Bodywork Professional Development of the UK Presents

IFR Foundations Workshop-London, England

March 19-21st, 2011 Saturday to Monday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Fibromyalgia Workshop-Edinburgh, Scotland

March 26-27th, 2011

Venue: Scottish Massage Organization Conference Location TBA

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Intermediate Workshop-London, England

April 1st-3rd, 2011 Friday to Sunday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Fascial Articulations will be presented as a AAMT sponsored workshop for  AAMT Sydney-Post National Conference Workshop Monday May 24th, Cairns- Sunday July 25th,  Adelaide- Sunday August 8th & Hobart Sunday September 12th, 2010

A window of alternatives to the prevailing approach

This workshop has come about due to my attempt to present how I currently treat clients in my clinical practice.  As any practitioner can attest, the development of their skill and skill set evolves over time.  This process of learning takes the therapist along many avenues in their attempt to refine how to assess and deliver a consistent and quality outcome of manual therapy care.

The approach and style, the orientation of their understanding, and their passion for particular modalities, all create and embody the uniqueness and manner through which the artistic expression of the therapist shines forth.  My manner and expression has changed over time, and now the hybrid of my understanding allows me to enjoy and find playfulness in pursuit of passion and intuitiveness for soft-tissue dysfunction through the delivery of a variety of applications.

These applications consist of direct and indirect myofascial release, with an emphasis on autonomic expression that manipulates the sensory receptors of soft-tissue. I also learned from my studies and practice, that targeting muscles alone as the source of soft-tissue dysfunction will yield less than satisfactory results. This led me on a journey of investigating the nature of myofascial and from that, I now recognize clinically, as researchers have scientifically, that the myofascia is a dynamic partner in the tonality of the musculature.

What’s more interesting to my clinical experience is that the other main soft-tissue constituents; tendon, ligament and joint capsule, are all main contributors to the dynamic interplay of fibrosis, adhesion, congestion and excess tonality surrounding the musculature.

I tend to treat from a differing perspective. Whereas, most therapists assess and treat muscles at the beginning of a treatment, I employ most of my muscle applications towards the end of a treatment.  I’ll begin with assessment of the cardinal lines of myofascial tension (Myers 2000) and the high leverage points that anchor myofascial within the myofascial net (Schleip 2003).

The three main lines that correspond to main muscular and habitual patterns of motion that we all employ are:  sagittal which mediates flexion/extension, coronal/frontal which mediates abduction/adduction and horizontal/transverse which mediates rotation. Myers named these lines as SBL Superficial Back Line, SFL Superficial Front Line and LL lateral Line. The assessment of three cardinal lines ensure you a more global relaxation in the fascial tension and restoration of increase mobility corresponds along these lines.

Once I have assessed myofascial tension, I assess joint ROM from a fascial perspective. You may ask how can one assess from a myofascial perspective for ROM?  Essentially the distinct difference is not moving into the limit of anatomical integrity, instead the assessment of joint motion is confined to the level of first resistance. That is, where you feel the first tug, snag or glitch to the smoothness and quality of this motion. The reason is this will usually indicate the congestion of the connective tissue in the form of superficial fascia or fibrous connective tissue component as capsular or ligament restriction.

Remember myofascial surrounds each and every muscle group as a unit, muscle fibres and even muscle fascicles have a connective tissue wrapping. Therefore when you feel the first level of resistance you are keying into the first level of myofascial restriction that prohibits smooth joint motion.

I then move the joint through its muscular range but again feel the first level of restriction as it nears end feel.  Again the rationale is autonomic and neurological. When a therapist moves a muscle into its end range, and if restriction is present, the client will feel the pull or strain. When they feel the strain, they cannot help but to unconsciously guard or the very least, respond by flinching.

The guard response is what I’m attempting to avoid. Again if I can avoid any reactive distress by my passive range of motion assessment, I avoid moving the client back into a sympathetic state.  Micheal Shea (1995) is found of stating, and I quote; “all soft-tissue release is predicated on how the autonomic nervous system is discharging its impulses.”

