Bodywork therapies is a general term that refers to a group of body-based approaches to treatment that emphasize manipulation and realignment of the body's structure in order to improve its function as well as the client's mental outlook. These therapies typically combine a relatively passive phase, in which the client receives deep-tissue bodywork or postural correction from an experienced instructor or practitioner, and a more active period of movement education, in which the client practices sitting, standing, and moving about with better alignment of the body and greater ease of motion.
Bodywork should not be equated with massage simply speaking. Massage therapy is one form of bodywork, but in massage therapy, the practitioner uses oil or lotion to reduce the friction between his or her hands and the client's skin. In most forms of body work, little if any lubrication is used, as the goal of this type of hands-on treatment is to warm, relax, and stretch the fascia (a band or sheath of connective tissue that covers, supports, or connects the muscles and the internal organs) and underlying layers of tissue.
Purpose
The purpose of bodywork therapy is the correction of problems in the client's overall posture, connective tissue, and/or musculature in order to bring about greater ease of movement, less discomfort, and a higher level of energy in daily activity. Some forms of bodywork have as a secondary purpose the healing or prevention of repetitive stress injuries, particularly for people whose occupations require intensive use of specific parts of the body (e.g., dancers, musicians, professional athletes, opera singers, etc.). Bodywork may also heal or prevent specific musculoskeletal problems, such as lower back pain or neck pain.
Bodywork therapies are holistic in that they stress increased self-awareness and intelligent use of one's body as one of the goals of treatment. Some of these therapies use verbal discussion, visualization, or guided imagery along with movement education to help clients break old patterns of moving and feeling. Although most bodywork therapists do not address mental disorders directly in their work with clients, they are often knowledgeable about the applications of bodywork to such specific emotions as depession, anger, or fear.
Although some bodywork therapies, such as Rolfing or Hellerwork, offer programs structured around a specific number or sequence of lessons, all therapies of this type emphasize individualized treatment and respect for the uniqueness of each individual's body. Bodywork instructors or practitioners typically work with clients on a one-toone basis, as distinct from a group or classroom approach.
Precautions
Persons who are seriously ill, acutely feverish, or suffering from a contagious infection should wait until they have recovered before beginning a course of bodywork. As a rule, types of bodywork that involve intensive manipulation or stretching of the deeper layers of body tissue are not suitable for persons who have undergone recent surgery or have recently suffered severe injury. In the case of Tragerwork, shiatsu, and trigger point therapy, clients should inform the therapist of any open wounds, bruises, or fractures so that the affected part of the body can be avoided during treatment. Craniosacral therapy, the Feldenkrais method, and the Alexander technique involve gentle touch and do not require any special precautions.
Persons who are recovering from abuse or receiving treatment for any post-traumatic syndrome or dissociative disorder should consult their therapist before undertaking bodywork. Although bodywork is frequently recommended as an adjunctive treatment for these disorders, it can also trigger flashbacks if the bodywork therapist touches a part of the patient's body associated with the abuse or trauma. Many bodywork therapists, however, are well informed about post-traumatic symptoms and disorders, and able to adjust their treatments accordingly.
Description
The following are brief descriptions of some of the more popular bodywork therapies.
Alexander technique
The Alexander technique was developed by an Australian actor named F. Matthias Alexander (1869-1955), who had voice problems that were not helped by any available medical treatments. Alexander decided to set up a number of mirrors so that he could watch himself during a performance from different angles. He found that he was holding his head and neck too far forward, and that these unconscious patterns were the source of the tension in his body that was harming his voice. He then developed a method for teaching others to observe the patterns of tension and stress in their posture and movement, and to correct these patterns with a combination of hands-on guidance and visualization exercises. As of 2002, the Alexander technique is included in the curricula of the Juilliard School of Music and many other drama and music schools around the world, because performing artists are particularly vulnerable to repetitive stress injuries if they hold or move their bodies incorrectly.
In an Alexander technique session, the client works one-on-one with an instructor who uses verbal explanations as well as guided movement. The sessions are usually referred to as "explorations" and last about 30 minutes. Although most clients see positive changes after only two or three sessions, teachers of the technique recommend a course of 20–30 sessions so that new movement skills can be learned and changes maintained.
