CORE Structural Integration and Myofascial Therapy: A Lifetime of Improving Structure and Function George P. Kousaleos, LMT

CORE Structural Integration and Myofascial Therapy:
A Lifetime of Improving Structure and Function
George P. Kousaleos, LMT

It is interesting that a cervical injury during a college rugby match lead me to my first Swedish massage. After four weeks of treatment the massage therapist sent me to my first 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 Rolfing, and in a few short weeks I received my first session of Structural Integration. Each step of the way I experienced significant improvement in decreasing my pain levels, improving my overall flexibility, 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 earliest days of my study of the disciplines of Structural Integration and Myofascial Therapy I was fascinated with the importance of recognizing the foundational relationships between structure and function. Indeed, over many years and decades of practicing and teaching this incredible work, I never lost sight of those relationships that not only improve structure and function, but increase neurosomatic awareness and restore a sense of physical and mental confidence.
From the early 1980’s I worked in New York City with leading ballet dancers, opera singers and classical musicians. They quickly appreciated the performance benefits 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 center 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 pliability of even the densest tissues, the most hardened of bodies.
After opening the CORE Institute in Tallahassee, Florida in 1990, and creating an entry level professional massage therapy program that included structural and myofascial education, I looked for opportunities to help prepare my students for the day that each of them would embark on their professional journey. I was thrilled when the British Olympic Association decided to hold their warm-weather preparation 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”.
Later that decade I began teaching in England, Scotland and the Republic of Ireland from 2009 to 2011. Many of those students from London, Manchester, Chelsea, Bath, York, Edinburgh, Aberdeen, Galway and Dublin assisted their Olympic teams at the 2012 London Games. Each of them took their place with those who preceded them in offering a sports and performance therapy that increased balance, responsiveness, ease of movement, and kinesthetic agility.
At the same time I was engaged in creating Myofascial Therapy protocols for the leading athletes of the Florida State University Football Team. From 2011 to this day these athletes receive twice a week treatment from 10 CORE Institute graduates during the regular season as well as during all spring and summer training camps. During this time, soft-tissue injuries decreased by 75% and FSU won three ACC Championships and the 2013 National Championship. Over 30 of these athletes are now playing in the NFL, with many of them continuing their commitment to regular myofascial therapy.
Last Fall I was honored 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 fields, including physiotherapy, podiatry and acupuncture. On the ninth and final day of the intensive seminar we invited current and former professional and Olympic athletes to a special clinic. Each athlete responded favorably to their sense of improvement from a 90-minute full body session, with several emailing us later in the week with amazing stories of how their training had improved. The common theme we heard was “I feel more awareness of my body and how integrated my movements have become.”
I am more than satisfied that during the past four decades I have represented one of the finest approaches to structural and functional improvement from the disciplines I studied 37 years ago. Each year I look forward to introducing this work to curious and dedicated therapists who are searching for the keys to providing long-lasting health and wellness to those they serve each day. Each day I enjoy my clinical sessions with professional and amateur athletes who want to maintain elite athletic levels, with clients rehabbing from serious injuries and disease, and with those who simply yearn for a deeper sense of self. Each day I find happiness.

Join us at the Downeast School of Massage to welcome George at his Core Myofascial Therapy Seminar on July, 10, 11, and 12, 2015. See description of his workshop at:  Register on line or call 207-832-5531.

A Labor of Love by Nancy Dail

A Labor of Love
By Nancy Dail

Thirty-three years ago we started our school around our kitchen table. It was a labor of love to develop an art and science that has transformed into the residence of our 8,000 square foot building. As an independent massage school owner, we are now a minority. Now the market is shared with community colleges, trade and technical schools, beauty schools, and corporations with multiple campuses. Many independent schools have sold to the larger corporate businesses. Education and its venue have changed. Technology allows online courses to be the normal avenue to project information. Massage therapy classes have a practical component that has to be experienced in the class room. Technology can not replace the experience of touch – receiving and giving. Independent massage schools still provide that type of education.