The nervous system discharges, soft-tissue releases. You cannot accomplish soft-tissue change without a compliant nervous system.  That said, of course, if you are strategically deciding to assess ROM and need to employ a special test, say for example an anterior drawer test of the knee joint, you would use excessive force provocatively, as it is necessary to assess if anterior cruciate  ligaments are damaged.  This is referred to as a provocative test.  However, there is always a price to be paid from an autonomic or neurologic standpoint regarding excessive compressive force.  The body will always respond whether the practitioner is aware or unaware of this. You have chosen to over ride the ANS, by re-producing pain to substantiate your assessment or diagnosis. Once pain is provoked, the ability for the soft-tissue to change is diminished.  This is nervous system  Cause and Effect.  The sophistication of the central and autonomic nervous systems is a wonder to behold.

The other forgotten component in changing persistent and stubborn soft-tissue dysfunction is change to joint capsule and ligamentous structures. Although once considered inert and non-contractile structures, they are major contributors to the holding of tensional and tonal states of the muscles.  The sooner you understand that all the soft-tissue is in dynamic interplay, the better it is for you regarding your clinical outcomes.

Once assessment is complete, I initiate technique with the ANS autonomic nervous system in mind, to ‘settle the system’ by use of the gentle ‘Two Point’, this facilitates the ANS to enter into a parasympathetic state, with the lowering of high sympathetic tone (Shea 1995). The Two Point is applied either to transverse planes or the major peripheral joints, i.e. knee, ankle, shoulder, elbow or wrist.

This then leads me to address the quality and quantity of range regarding any involved joint by utilizing indirect technique approaches that are osteopathic in nature.  Among them is joint play, that is, combining accessory motion (anterior/posterior, lateral translation, distraction or rotational movements of approximated positions (close pack)), with crowding or approximation to the joint mechanoreceptors that facilitate a neurologic response of relaxation.

The other assessment component employed is the use of the assessment of ease or bind motion of the crowded joint by assessing the three planes of distortion within an ease or bind position.  This in osteopathic parlance is called stacking. Stacking is the engagement of two or more planes of distortion simultaneously to re-organize and transform congested soft-tissue.  It is a highly effective approach for changing proprioceptive mechanoreceptors in the joint capsule and surrounding ligamentous structures.

I address the musculature & joint restrictions by utilizing low load resistive (modified MET’s). This is directionally based rather than muscle specific. My intent is to target joint capsule, fibrous connective tissue responds well to low load resistives, thus joint capsule & ligaments respond to this type of technique.  Upon conclusion of all the above, I then address musculature. Clearly there are very appropriate times to address and release muscular hypertonicity straight way. My point is that when muscles are not responding or releasing, then you need to change your strategy and orientation.

FASCIAL PLANES OF DISTORTION

When palpating to distinguish the direction of a myofascial distortion, it is recommended that the therapist palpate the surface of the skin to determine the plane(s) of restriction. This method was first noted in osteopathic literature and is commonly held throughout all manual therapy disciplines.

The osteopathic concepts of ‘ease’ and ‘bind’ are assessed in two ways: either the direction of the restriction or barrier is palpated or the direction of the motion barrier or restriction is assess by PROM passive range of motion as a motion restriction. Ease is always away from the barrier or the greatest degree of movement. Bind is the barrier or where movement has the greatest degree of restriction

HOW TO LOCATE SUPERFICIAL FASCIA

Palpate the skin with your palm or fingertips in a manner that forms to the shape of the skin over the area you are palpating.  Do not tense your hand or forearm and your shoulders should be relaxed as you perform this assessment.

Next engage through the skin by increasing the depth of your pressure to the first layer of muscle, then back off. You should be between skin and muscle.  This is the space where superficial fascia resides. Palpation is to the first level or layer of restriction.

The skin should be assessed for its mobility.  Place your hands flat upon the surface of their skin and move the skin in all directions.  Ideally, the skin should move equally in all directions, except around tendinous insertions into osseous structures.  If it does not move well in a particular direction, this will indicate the underlying fascia is restricted.