Rolfing
Rolfing, which is also called Rolf therapy or structural integration, is a holistic system of bodywork that uses deep manipulation of the body's soft tissue to realign and balance the body's myofascial (muscular and connective tissue) structure. It was developed by Ida Rolf (1896-1979), a biochemist who became interested in the structure of the human body after an accident damaged her health. She studied with an osteopath as well as with practitioners of other forms of alternative medicine, and developed her own technique of body movement that she called structural integration. Rolfing is an approach that seeks to counteract the effects of gravity, which tends to pull the body out of alignment over time and cause the connective tissues to stiffen and contract.
Rolfing treatment begins with the so-called "Basic Ten," a series of ten sessions each lasting 60–90 minutes, spaced a week or longer apart. After a period of integration, the client may undertake advanced treatment sessions. "Tune-up" sessions are recommended every six months. In Rolfing sessions, the practitioner uses his or her fingers, hands, knuckles, or elbows to rework the connective tissue over the client's entire body. The deep tissues are worked until they become pliable, which allows the muscles to lengthen and return to their proper alignment. Rolfing treatments are done on a massage table, with the client wearing only undergarments.
Hellerwork
Hellerwork is a bodywork therapy developed by Joseph Heller, a former NASA engineer who became a certified Rolfer in 1972 and started his own version of structural integration, called Hellerwork, in 1979. Heller describes his program as "a powerful system of somatic education and structural bodywork" based on a series of eleven sessions. Hellerwork is somewhat similar to Rolfing in that it begins with manipulation of the deep tissues of the body. Heller, however, decided that physical realignment of the body by itself is insufficient, so he extended his system to include movement education and "self-awareness facilitated through dialogue."
The bodywork aspect of Hellerwork is intended to release the tension that exists in the fascia, which is the sheath or layer of connective tissue that covers, supports, or connects the muscles and internal organs of the body. Fascia is flexible and moist in its normal state, but the effects of gravity and ongoing physical stresses lead to misalignments that cause the fascia to become stiff and rigid. The first hour of a Hellerwork session is devoted to deep connective tissue bodywork in which the Hellerwork practitioner uses his or her hands to release tension in the client's fascia. The bodywork is followed by movement education, which includes the use of video feedback to help clients learn movement patterns that will help to keep their bodies in proper alignment. The third component of Hellerwork is verbal dialogue, which is intended to help clients become more aware of the relationships between their emotions and attitudes and their body.
Tragerwork
Trager psychophysical integration, which is often called simply Tragerwork, was developed by Milton Trager (1908-1977), a man who was born with a spinal deformity and earned a medical degree in his middle age after working out an approach to healing chronic pain. Tragerwork is based on the theory that many illnesses are caused by tension patterns that are held in the unconscious mind as much as in the tissues of the body; clients are advised to think of Tragerwork sessions as "learning experiences" rather than "treatments." Tragerwork sessions are divided into bodywork, which is referred to as tablework, and an exerciseperiod. Trager practitioners use their hands during tablework to perform a variety of gentle motions—rocking, shaking, vibrating, and gentle stretching—intended to help the client release their patterns of tension by experiencing how it feels to move freely and effortlessly on one's own. Following the tablework, clients are taught how to perform simple dance-like exercises called Mentastics, for practice at home. Tragerwork sessions take between 60–90 minutes, while clients are advised to spend 10–15 minutes three times a day doing the Mentastics exercises.
Feldenkrais method
The Feldenkrais method, like Hellerwork, refers to its approach as "somatic education." Developed by Moshe Feldenkrais (1904-1984), a scientist and engineer who was also a judo instructor, the Feldenkrais method consists of two major applications—Awareness Through Movement (ATM) lessons, a set of verbally directed exercise lessons intended to engage the client's intelligence as well as physical perception; and Functional Integration (FI), in which a Feldenkrais practitioner works with the client one-on-one, guiding him or her through a series of movements that alter habitual patterns and convey new learning directly to the neuromuscular system. Functional Integration is done with the client fully clothed, lying or sitting on a low padded table.
Perhaps the most distinctive feature of the Feldenkrais method is its emphasis on new patterns of thinking, attention, cognition, and imagination as byproducts of new patterns of physical movement. It is the most intellectually oriented of the various bodywork therapies, and has been described by one observer as "an unusual melding of motor development, biomechanics, psychology, and martial arts." The Feldenkrais method is the form of bodywork that has been most extensively studied by mainstream medical researchers.
