day they are prime candidates for neck, low back and shoulder tension. Let’s look at what a rotation does for instance. Most people have this twist to their hips, in fact it can shorten a leg. So much so that in the old days we use to give shoe lifts to these people, talk about not addressing the cause. To ease the pull, I take the muscles and massage them first, (Prone) working with the leg in a rotation to find the tension in the gluteus muscles. Then I stretch the hips in the direction it wants to twist in (by lifting the hips), go with the side that is anterior, this turns off the receptors. Then I bring the hip back (in the direction it should be) and hold it in a stretch to get the ligaments and muscles that are tight to allow it to go relax back into place. Using this positional release and deep breathing I have helped people correct the misaligned muscles and reduce the tension considerably. Then by using my towel techniques I show them how to stretch their own back or neck with various exercises.
Since I started really applying these techniques, I have been able to help people that had pain, in necks, hips or low back in three to four sessions. Some of these people had been everywhere and had tried lots of therapies as well as chiropractic and were loosing hope, they felt frustrated and were ready for something new. The ones getting the best results, where of course doing the exercises regularly at least once a day, twice is even better. I saw people change to the level that their hips where now staying in alignment after a four or five sessions, the leg length was staying even and most important a reduction in pain. Now they had something that they could do for themselves, the therapy is part of it. More important however for long lasting results are the exercises to balance and strengthen the body.
I am teaching these systems all over the country and in Latin America and welcome researchers and therapists interested in exploring my work. In fact, if you want to poke holes in my theory, I welcome it. It can only help me expand more and improve my work.
For any questions please call:
Othon Molina Ph.D. c LMT