If the skin does move in one particular plane of movement, say in a cephalic or sagittal direction, a myofascial technique can be applied in the direction of the restriction.

Skin adhesion is an indication of the ease or bind of the superficial fascia below it. You can easily assess fascial restriction by moving the skin over superficial fascial tissue. Assess the four cardinal directions by moving the skin proximal/distal medial/lateral or inferior/superior

DIRECT & INDIRECT TECHNIQUE: CONCEPTS OF EASE & BIND

The direction(s) the skin moves easily is called ‘ease’. The direction(s) that the skin resists moving is called ‘bind’. This is the method to assess planes of fascial distortion.

You engage bind by using a static compression of the skin into the superficial fascia and you will release the current assessed bind and create both a new ease and bind position.   If the skin moves easily in the area you are assessing, then you are probably able to use techniques that are more muscular oriented.  If however, the skin does not move easily, then in a general sense you are dealing with myofascial that needs to be released before you can achieve desired results from your muscular approaches.
This simple assessment can be utilized to assess superficial back and front line restrictions or lateral line restrictions. (Myers 2000) “Manual therapy comprises direct & indirect techniques.  Direct techniques load or bind tissue and structure. The tissue is moved towards a barrier on one or more planes.  The direction of displacement of the soft-tissue is in the least mobile, most restricted & most limited direction. Techniques are performed at or just before the barrier. The result is a change of the position of the barrier which will move closer to what would be the end of a more normal range of motion. For example, a direct approach might be employed to treat elbow flexion contracture with shortened and contracted biceps that limits elbow extension, a direct technique would be to move the elbow into extension. At the barrier, or just before the barrier at the interbarrier zone, a technique is performed with the result an increase in range of extension motion.

Indirect techniques unload or ease the tissue or structure.  The tissue is moved away from the barrier on one or more planes. The direction of movement of the tissue is the most mobile, least restricted, least limited direction. The distortion is thereby exacerbated.  The problem is exaggerated. For example, with limited extension, there is relatively too much flexion. The problem could be described as excessive flexion. The treatment would be towards flexion.  The result is a ‘release’ phenomenon: the soft-tissues “let go” of tension in a tissue tension release.” (Giammatteo & Kain, Integrative Manual Therapy 2005 Vol.4, p70 North Atlantic Books)

MYOFASCIAL SLEEVE RESTRICTIONS

Myofascia behaves as a superficial wrapping as seen from Serge Paoletti’s anterior fascia of the low extremity.
Which brings me to assessment & palpation of fascial sleeves. Most practitioners are used to assessing rotation of the humerus or femur which determines movement at the shoulder or hip.
Another assessment that can be included is assessment of restriction of upper or lower extremity fascial sleeves. This is assessment is crucial to improving motion at the joint and for allowing the smoother movement of the muscle through its fascial sheath.

When addressing the scapular complex (GH joint, AC joint, SC joint & scapula-thoracic joints, humeral ulnar, radial ulnar, radial carpal), sleeve restrictions often will be the first restriction to release.  Since myofascial loves to be encased through fascial ‘grasps’, this simple static compressive technique can clear fascial tissue quite quickly.

• Assess which direction of rotational restriction is ease and which direction is bind.
• Engage myofascial by using a grasp and apply the twist in the direction of ease to unload the tissue, or bind to load the tissue.
• Usually the engagement of the superficial myofascial wrapping is enough to create a myofascial glide, usually within 10-30 seconds. However if this isn’t successful, then here are some points to consider:
• From a palpation standpoint you are pressing too hard
• You will need to engage a second plane of fascial distortion, which is to put a direction or vector on the myofascial by creating a ‘lateral shear’. Osteopaths call this ‘stacking’
• You may ask the client to use slight movement as you engage the myofascial, usually in a rotational direction.
• Micheal Stansborough and other direct myofascial release authors call this Active Movement Participation AMP.
• You will find once you’ve cleared a rotational distortion or restriction you will increase ROM at the joint and the clarity of the restriction will become more focal.
• Myofascial restrictions & distortions will obscure the ability to distinctly palpate the muscular structure beneath it.

