Aspects of Deep Tissue Bodywork Part I – Muscle: Anatomy, Function, Fatigue & Release

There are soothing and pampering, or ‘feel-good’ forms of bodywork with secondary therapeutic effects – and there are treatment modalities where the therapeutic effect is of primary concern.  Deep tissue sessions definitely fall into the latter category. 

Sometimes the literature also refers to them as orthopedic muscle sculpting a term, which in itself highlights the two important factors involved in these treatments: precision and structure.  The therapist takes on the role of a sculptor who with precision aims to help the client’s muscles regain their ideal shape (irrespective of size) and placement, by tracing them with deep strokes and pinpointing tense spots.  This process, when applied skillfully, and, again, with precision, can be so effective that it will have an orthopedic effect: In other words, it can restore the correct function of the skeletal system, its articulations and associated structures.  For the one receiving a series of such treatments, this is a deeply healing experience and most often in terms of the actual result, surpasses the effects of the prescriptions from an orthopedic physician, or the ministrations of mechanically oriented physiotherapist.

So, in case you are a therapist, you may ask yourself, what do I need to do in order to achieve such results?  What do I need to know?  What skills would I want to have at my command?  You require three things: Knowledge, experience and sensitivity, or awareness.  Knowledge is the basis, in this case sound anatomical knowledge of muscles, fascia, bone, nervous system, emotions – and their interplay.  Experience refers to technical precision in terms of strokes and point holding, learned from the ground up and refined over time.  Whereas the sensitivity required, is of a two-fold nature: you need to be aware enough to listen to and pick up on the signals given by the client’s body in reaction as the treatment progresses and by your own body, in order to not to tire and in order to let the treatment unfold naturally, like water flowing over rocks in a steady pace.

Yet again: knowledge is the basis.  Which is why the first two posts in this multi-part series on deep tissue treatments are dedicated to deepen the understanding of the anatomy, function as well as frequent malfunction of especially muscles and connective tissue, or fascia.  As a therapist you would not only want to know where and how each muscle is attached to one bone and inserted into another.  You also would want to understand how muscles work, what gives them energy,how they tire, as well as you would want to understand the results of muscle fatigue and its impact on fascia and bone structure.  Such knowledge will greatly help you in your practice, because it makes you get a grasp the physiological and psychological effects of your treatment.  On its foundation you are in a position to fine-tune your treatments, thus giving them greater precision for even better results.

A healthily sustained and exercised body is mostly muscle.  It is this most obvious bulk that we feel with various strokes, pressures and stretches during a deep tissue session.  And these muscles have more than only a motor function in the sense that they allow the body to move.  In them memories are stored, good and bad, including physiological and psychological traumas like accidents and moments of defeat, extreme inner pain and helplessness.  Most of the ailments associated with habitual posture, everyday stresses and emotional holdings are represented in the muscles as aches, stiffness, soreness, tension, spasms, cramps, tiredness etc.

For example, for more than 80% of the cases of low backache and cervical spondylosis (a very common diagnosis here in India), no radiological or biochemical abnormality is found. Such cases are also usually reluctant to effective cure with conventional medicine.  Although analgesics and muscle relaxants can provide temporary relief in a few cases, the effect usually lasts only as long as the drug is ingested on a regular basis.  If one searches for the cause outside the usually assumed culprits, that is bones and ligaments, the search would inevitably lead one to discover that the so called “unknown cause” for the pain and discomfort in back and neck can be found in the chronic muscle spasms in these very areas.

Muscles are by far the most metabolically active organ in the body.  They burn a tremendous amount of energy.  The working muscle’s need for replenished ATP (Adeno-Tri-Phosphate) is in fact so great that during any given day, the body will produce ATP in an amount equal to its weight.  As the cells’ main fuel produced in the mitochondria, Adeno-Tri-Phosphate or ATP is crucial to three separate phases of the contractile process inside the muscle cells.  Which is one of the reasons why, if you weigh 65 Kgs, your body will need to produce 65 Kgs of ATP every day for you to stay alive.  This need for ATP is fulfilled by aerobic glycolysis and Kreb’s cycle i.e. by burning of glucose in the presence of oxygen to produce ATP, as well as CO₂ and H₂O along with it. The whole ATP-production process thus needs a constant supply of sufficient amount of oxygen, the requirement of which is especially high during high levels of work in the muscle cells. 

Now you may ask, why go into all this science mumbo-jumbo?  Because roughly and very unscientifically speaking, deep tissue treatments increase the oxygen flow in the muscles, thus helping the body to produce more ATP.  Which, in turn, is why after a good deep tissue treatment a client feels more alive, more completely embodied.