Trigger point therapy
Trigger point therapy, which is sometimes called myotherapy, is a treatment for pain relief in the musculoskeletal system based on the application of pressure to trigger points in the client's body. Trigger points are defined as hypersensitive spots or areas in the muscles that cause pain when subjected to stress, whether the stress is an occupational injury, a disease, or emotional stress. Trigger points are not necessarily in the same location where the client feels pain.
Myotherapy is a two-step process. In the first step, the therapist locates the client's trigger points and applies pressure to them. This step relieves pain and also relaxes the muscles associated with it. In the second part of the therapy session, the client learns a series of exercises that progressively stretch the muscles that have been relaxed by the therapist's pressure. Most clients need fewer than 10 sessions to benefit from myotherapy. One distinctive feature of trigger point therapy is that clients are asked to bring a relative or trusted friend to learn the pressure technique and the client's personal trigger points. This "buddy system" helps the client to maintain the benefits of the therapy in the event of a relapse.
Shiatsu
Shiatsu is the oldest form of bodywork therapy, having been practiced for centuries in Japan as part of traditional medical practice. As of 2002, it is also the type of bodywork most commonly requested by clients in Western countries as well as in East Asia. The word shiatsu itself is a combination of two Japanese words that mean "pressure" and "finger." Shiatsu resembles acupuncture in its use of the basic concepts of ki, the vital energy that flows throughout the body, and the meridians, or 12 major pathways that channel ki to the various organs of the body. In Asian terms, shiatsu works by unblocking and rebalancing the distribution of ki in the body. In the categories of Western medicine, shiatsu may stimulate the release of endorphins, which are chemical compounds that block the receptors in the brain that perceive pain.
A shiatsu treatment begins with the practitioner's assessment of the client's basic state of health, including posture, vocal tone, complexion color, and condition of hair. This evaluation is used together with ongoing information about the client's energy level gained through the actual bodywork. The shiatsu practitioner works with the client lying fully clothed on a futon. The practitioner seeks out the meridians in the client's body through finger pressure, and stimulates points along the meridians known as tsubos. The tsubos are centers of high energy where the ki tends to collect. Pressure on the tsubos results in a release of energy that rebalances the energy level throughout the body.
Craniosacral therapy
Craniosacral therapy, or CST, is a form of treatment that originated with William Sutherland, an American osteopath of the 1930s who theorized that the manipulative techniques that osteopaths were taught could be applied to the skull. Sutherland knew from his medical training that the skull is not a single piece of bone, but consists of several bones that meet at seams; and that the cerebrospinal fluid that bathes the brain and spinal cord has a natural rise-and-fall rhythm. Sutherland experimented with gentle manipulation of the skull in order to correct imbalances in the distribution of the cerebrospinal fluid. Contemporary craniosacral therapists practice manipulation not only of the skull, but of the meningeal membranes that cover the brain and the spinal cord, and sometimes of the facial bones. Many practitioners of CST are also osteopaths, or DOs.
In CST, the patient lies on a massage table while the therapist gently palpates, or presses, the skull and spine. If the practitioner is also an osteopath, he or she will take a complete medical history as well. The therapist also "listens" to the cranial rhythmic impulse, or rhythmic pulsation of the cerebrospinal fluid, with his or her hands. Interruptions of the normal flow by abnormalities caused by tension or by injuries are diagnostic clues to the practitioner. Once he or she has identified the cause of the abnormal rhythm, the skull and spinal column are gently manipulated to restore the natural rhythm of the cranial impulse. Craniosacral therapy appears to be particularly useful in treating physical disorders of the head, including migraine headaches, ringing in the ears, sinus problems, and injuries of the head, neck, and spine. In addition, patients rarely require extended periods of CST treatments.
Some bodywork approaches involve various types of long-term aftercare. Rolfing clients return for advanced treatments or tune-ups after a period of integrating the changes in their bodies resulting from the Basic Ten sessions. Tragerwork clients are taught Mentastics exercises to be done at home. The Alexander technique and the Feldenkrais approach assume that clients will continue to practice their movement and postural changes for the rest of their lives. Trigger point therapy clients are asked to involve friends or relatives who can help them maintain the benefits of the therapy after the treatment sessions are over.