Australian Association of Massage Therapists

21-23 May 2010

6TH NATIONAL CONFERENCE Held at the Sydney Hilton

INCLUDING INTERNATIONAL PRESENTERS FROM THE USA & CANADA!

American presenter Whitney Lowe

Whitney Lowe has been a massage professional for over 20 years and is widely
known for his expertise in assessment and massage therapy treatment approaches
for chronic pain and injury conditions. His contributions to the massage fi eld are
wide-ranging and include extensive research and professional publications, teaching,
clinical work, consulting, and participation in national boards and committees.
Research and publication are a priority for Lowe. Lowe’s texts, Orthopedic
Assessment in Massage Therapy and Orthopedic Massage: Theory and Technique,
are used by massage therapy professionals and schools in their massage training
programs. In addition, he is a contributing author to several other books and his
articles appear regularly in professional peer-reviewed journals and popular
magazines, such as Massage Today, Massage & Bodywork and Massage Magazine.

Invitation
On behalf of the Australian Association of Massage Therapists (AAMT), it gives me great pleasure to invite you to attend our 6th National Conference, held at the Sydney Hilton, May 21-23 2010. For 2010, we are excited to announce 5 International presenters from North America offering a diverse and exciting selection of sessions to cover the wide interest of AAMT members: Whitney Lowe (Oregan, USA) – Orthopedic Assessment and Massage
John Barrera (Texas, USA) – Assessment and treatment techniques for the Atlas/Axis/Cranial base
Mya Breman (Florida, USA) – CranioSacral Therapy
Colleen MacDougall (Edmonton, Canada) – The regulatory changes in Alberta, Canada and the effects to membership
Paul Buffel (Saskatoon, Canada) – Yoga presentation
Importantly, I would like to thank those who attended our 2009 national conference in Hobart and took time to fill out session feedback forms and rated the overall success of the conference. Once again, we have created a streamed program, which will result in every delegate having an opportunity to be involved in a hands-on workshop on one of the afternoons. Needless to say, workshop allocations are done on a fi rst in fi rst served basis so please register early to avoid disappointment.
As with all past AAMT conferences, the Gala Dinner ticket is included and I strongly encourage you to attend this important event, which includes a 3-course dinner and beverages. It is also the time to let your hair down and have fun with like-minded people in our industry. Please note that there is no discount on conference fees for delegates unable to attend our Gala Dinner, as we negotiate venue costs based on a variety of expenses and catering makes up a large part of this.
Finally, I’d like to thank our sponsors and trade exhibitors for their generous support and we look forward to seeing you at our 6th AAMT National Conference in Sydney.
CU in Sydney!

David Sheehan
AAMT Conference Coordinator
CPE Points

This is an offi cial AAMT event and will attract 40 CPE points to registered members
of the AAMT. The program in this brochure may be subject to change.

PRINCIPAL SPEAKERS

John D. Barrera

John D. Barrera is a clinical Massage Therapist and International presenter with over 25 years of active medical/clinical massage experience. He has spent the last nine years furthering the development of Atlas/Axis/ Cranial Base balancing for the massage therapist.
John has authored three measurement and treatment strategy flow charts that will further the understanding of the massage therapist and other allied health professionals in this emerging and fascinating field of study. The Atlas/Axis/Cranial Base Connection could be an answer to relentless head, neck and body pain.

Mya Breman

Mya’s career underwent a drastic shift when she left TV and radio to join the Upledger Institute as marketing director in 1989. Impressed by the results, she returned to school to study manual therapy. She has now become an experienced Licensed Clinical Social Worker and extremely fortunate to be mentored by Dr. Upledger in CranioSacral Therapy and Dr. Bruno Chikly in Lymphatic Drainage Therapy. She loves blending structural and emotional therapy in everyday problem solving, as well as, the most complex trauma. In addition to seeing private clients at UI HealthPlex, she frequently lectures at conventions, conferences and schools worldwide.