When the work by the muscle cells exceeds the energy input and oxygen supply, muscle cells shift partly to anaerobic glycolysis, producing large amounts of lactic acid and other toxic metabolites as waste.  It is probably the irritation of the muscle tissues and nerve fibers that produces the typical soreness in muscles, which have exerted beyond their aerobic capabilities.

Within the general parameters of normal human activities, this is a natural phenomenon. When the lactic acid levels reach a certain threshold, normally the brain sends a signal to stop any further exertion. Once the workload on the muscles is decreased, accumulated lactic acid and other wastes are slowly washed away through blood stream and a fresh supply of oxygen is restored.

However, in today’s fast paced life, no one has the time to pause for a moment and listen to one’s own body’s needs.  There is not sufficient time for rest and relaxation.  Increasing responsibilities, the competitive spirit, the ‘always-in-a-hurry’ attitude all take their toll on the body.  The constant abuse gets stored in the body as chronic tension in muscles and fascia, especially around the knees and ankles, in the shoulders and in the neck, as well as in the lower back.  The continuous state of tension in these areas leads to an increasing build-up of lactic acid in the muscle cells.  Lactic acid over time gets crystallized forming “knots” in the muscles.  These knots keep on growing in size pulling muscle fibers and fascia along the long lines of tension.  Both crystals of lactic acid and muscle pull irritate the adjacent nerve fibers leading to backache, cervical spondylosis, arthritic pain of the knee join, and so forth.

The fact that in most such cases, no abnormality is found radiologically, in itself serves as proof that hardened muscles, not bones and ligaments, are a major cause most musculoskeletal problems.

Only a skillful manipulation of the soft tissues (muscles and fascia), by a knowledgeable therapist can, through deep tissue treatments, help release crystallized lactic acid and restore suppleness in the muscles.  Drugs cannot solve the problem.  Because drugs do not help the body produce the ATP the body needs.  Only gentle exercise and ample amount of moving the body, as well as deep tissue treatments on hardened muscles can achieve that. 

In other words, deep tissue treatments work because they fulfill a physiological need and correspond to the body’s own logic.

Potential Effects of Bodywork/Massage on the Bodymind-Continuum – According to Tappan’s Handbook of Healing Massage Techniques

Gagori says that when she learned bodywork in the context of the 4-modul Taosomatics program, Frances Tappan’s book on healing massage techniques had been required reading.  We quote from it today to give a brief overview of the benefits of bodywork on the different and interacting system of the bodymind.  This is a general overview taking all possible techniques into account, without differentiating between the specific impacts of the different techniques.

“The literature will often refer in general to the “effects” of massage, but it must be noted that different techniques of soft tissue manipulation and joint movement have different effects.  For example, a light sliding effleurage usually has a relaxing effect.  Tapotement has a stimulating effect if received for a short time and may have a sedating effect if received for a longer period of time.  Practitioners choose specific techniques to obtain specific effects and need to know what those are for effective application.”

Body System/ Mental & Emotional Aspect	Effect
Integumentary System, Pertaining to the Skin	Stimulate sensory receptors in skin Increase superficial circulation Remove dead skin Add moisture with oil or lotion Increase sebaceous gland excretions
Connective Tissue/ Fascia	Improve pliability of fascia Separate tissues
Circulatory System	Increase local circulation Enhance venous return Reduce blood pressure and heart rate with regular relaxation massage
Muscular System	“Milk” metabolic wastes into venous & lymph flow Relax muscles in general & specifically with specific intention Relieve myofascial trigger points

Skeletal System	Increased joint mobility & flexibility
Nervous System	Stimulates parasympathetic nervous system (relaxation) Reduces pain (neural gating mechanism) Increases body awareness
Endocrine System	Release of endorphins (also involves nervous system)
Immune System	Increases lymphatic flow Improves immune function via stress reduction
Digestive System	Movement of contents of the large intestines Better digestion with relaxation
Mind/Intellect	Increased mental clarity
Emotions	Reduced anxiety General feeling of wellbeing Release of unexpressed emotions

Bodywork Training on Paradise Island - Memories of Mauritius

Hi, this is Choyin, speaking… while I am actually writing.  I contribute a lot of the posts to this blog, and so far it has been a pleasure for me, albeit mostly serious stuff.  I hear you, really, I do.  No one can stand too much of that.  Too much of a good thing always turns into a bad thing.  Seriousness can become ridiculous, and quickly.  So today, we take off instead: to a Paradise island, or down memory lane.  Which will depend on how you look at it, or I look at it, because it is my story – about a trip quite a few years ago that was mostly dedicated to teaching bodywork and Tibetan yoga with my then partner Paula Horan in Mauritius. 