In some ways the comfort zone of the kitchen table education is the experience of the independent school owner. One-on-one teaching is not unheard of and the individual is not a number but a name in the class room. Massage Therapy education is not just about the ability to provide services for the public. It is taking the sense of touch and developing an understanding of why we need to experience close human contact. It is about learning the benefits of touch and massage for each age group in almost any circumstance from birth to old age. It is about intent and realizing the potential for accelerating healing energies.

When I think about all the safe touch that our graduates have provided over the last 33 years, it warms my heart and continues to promote our mission here at the Downeast School of Massage: to train individuals in the art and science of therapeutic massage for and entry-level professional career, for continuing education and for personal growth. The personal growth part is not what adults usually sign up for. It comes irregardless of plans but as a part of the process of becoming a massage therapist and in-class-room course work.

Self-care is not part of the education of all health professional fields. As care givers, health professionals are often taught to expend their energies at the expense of self and not reserve stores to replenish healthy stock. This leads to unhealthy practices and eventual burnout in the form of depression, disease, or even injury. Massage therapy can not afford to not teach self-care as the therapist will otherwise not last in the profession. The independent school owner embraces this need as the focus of the school is about the student and his/her success.

The Downeast School of Massage starts its Fall classes next week. It is not too late to enroll and become part of the rewarding career field of Massage Therapy. This career needs individuals to perpetuate growth and provide services to people of all ages. Massage Therapy is not an obscure profession anymore but an accepted part of health care. Our complete integration is upcoming and part of the near future. After being a massage therapist for almost 40 years I choose to be part of the future of this great career field and will continue to provide safe touch for my clients and touch education for my students. Join us in this adventure!

Nancy W. Dail, BA, LMT, NCTMB has been a professional practicing massage therapist and a member of the AMTA since 1974. She is the founder and director of the Downeast School of Massage in Waldoboro, Maine (USA) (1980). A leader in her field, Nancy presents workshops internationally, is certified in Orthopedic and Sports Massage, and has developed the working philosophy of Dimensional Massage Therapy as lead author in Kinesiology for Manual Therapies published by McGraw-Hill. Her BA in Health, Arts, and Science from Goddard College helps her balance her administrative duties as Director with teaching Dimensional Massage, Advanced Skills, Kinesiology, Ethics and related subjects at DSM.