Risks
The deep tissue massage and manipulation in Rolfing and Hellerwork are uncomfortable for many people, particularly the first few sessions. There are, however, no serious risks of physical injury from any form of bodywork that is administered by a trained practitioner of the specific treatment. As mentioned, however, bodywork therapies that involve intensive manipulation or stretching of the deeper layers of body tissue are not suitable for persons who have undergone recent surgery or have recently suffered severe injury.
Normal results
Normal results from bodywork include deep relaxation, improved posture, greater ease and spontaneity of movement, greater range of motion for certain joints, greater understanding of the structures and functions of the body and their relationship to emotions, and release of negative emotions.
Some studies of the Feldenkrais method have found that its positive effects on subjects' self-esteem, mood, and anxiety sympoms are more significant than its effects on body function.
Abnormal results
Abnormal results from bodywork therapies would include serious physical injury or trauma-based psychological reactions.
BOOKS
Pelletier, Kenneth R., MD. The Best Alternative Medicine. New York: Simon and Schuster, 2002.
PERIODICALS
Dunn, P. A., and D. K. Rogers. "Feldenkrais Sensory Imagery and Forward Reach." Perception and Motor Skills 91 (December 2000): 755-757.
Hornung, S. "An ABC of Alternative Medicine: Hellerwork." Health Visit 59 (December 1986): 387-388.
Huntley, A., and E. Ernst. "Complementary and Alternative Therapies for Treating Multiple Sclerosis Symptoms: A Systematic Review." Complementary Therapies in Medicine 8 (June 2000): 97-105.
Johnson, S. K., and others. "A Controlled Investigation of Bodywork in Multiple Sclerosis." Journal of Alternative and Complementary Medicine 5 (June 1999): 237-243.
Mackereth, P. "Tough Places to be Tender: Contracting for Happy or 'Good Enough' Endings in Therapeutic Massage/Bodywork?" Complementary Therapies in Nursing and Midwifery 6 (August 2000): 111-115.
Stallibrass, C., and M. Hampson. "The Alexander Technique: Its Application in Midwifery and the Results of Preliminary Research Into Parkinson's." Complementary Therapies in Nursing and Midwifery 7 (February 2001): 13-18.
ORGANIZATIONS
Bonnie Prudden Pain Erasure Clinic and School for Physical Fitness and Myotherapy. P.O. Box 65240. Tucson, AZ 85728. (520) 529-3979. Fax: (520) 529-6679. <www.bonnieprudden.com>.
Cranial Academy. 3500 DePauw Boulevard, Indianapolis, IN 46268. (317) 879-0713.
Craniosacral Therapy Association of the United Kingdom. Monomark House, 27 Old Gloucester Street, London, WC1N 3XX. Telephone: 07000-784-735. <www.craniosacral.co.uk/>.
Feldenkrais Guild of North America. 3611 S.W. Hood Avenue, Suite 100, Portland, OR 97201. (800) 775-2118 or (503) 221-6612. Fax: (503) 221-6616. <www.feldenkrais.com>.
The Guild for Structural Integration. 209 Canyon Blvd. P.O. Box 1868. Boulder, CO 80306-1868. (303) 449-5903. (800) 530-8875. <www.rolfguild.org>.
Hellerwork. 406 Berry St. Mt. Shasta, CA 96067. (530) 926-2500. <www.hellerwork.com>.
International School of Shiatsu. 10 South Clinton Street, Doylestown, PA 18901. (215) 340-9918. Fax: (215) 340-9181. <www.shiatsubo.com>.
The Society of Teachers of the Alexander Technique. <www.stat.org.uk>.
The Trager Institute. 21 Locust Avenue, Mill Valley, CA 94941-2806. (415) 388-2688. Fax: (415) 388-2710. <www.trager.com>.
OTHER
National Certification Board for Therapeutic Massage and Bodywork. 8201 Greensboro Drive, Suite 300. McLean, VA 22102. (703) 610-9015.
NIH National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P. O. Box 8218, Silver Spring, MD 20907-8218. TTY/TDY: (888) 644-6226; Fax: (301) 495-4957. Web site: <http://www.nccam.nih.gov>.