Now again, teaching is likewise a serious topic, and so is Tibetan yoga.  Mostly, these two are taken much too seriously and in the wrong way, especially in India, or worldwide by those who consider themselves “teachers”.  Too bad for this country that so far there seem to have been only “Three Idiots” rebelling against it. How about 30 Million?  Or 300 Million?  Then teaching and yoga might become what they by nature are:  easy, relaxing, spontaneous, lightly & mildly enlightening.  You know the stuff they call ‘fun’.  Not my favorite word because it IS over-used, and sooo shallow; saying nothing really, other than that I pretend to myself that I am not bored.  But then, yeah, life can be fun – and so can teaching; especially on a Paradise island.

There were three courses, a 2-weeker privately organized, a 4-day introduction into Siddha Marama massage for the staff at the Mauritius Hilton in Wolmar, and of course, a 5-day NadiPrana or Tibetan yoga retreat, plus all the other stuff that Paula used to do and still does, like Reiki.  As a matter of fact, the courses came in reverse order, the NadiPrana retreat first. 

It does not really matter where you do such a retreat.  Paradise Island or not: you turn inward.  You become silent.  Not in order to transform into a deaf, dumb or mute (no speaking allowed during the retreat), but in order to hear, and see, and smell, and taste and touch even better, more fully.  Silently focusing on what is happening through letting your body and breath move you will inevitably imbue you with immeasurable fullness.  During the retreat you don’t venture out further than the porch from your room, or the dining area and the practice hall.  But on that porch you can have it all: the evening clouds and the sunsets much more vivid than in a 3-D movie, because here everything is unfathomably ‘real’.  It involves the concert of all the senses, not just the eyes.  You can also re-discover all the things you don’t usually look at because you take them for granted, like the dessert pudding on your plate, or the deep red of your cranberry tea.  And then you breathe.  Sure, you always do that.  Otherwise you’d drop dead.  But do you feel it?  Do you very once in a while in the day or at night feel your breath?  Breath is flowing in and out, so nice and easy, no big deal.  But in the ‘no-big-dealness’, every once in a while comes a great revelation… which then also quickly disappears, thank God.  We don’t want to have anything too great hanging over our heads and block our vision, do we?  To sum it up, the NadiPrana retreat on Mauritius was outwardly uneventful.  And that is a good thing.  Two of the bodyworkers who would later join the 2-week program, also took part.  They said they could not believe how different it felt to touch after that.  How rich and immediate, no thoughts or ego in-between.  Way to go, for a good massage: rich and immediate.

At the Hilton, they were looking at us guardedly, at first.  Who are these two people who want to teach us?  One American and one German, but living in India?  All the split-personality stuff briefly came up that goes on in the three ring circus of the corporate world, actually anywhere in the world where ambition comes into play:  the “I-am-already-in-and-I-belong” superiority feeling, versus the nagging undercurrent of doubt: “Am I really good enough?”; “Could he or she bring my weak points out for all to see?”  The best approach to deal with that is, not to deal with that: to ignore it and get on with the program.  Anyway, these were genuinely beautiful people, one of them very well trained with a degree from a physiotherapy school in London, the others in-house trained only.  We enjoyed their curiosity and their willingness to drop the guard every session a little more, all of them.  Their most meaningful discovery, however, was not in the new techniques that we introduced to them, their greatest discovery was, to experience and feel how much the stance or posture that the therapist takes during the treatment, changes the quality of experience for therapist and client alike.  Four days is not a long time.  Not much can be achieved.  But, to really understand posture, is indeed a big achievement – not only for a massage therapist – but also for the human being whose job happens to be that of a massage therapist.  And for those who are curious about the results of the endeavor: yes, they all were able to deliver well-paced, naturally flowing and invigorating siddha marma treatments after four 10-hour days of training.

The last event was the 2-week training in basic bodywork (Swedish, Easlen & Deep Tissue), and it unfolded the same as all the other bodywork intensives that we taught together over the years: exciting and challenging.  What else if not intensity can be the order of the day, when you bring a dozen people from different corners of the earth together, lock them in one place (except for the swimming breaks in the afternoon) for 15 days and ask them to work together from 6:00 Am to 10:00 PM? 