Frequently Asked Questions in Oncology Massage

Frequently Asked Questions in Oncology Massage

Copyright © 2012, Tracy Walton
617 661 5800,

Oncology massage therapy is an expanding specialty in the profession of skilled touch. As the field of massage therapy expands, therapists are drawn to this soulful, stimulating work for many reasons. Chief among them are the chance to ease the journey of people with cancer, an opportunity for specialization, and a way to distinguish their work from other therapists.
I receive many questions about this work. First, how is oncology massage unique? How does massage change for people with cancer and cancer histories?
The short answer is that massage is modified to the signs, symptoms and complications of cancer. It is also adjusted to the effects of cancer treatment. Some of these treatment effects resolve when treatment is complete, but some may linger indefinitely. One essential skill in oncology massage is determining how to work years or even decades after treatment is complete!
This short answer doesn’t capture the range of cancer presentations, or the clinical thinking skills needed, but it provides a starting framework for oncology massage. Good health history questions fill in some details. Although space limits a complete list of intake questions here, resources at the end of this article explain the intake process in more depth. Training in oncology massage is strongly recommended in order work safely and to use interview questions with purpose.
The first question, “Where is the cancer in your body?” points to pressure and joint movement contraindications. By asking “where?” we find out the type of tissue involved, the depth of any mass and its anatomical location. If a solid tumor is superficial enough to be disturbed, the MT is gentle with pressure and movement in the area. If the tumor is deep, say, within a lung or liver, the therapist’s movements may be unlikely to disturb it, but if the function of these organs is impaired, there are likely to be several other significant massage adjustments.
This question, “Where is it?” also includes any metastasis (cancer spread) to adapt to in the session. For example, cancer involving bone can lead to pathologic fracture, similar to osteoporosis. Massage therapists always ask about bone involvement so that we do not injure the bone, either with our pressure or by moving the joints. Follow-up questions about bone stability are vital. “Bone mets” can make bone extremely fragile, or the bone can be quite stable, despite the mets. The client’s physician advises where and how the bones are most vulnerable, so that a therapist can appropriately adjust movement and pressure.
Another logical question is, “What treatments have you undergone, and how do they affect you?” Cancer medicine is strong medicine; effects of surgery, radiation and chemotherapy and other treatments are important massage therapy concerns. There are many massage guidelines, including less pressure if the blood is clotting poorly, predictable rhythms and slower speeds for nausea, or shorter sessions for fever or fatigue. There are even massage contraindications in force years later, adapting to the late effects of cancer treatment. These are often not intuitively obvious to the massage therapist. Issues such as lymphedema risk, organ function impairment due to injury from radiation, bone thinning, and other factors mean that some massage adjustments are lifelong.
Other questions for the oncology massage intake include the client’s activity level and tolerance, whether there are any medical restrictions on their activities, and their blood counts. The activity level and tolerance give us a sense of what the massage tolerance might be. A client exhausted by treatment may require a gentle session. A more robust client might welcome and tolerate a little bit more, but it is vital to start conservatively. If there are medical restrictions on activity, we “mirror that medical concern,” and adjust the massage in kind. Low blood counts might signal low immunity, easy bruising, or low energy from anemia. Corresponding infection control, gentler pressure, or a gentle overall session may be in order.
We also ask clients about medications (many of them taken to control metastasis, increase blood counts, manage symptoms, or prevent cancer recurrence). We modify massage therapy to the effects of medications and the reasons for taking them. We adapt to many side effects such as pain, constipation, nausea, fatigue, or even an increased risk of blood clots. The latter is a particularly important scope of study in oncology massage, because several cancer and cancer treatment factors elevate DVT risk, and blood clots can often be clinically silent. This “hidden contraindication” as well as the other clinical issues require massage therapists to devote time, training, and study in order to practice safely.
These are a few sample interview questions. Several resources support us in interviewing and working with people with cancer. A few are listed hereResources for further training and information include:
1. “Oncology Massage Therapy: Caring for Clients with Cancer” is offered by Tracy Walton & Associates at the Downeast School of Massage, September 13-16, 2012, in Waldoboro, ME. The course features a supervised practice clinic with people with cancer and cancer histories. Courses fill quickly, and early registration is strongly recommended.
2. Tracy’s pathology textbook, Medical Conditions and Massage Therapy: A Decision Tree Approach describes detailed interview questions and massage adaptations for general cancer presentations, as well as specific presentations for certain cancers such as leukemia, breast and prostate cancer, lung cancer, colon cancer, lymphoma, and others.
3. “Touch, Caring, and Cancer: Simple Instruction for Family and Friends,” is an award-winning DVD and handbook for people with cancer and their care partners. View a trailer at at
4. Many full-length articles by Tracy Walton, two in the Massage Therapy Journal, are available free on-line. Another specifically on massage and chemotherapy. Links to these and other resources are at, a clearinghouse for oncology massage information.
5. The Society for Oncology Massage at This site is dedicated to advocacy, patient support, educational standards, and standards of practice in oncology massage. There is even an oncology massage therapist locator service.

The questions listed here contribute to a solid interview. As touch providers, we are in the wonderful position of providing support, compassion, symptom relief, and relief from isolation on a hard path. In order to do this, we need skill, information, and finesse. When we bring these to the massage treatment room, we can lead a good interview and get a good start to the work.