Susan Davis

Susan Davis is a registered nurse, holds a B.HSc and several diplomas in the practice of remedial massage therapy. She has been in the massage profession for over 30 years.
Susan has continued her education at the leading edge of developing knowledge. She teaches
practical massage at Sydney University and has been a mentor to many young therapists through the Davis Health Centre. Susan is completing her Masters in Lifestyle Medicine under Professor Garry Egger. Her thesis on the relationship of musculoskeletal pain and disorders as an indicator of more serious chronic lifestyle issues is the cornerstone of her presentation at the conference.

Paul Hermann

Paul is an Osteopath and one of Australia’s leading experts in Swiss Ball Training and Exercise Rehabilitation. He is the owner and Director of Stay Tuned Sports Medicine and has worked in the Health and Fitness industry for over 17 years as a Gym Instructor, Personal Trainer, Coordinator of successful exercise rehabilitation programs, and lectures nationally and internationally.

Richard Hill

Richard Hill is internationally regarded for his knowledge and understanding of the workings of the brain, body and mind. He specialises in the interplay between the mind and the body and how the conversation in both directions alters the way we function both physically, behaviourally and neurobiologically. He has spoken at the AAMT National Conference in 2008 and at the National Health Practitioners of Canada Conference in 2009. He lectures to the psychotherapy profession and the business community making the very complicated
processes of brain, mind and body easy to understand.

Brad Hiskins

Brad is a veteran of the Sports Soft Tissue Industry with 11 years at the Australian Institute of Sport, four Olympic Games (two as Head Soft Tissue Therapist), two Commonwealth Games (both as Head STT) and 19 world championships with varying teams. Brad is the founder of the website ‘soft tissue therapy’ and the STT eMag. He currently operates Clinic 88 and also treats in 8 health clinics in Canberra and the East Coast while teaching nerve assessment and treatment at Canberra Institute of Technology. Brad has 55 published articles in numerous
magazines and journals and was a contributor to the development of Australia’s national competency standards.

Paula Nutting

Paula has been involved in the musculo-skeletal fi elds in many facets; nursing, remedial massage, personal training and cemented her studies with the Musculo-skeletal Degree. Her work concentrates in the muscle timing dysfunctions and how it creates many of the common conditions seen by practitioners.

http://www.fasciacongress.org/2009/index.htm

The second conference at Vrije Universiteit will continue the high level of scientific presentations set in the first conference. The Amsterdam Congress will be a four day schedule followed by an additional day of post-conference clinical workshops. This will add new dimensions – presentation of the clinical practices, both in lecture/demonstrations and in small group sessions, and integration with academic faculty conducting rehabilitation research. Vrije University has a main auditorium seating 900 and numerous smaller rooms for concurrent sessions.

The Fascia Research Congress 2009 in Amsterdam will be hosted by Faculteit Bewegingswetenschappen (Faculty of Human Movement Sciences) at Vrije Universiteit.

The Scientific Chair of the conference is Peter Huijing, PhD, a physiologist and keynote presenter from the first fascia research conference who is the recipient of the prestigious Muybridge Award for his work on fascial connections and force transmission within muscle tissue. The Administrative Chair is Peter Hollander, PhD who was dean of the School of Movement Sciences from 1998 to 2007 and has been active in sports related exercise physiology with an emphasis on swimming.

IMPORTANT UPCOMING DATES:
Research Abstract Submission Deadline…February 15, 2009.

Fascia Background

Fascia has both generalized and specialized functions in the human organism. As such, it is the subject of a wide range of scientific research with many specializations of focus and emphasis. Similarly, fascia and its properties are of central importance to clinicians practicing in various conventional therapies and in the wide range of complementary and alternative medicine (CAM) modalities.

Recent scientific research in the field of the human fasciae has resulted in several significant findings. Combined, the results from the worldwide research activities constitute a body of significant and important data. It is our shared vision that it is time to gather together all the latest and best scientific information about the body’s connective tissue matrix.

Future conferences will continue to provide collegial settings for the mutual benefit and collaboration of basic scientists, academicians, and professionals engaged in the many clinical practices where fascia is an important consideration.