Tracy Walton, LMT, MS, is a researcher, writer, award-winning educator, and specialist in massage therapy and cancer care. She is a dynamic voice for the power of touch, and is the author of the pathology textbook, Medical Conditions and Massage Therapy (Lippincott Williams & Wilkins). Tracy appears in the film “Touch, Caring, and Cancer,” an inspiring instructional program for care partners. She has worked in private practice, hospital and spa settings since 1990. In her presentations, Tracy warmly welcomes and reaches consumers, researchers, health care providers, and massage therapists from all levels of training. Learn about her work in oncology massage at



By David Lauterstein

Did you know the scalenes are actually the uppermost of the intercostal muscles?  Yes!

The intercostals lie between your ribs and assist inhalation and exhalation.  Of course, there are no ribs in the neck!  However, a number of books note that the scalenes attach to the vestigial ribs of the cervical vertebrae.  That is, in our embryological development little buds appear on the cervical vertebrae that in fish, for instance, would develop into ribs, but in humans they end up being just little bumps to which the scalene muscles attach.

Who ordinarily thinks about breathing with the neck?  Yet scalenes do have a very important respiratory function.  They, interesting enough, live right where the gills would be.

Many books consider the scalenes, next to the diaphragm, the second most important muscles of respiration.  The scalenes move the ribcage from above, while the diaphragm moves it from below.

The anterior scalene runs from the side of the second cervical vertebrae down to the first rib beneath the clavicle.  Because it attaches to the front of that rib, the chronic contraction of the anterior scalene is one of the muscles that pulls our head forward; in chronic head-forward posture it is useful to address this muscle among others.  The medial and posterior scalenes are more along the side of the neck and therefore have more to do with tilting the head to one side or the other.

It is common in whiplash that the scalenes are injured as the head is whipped forward then forcefully back, slightly tearing some of these muscle fibers through a sudden excessive stretch.

Energetically, the scalenes can be connected with all the virtues and challenges of the throat chakra.  The head forward posture therefore may arise from sadness, self-esteem issues, chronic fear, reactions to recent stress, or long-held defeats.  Inhibitions to speak one’s mind or heart may also manifest in the scalenes.

Here is a very helpful Deep Massage fulcrum* which affects the scalenes as well as the superficial posterior neck muscles.

Therapist:  seated at the head of the table

Client: supine

Center yourself

Working on the left side of the scalenes, place your middle finger of your left hand, assisted by your other fingers, near the origin of the sternocleidomastoid, just above the sternal end of the clavicle.  Take out the looseness.   THROUGHOUT THIS TECHNIQUE IT WILL BE BETTER TO USE LESS, RATHER THAN MORE PRESSURE.  HONOR THE DELICACY OF THE MUSCLES AND VESSELS HERE!

This fulcrum utilizes the active movement of the client.  Ask the client to lift the chin as if looking up.  This will take up the slack, stretching the anterior scalenes particularly.  Now let us add additional vectors, again in a movement partnership.  Ask the client to slowly turn the head to their right, as if to look over the right shoulder.  As they move draw your fingers horizontally through the tissues on the left side of the neck.  For this whole pass you are at the level of C6 and 7.  You may continue with your tractioning of the fascia all the way back as far as the spinous processes at the center of the neck.  In this case, you will have gone considerably past the scalenes, but you will more completely address the soft tissues of the neck pulling them back and with them the head comes back more of top of the body instead of being projected out in front of it.

Now ask your client to bring their head back to center.  Begin a second fulcrum, now at the level of the middle of the neck, around C3-5.  Repeat each of the steps above.

Finally, asking your client to return to center again, begin a third fulcrum at the level of C1-2.

Now repeat these steps on the other side –  with the client turning their head to the left, drawing your fingers through the right side of the neck in three passes with movement as described above.

*                           *                           *

The poet Rumi said, “Loosen the knot of greed so tight around your neck!”  I say at least loosen the scalenes!  Then you may notice a strikingly more balanced relationship between mind, body and breath.




  • The word “fulcrum” in Deep Massage: Lauterstein Method and Zero Balancing denotes a technique through which, like the balance point of a see-saw, clear touch can help the client come into a higher state of structural and energetic balance.  For more information, see The Deep Massage Book p.15-23.


Join David in a workshop on Deep Massage on September 28, 29, and 30, 2012 at the Downeast School of Massage, in Waldoboro, ME. See for details under continuing education.

The Value of Ethics

The Value of Ethics

The Value of Ethics

By Nancy Dail

Aristotle, Plato, and Socrates were Greek philosophers who laid down the foundation for Ethics in society. The word ethics comes from the Greek ethikos meaning “arising from habit”. The motivation to behave ethically as a moral standard is to believe that if you act appropriately you will support character traits that are in line with socially acceptable behavior, support legal standards, and promote professionalism in the business community. You would in essence make a habit of acting appropriately for the benefit of society.


Where did you develop character traits that support ethical practices? Family, school, mentors, community figures, heroes, the media, religion, literacy, and even the time in which we live all have an impact on the development of character traits that influence how one acts morally. “Cardinal virtues” of wisdom, courage, temperance and justice were Aristotle’s answer to the most important character traits with the understanding that it is paramount to balance the virtues and not let one overcome another. Since our actions impact others in indeterminable ways, it becomes necessary to follow codes of ethics that spell out our boundaries that are the ethical parameters of practice.


Each practitioner upon entering a profession is invested with the responsibility to adhere to the standards of ethical practice and conduct set by the profession. A therapist must therefore be operating legally, exhibit maximal competence, continually seek advancement through continuing education, join a professional association and follow the code of ethics set forth by the profession. Practitioners must be very clear about their professional identity otherwise ethical dilemmas will be more frequent and difficult to resolve. Clarity can be a challenge in the dynamics of our industry. States are all over the map with licensing and requirements for different hours. There are many continuing educational workshops that may not provide enough information for the practitioner to become confident in the modality. Is it made clear by the CE provider what it takes to advertise the subject of the workshop? Whose responsibility is it anyways to make that determination? Where is the value in being ethical in this situation? What benefits the client and what benefits the practitioner?


After pioneering in this field for almost 40 years, I have seen the massage therapy profession come a long way. We have schools, licensure in most states, national certification, a rich industry of continuing education, vendors, research organizations and multiple associations. But ethics is not a finite set of rules that do not change, in fact, ethics is an adventure in the values and ideals that shift and evolve with the profession. The value of ethics must be a benefit for the client and will be the foundation of the practitioner’s success. Exploring the value of ethics brings meaning to the industry, helps support professional character traits, and promotes clarity of practice.


Nancy Dail teaches courses in Dimensional Massage Therapy and Ethics at workshops and conventions internationally. She is the lead co-author of Kinesiology for Manual Therapies published by McGraw-Hill. For more information about Dimensional Massage Therapy or Ethic workshops see other pages on this site. See her schedule for workshops in your area on this website or contact her at



The Body Blitz – A Real Spa Experience

The Body Blitz – A Real Spa Experience
By Nancy Dail

What was it like to dwell in the time of the Roman era and partake in a real Roman Bath experience? Since I do not have a time machine, I might never have known if I had not partaken in the hydro experience at the women only, Body Blitz in Toronto, Canada this past week. Imagine if you will a sea salt water pool with multiple waterfalls spilling from a central flagstone structure and 24 water jets able to massage you underwater. The pool was the size of a regular swimming pool with a circular cold plunge pool on one end and a hot green tea pool on the other end. Lounge chairs lined the long length of the pool and showers headed one end and a water fountain and open lockers were at the other end. The experience included a suggestion for the Therapeutic Waters Circuit. It began with a 5-10 minute sea salt pool soak after, of course, a shower. From the sea salt pool one went into the steam room for 5-10 minutes if you can take the extreme wet heat. Don’t wear glasses as you will instantly not be able to see! The steam is followed by a rinsing shower to remove the toxins and a 1 minute cold plunge. It is recommended that you go in up to your neck to stimulate your thyroid; I would not do this slowly if I were you. It might be construed as torture! Following the cold plunge is relaxation time with rehydrating. It is important to continually replace the water you lose in the circuit. For a more in-depth detoxification, the infrared sauna awaits for roughly 10 minutes. Rinse again and enter the cold plunge pool for another pore seal. Next is the hot green tea pool immersion (for at least 5 minutes) for a further relaxation of muscles and a boost for the immune system. Rinse again and another cold plunge supposedly for a whole minute. Finish off with the sea salt pool for a final relaxation soak and to regain normal body temperature while absorbing minerals from the sea salt immersion. It is recommended that the whole experience be for an hour circuit with a maximum stay of 2 hours. We did complete a medical history prior to the hydro circuit that could have been also used for a massage or shiatsu treatment if we had been so inclined. Contraindications could include a cardiac or respiratory condition, high or low blood pressure, pregnancy, or any other health condition needing a physician’s approval. For additional cost, was a juice and/or tea bar that is available during the spa experience. The result? Ultimate relaxation. I slept really well that night. I can see me being a spa critic traveling from spa to spa – a girl can dream can’t she?