About Fascia

Fascia is the soft tissue component of the connective tissue system that permeates the human body. It forms a whole-body continuous three-dimensional matrix of structural support. Fascia interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique environment for body systems functioning. The scope of our definition of and interest in fascia extends to all fibrous connective tissues, including aponeuroses, ligaments, tendons, retinaculae, joint capsules, organ and vessel tunics, the epineurium, the meninges, the periostea, and all the endomysial and intermuscular fibers of the myofasciae.

There is a substantial body of research on connective tissue generally focused on specialized genetic and molecular aspects of the extracellular matrix. However, the study of fascia and its function as an organ of support has been largely neglected and overlooked for many years. Since fascia serves both global, generalized functions and local, specialized functions, it is a substrate that crosses several scientific, medical, and therapeutic disciplines, both in conventional and complementary/alternative modalities.

Among the different kinds of tissues that are involved in musculoskeletal dynamics, fascia has received comparatively little scientific attention. Fascia, or dense fibrous connective tissues, nevertheless potentially plays a major and still poorly understood role in joint stability, in general movement coordination, as well as in back pain and many other pathologies. One reason why fascia has not received adequate scientific attention in the past decades is that this tissue is so pervasive and interconnected that it easily frustrates the common ambition of researchers to divide it into a discrete number of subunits which can be classified and separately described. In anatomic displays the fascia is generally removed, so the viewer can see the organs nerves and vessels but fails to appreciate the fascia which connects, and separates, these structures.

Clinician Perspective on Fascia

There is increasing interest in certain therapeutic communities in the role that fascia plays in musculoskeletal strain disorders such as low-back instability and postural strain patterns of all types, fibromyalgia, pelvic pain, and respiratory dysfunction, chronic stress injures, as well as in wound healing, trauma recovery and repair. The Fascia Research Congress seeks to present recent findings that advance knowledge of biomechanical and adaptive properties of fascia that may account for clinical observations in health and dysfunction.

The expanding worldwide scientific research on the human fascial tissues forms a body of knowledge pertinent to a wide range of professionals engaged in conventional and CAM modalities who serve individuals afflicted with specific pathologies or injuries of fascial tissue. The latest research will further the mechanistic understanding of many manual therapies and CAM modalities which contact, mechanically manipulate, penetrate, or otherwise involve fascial tissues.

On behalf of the Australian Association of Massage Therapists (AAMT), it gives me great pleasure to invite you to
attend our 5th National Conference, held at the Wrest Point Convention Centre in Hobart Tasmania, 22-24 May 2009.

The theme for 2009 is focusing on core stability, including topics such as structural assessment for and injury due to lack of.

For 2009, the Bowen Therapists Federation of Australia is participating in collaboration with AAMT to present this
event to their membership, which reflects positively on our conference program by increasing the number of
opportunities for delegates to participate in afternoon breakout sessions.

Importantly, I would like to thank those who attended our 2008 national conference in Adelaide and took time to fill
out session feedback forms and rated the overall success of the conference. Once again, we have created a streamed
program, which will result in every delegate having an opportunity to be involved in a hands-on workshop on one of
the afternoons. Needless to say, workshop allocations are done on a first in first served basis so please register early
to avoid disappointment.
With a diversity of interest within the membership comes the challenging task of creating a program that caters
for everyone and I would like to extend my sincere thanks to this year’s Conference Committee and Chief Executive
Officer, Tricia Hughes for the discussion and program input which began soon after our Adelaide conference.
As with all past AAMT conferences, the Gala Dinner ticket is included and I strongly encourage you to attend this
important event, which includes a 3-course dinner and beverages. It is also the time to let your hair down and have
fun with like-minded people in our industry. Please note that there is no discount on conference fees for delegates
unable to attend our Gala Dinner, as we negotiate venue costs based on a variety of expenses and catering makes
up a large part of this.
Finally, I’d like to thank our sponsors and trade exhibitors for their generous support and we look forward to seeing
you at our 5th AAMT National Conference in Hobart.

David Sheehan Conference Organizer

To register your interest please visit the AAMT for a registration form: here