Graduation Speech for Massage Therapists

Graduation Speech Downeast School of Massage January 2011 Class

The Dalai Lama, when asked what surprised him most about humanity, answered “Man. Because he sacrifices his health in order to make money, then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

As a massage therapist then, I would say that we have our work cut out for us. When we advocate for man and woman we can present a reasonable positive perspective of prevention that includes holistic health, compassion, referral, and quality care. We can give our clients opportunity to change and/or relief from pain and stress. It is after all, their treatment, their time on the table, their choice in direction. Our responsibility lies in our representation of ourselves and our profession. Now as graduates, you represent the profession of massage therapy. This is now your vocation – as Thomas Moore says: “In a sense all work is a vocation, a calling from a place that is the source of meaning and identity, the roots of which lie beyond human intention and interpretation.”

We always ask perspective students why they want to come to massage school. Mostly students will say it is because they feel called to this service; they want to help people directly through touch and not just through paperwork. In a way touch releases the work and transcends it to a source of meaning and identity. But there are many paths that you can choose during and after massage school. DSM has provided the experiences to shape your future choices; we have given you a foundation to build on. Education is the concrete you needed – the foundation of your practice. The paths you choose back and forth to the foundation will be up to you.

Whatever path you choose make sure that your soul is involved in your choice.

Quote: Thomas Moore, Care of the Soul: “When the soul is involved, (or inner self), work is not carried out by the ego alone; it arises from a deeper place and therefore is not deprived of passion, spontaneity, and grace.”

If we can but help to reverse the direction of man we have to look at how we practice our work, that we are intentful and present with each client and represent passion and caring. We need to gently help clients to help themselves, reduce their stress so they can take time to assess life and its meaning. Reducing pain, stress, and discomfort is a noble path. Helping man and woman to recognize that they have a whole body, mind, and spirit is a calling.

What path will you take?

The Road Not Taken by Robert Frost

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth.

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I–
I took the one less traveled by,
And that has made all the difference.

Graduates, I hope that when you assess what you have accomplished at DSM that you have created your own experiences to reflect upon. Your bodies will always remember the hours of sincere intent you have each put into this course and the massage you have received as a result of your class work and each other’s skill. Your experiences in school will help you choose your path for your future and carry you forward to your aspired goals. Although the future is unpredictable, you are not alone. You have bonded with each other with your experiences here. You have a physical and energetic link to each other and to the school. You could no more separate yourself from your memories than a wave could separate itself from the ocean and still be a wave.

Treat your practice and therefore yourself like every day is the dawn of a new day. Let it continually revive your soul and inspire your heart. Anything less is beneath your capabilities. Trust yourselves, your skills and listen to your instincts. Listen to your inner truth that you have been cultivating here. Have confidence in your abilities, you have proven yourselves here. Experience will now be your teacher. I trust that should you need our support here at DSM, you will reach out to us. Graduation is a beginning, not an ending. It is time to share your gifts with others. Good luck. It has been a privilege to work with you. May the path you choose make all the difference.

Congratulations graduates!!
Nancy Dail
Director Downeast School of Massage

Short Upper Arms

Often in a practice we run across individuals with similar problems in a series that can sometimes be blamed on the season or weather. Certainly clients with back issues come to us after shoveling snow or during gardening season. For what ever reason, however, lately, I am seeing several clients with short upper arm structures and resulting issues from their genetic frame. Normally, if you measure the arm or humerus in our upper extremity it expands from the glenoid fossa of the scapula superiorly to the distal end (olecranon process of the ulna) inferiorly to the waist and iliac crest. Individuals with short upper arms have humeral bones that do not measure down to the iliac crest. Usually they have no idea why they have leaned forward their entire lives or why they may not have been able to reach something on a top shelf when someone the same size can. Often these folks will have more trouble with work stations and are likely to develop carpal tunnel-like symptoms.

A medical history and a visual observation will reveal clients with short upper arms present with over pronated forearms; very hypertonic pronator teres and resulting numbness and tingling to wrist and fingers. The structure itself lends to abducted scapulae with prominent medial humeral rotation, more so on the dominant upper extremity. Add repetitive actions and non-ergonomic work areas and you have a laundry list of muscles to unravel and release entrapments and a recipe for carpal tunnel syndrome, pronator teres syndrome and possibly double crush syndrome.

A Dimensional approach begins the sequence in a supine position with techniques to release hypertonic trapezius, SCM, posterior cervical muscles and pectoralis minor and major muscles. Active engagements techniques help to pin and stretch pectoralis minor and subscapularis. Both muscles are usually very tight on these types of frames. Moving on to the upper arm, release and stretch arm muscles with elliptical movement and dual-distraction moves. Release the elbow joint with movement and techniques. Elliptically move the forearm muscles and release the pronator teres. Sidelying is next with serratus anterior as a star target. Position the client prone lastly to release the soft tissue of the back. Exercises are suggested.

There are a wide variety of techniques massage therapy uses on clients with all kinds of structural issues. The above is my approach for short upper arms and clinical issues that often present themselves to this target group. Other considerations could be hip and pelvic positions, gait, and lower extremity factors. One fact remains apparent that the structure we have contributes to a reaction to our repetitive activities. A wise massage therapist will see beyond the repetitive action!

Nancy Dail teaches courses in Dimensional Massage Therapy and is the co-author of Kinesiology for Manual Therapies published by McGraw-Hill. For more information about Dimensional Massage see other pages on this site. See her schedule for workshops in your area on this website or contact her at

The Trapezius and the Sails of Life

We use our shoulders, arms and hands to take action. On the other hand, they are used expressively in talk, they are parts of speech. Gestures with shoulders, arms and hands reveal with connotative clarity what we really mean. We see also in writing and sign language an entirely linguistic use of shoulders, arms and hands. Massage itself meaningfully bridges these two worlds of action and language. We perform our strokes with shoulders, arms and hands and use them to convey anatomical information and non-verbal messages.
We have all seen clients whose shoulder blades virtually adhere to the ribcage. Structurally and energetically, the shoulder blades’ ability to glide freely over ribs is of enormous importance. Without that freedom, stress, instead of “rolling” off our backs, can become “impacted”, affecting the free excursion of ribs, spine, ultimately the lungs and heart.
The energies flowing vertically through the body intersect in the shoulders and upper limbs with horizontal flows reaching out to the world around us. This can be seen as an axis of love.
The trapezius is one of the body’s primary energetic shock absorbers, just as lower limbs are the body’s main physical shock absorbers. As stress comes and goes, trapezius’ tension increases then dissipates. However, with chronic stress or acute trauma, the body may absorb stress, rather than letting it go.
In the trapezius virtually every adult carries some residue of past life tension with a resultant diminished capacity for dissipating everyday stress. When shock absorbers start losing resilience, the effect of stress stays longer and goes deeper into the bodymind.
A primary purpose for trapezius work then is to let go of any residue of the past that no longer serves us and to initiate new habits of handling stress by letting go, rather than by absorbing it.
The freed trapezius allows the full excursion of breath underneath it. It amplifies healthy movement of upper limbs and torso. The healthy trapezius is a sail. Freed, it enables us to tack into the winds of life with optimized momentum and wastes no energy holding onto what we no longer need.

Therapist: comfortably seated at head of the massage table
Client: Supine (If neck is lordotic – chin higher than forehead – put a small pillow under the head.)

Before putting your hands on, center yourself. Breathe. Position yourself so that even seated, your touch will gracefully derive from your body weight and gravity, rather than effort. Position your treatment chair or stool to allow space between your body and that of the client. Let all your joints be gently rounded, wrists aligned, elbows only slightly bent, shoulders and breath relaxed, an open space between the sides of your ribs and the insides of your arms. With hips and knees relaxed and soles of your feet on the floor, feel grounded.
Briefly review in your mind the particular life stresses the client may have revealed in the pre-session interview (and in past sessions if this is a repeat client). Realize that you are not just touching the trapezius, a muscle positioned in the client’s body/space. You are equally touching time and the accumulated content and tension from many years of life. Every touch that impacts the client’s ongoing life takes place at the intersection of space and time.
• Let your fingers rest on the clavicles. With your thumbs begin to explore the trapezius’ belly. Start near the base of the neck and work your way out in at least 4 areas each more lateral than the last, with mindful, caring touch, using light pressure. Note any associations that palpating this client here evokes for you. Some clients feel thickened; others frozen; others with overall freedom but with a few specific nuggets of tension, that seem to have been there a long time. Sometimes I feel like I’m a prospector, palpating for long-lost treasures underlying tension. Work your way out in successive points near to where the clavicle and scapula meet.
• Now return to the trapezius’ belly immediately lateral to T1. Be conscious and contact clearly with both your physical structure and your energy, mentally, emotionally, and spiritually engaged in what you’re doing. Press in with both thumbs, down toward the feet and easily rest in just lateral to T1. Give the client a moment experience this initial contact. Pause.
• Now press in further, engaging tensions found more deeply. (If you find no tension, clearly disengage and explore points more lateral.) Continue yourself to breathe and relax, sinking into the tension. Commonly at this point, you can see from the client’s breathing and facial expression that she or he is engaged. Pause.
• Rest in yourself more completely. Deepen your breathing, be patient. Lean gracefully further in, letting gravity be the therapist. Find the optimum depth for this fulcrum. Now pause again, without letting go of any vectors. It is important that you the therapist now go to a “witness” state, not moving. Allow the client time to let go, from the inside out, of successively deeper, “sedimentary” layers of tension that have developed here over the course of life.
• When you sense it’s been long enough – usually two to seven seconds will do fine – clearly disengage and move on. Then press in an inch more laterally on both sides. Repeat the steps above. Keep alive your sensitivity and patience. These tensions accumulate over a lifetime. They need the gift of time and touch to let go of the layers and years of tensions held.
• Continue working the belly of the trapezius in successively more lateral areas until you’ve given attention to four or five areas bilaterally. Even if you find more tension on one side than another, maintain conscious contact with both sides. The bilaterality of contact is important since we are looking to restore the feeling of having wings, rather than a yoke here. These wings are needed for flight!

Wonderfully, this work with the trapezius is one of the easiest fulcrums to perform. But don’t underestimate it! It has global consequences on the health of our clients’ minds and bodies. When we approach the trapezius with reverence, respect, patience, and skill we are given the opportunity to let go of lifetimes of stress and to regain the sense of the lightness of being.

David Lauterstein is Co-Director of Lauterstein-Conway Massage School in Austin, Texas, for 23 years one of the premier schools in the Southwestern U.S. He has been a bodywork teacher since 1982 and is a 2011 World Massage Therapy Hall of Fame Inductee. He is the author of Putting the Soul Back in the Body and the forthcoming Deep Massage Book from Complementary Medicine Press.