One thing was different though, the get-together in the evening after the closing session.  Mauritians love plenty of good and varied food.  They are generous and they know how to throw a party.  They are a very lovely people, most of them of either African or Indian origin.  And they speak French, or Creole among themselves (English more for business).  Can you imagine how much the liveliness inherent in speaking French or Creole would loosen up the usually more rigid facial structures of people from India?  Just plain wonderful to see.  And refreshing to be with. 

Elements That Need to Come Together for a Satisfying Hands-On Bodywork Session

This is going to be written from the client’s point of view. The reason being that client feedback is often the most insightful tool for the therapist to evaluate his or her performance.  However, the client also needs to be educated in the sense that he can differentiate between a bad and a good treatment.  In other words, the client needs to be comfortable and at ease with his or her body.  He does not need to be able to name all the muscles touched in the treatment, but he needs to be able to really feel and appreciate the strokes, plus his body’s as well as the mind’s reaction, down to the more subtle emotional and energy ripples that are being triggered.  I have received my share of bad massages, but fortunately in the majority of cases: excellent and highly satisfying treatments.  So what makes the difference between a bad and a good massage?

To address one important issue up-front: It is not the price tag.  The most expensive treatments in the most expensive spas can turn out to be highly disappointing.  A non-committed, only partially trained therapist doing his or her job as a routine, or even a committed and well-trained one being forced to deliver one massage too many on his or her shift, these two factors are most often the reason for lack of quality in the treatments given at a 5-star spa.  Now, I am not saying that all treatments at all high-end spas lack in therapeutic authenticity.  But some clearly do.   Interiors and ambiance cannot compensate for such lack.  Interiors may be pleasing to the eye.  Expensive fragrances and high quality aromatic oils may help the client’s mind to settle in the present moment, open and ready to receive what is about to happen.  But then it comes down to the ‘show-me-the-money’ part, which in this case translates into: “Show me what you can do, prove it in the touch and the natural flow of the treatment.” 

For the sake of easier readability, let us break down the ‘touch-and-natural flow-mystery’ into the components that make up this natural flow, and the sense of appropriateness in the touch.  Mainly, there are eight aspects or elements:

1. Clarity of Intention: When being treated I need to have the sense that the therapist is going about his or her work with a clearly defined purpose.  He or she needs to exude confidence.  Which also shows in posture and body language, as well as in the choice of words and tone of voice in the way he or she introduces him- or herself, and explains the treatment to be given.  Smiles, especially when perfunctory, are not as important as good posture and a sense of dignity that the therapist may exude.  Usually a therapist’s good posture and sense of dignity translate into his or her ability to achieve the goals that he or she is working to achieve through the treatment.  Smiles, although nice to look at, have no power.  However, true and heartfelt smiles are a wonderful gift.  We all love and welcome them.
2. Appropriateness and Correctness of Technique: Not all techniques are appropriate for all clients, at all times. Furthermore, within a given technique a range of variations is possible with respect to my present physical and emotional state as a client.  I expect the therapist to make a quick gut-level decision of what is appropriate and then execute it correctly, in the sense that it corresponds to my body’s and mind’s present state as much as it fulfills the requirements of the treatment protocol. However, with the clarity of intention on the part of the therapist discussed above, appropriateness and correctness of technique very often just fall into place.  Sounds too complicated?  Well, it isn’t.  “Different folks need different strokes”, as the saying goes. Or the same strokes delivered differently.  When you are clear, you automatically do the right thing.
3. Sensitivity and Quality of Touch: Most of the different strokes can be delivered at different depths.  They can go so deep as to touch the bone.  Or they can be delivered lightly, so lightly as a matter of fact that they just touch the aura, without any actual contact with the body.  I want the therapist to have the sense how deep he can go or how light he needs to keep everything, with any particular stroke.
4. Responsiveness to Client’s Needs:  Sometimes, in the course of a treatment I have the feeling, that the back of my legs; or the muscles along the spine; or the chest, need more attention than other areas.  I am happy when the therapist can read these needs.  Sometimes I wish to communicate by talking or even bantering a bit during a massage.  Sometimes I want to remain silent.  I am content when the therapist can discern the respective signals.  And so forth.  We are all sending out unspoken messages all the time.  A good therapist needs to pick up on them and act accordingly.
5. Ability to Focus Energy and Concentrate on Intention:  In short, I want my therapist to be aware and alert with all the stretches and moves that he or she is applying.  He or she needs to ‘be here now’, not daydreaming, not thinking of other things, and just going through the motions, without dedication or spirit.  I perceive lack of awareness on the part of the therapist as an insult to me, as a client and as a human being.  A therapist’s lack of awareness closes me energetically and emotionally.  It totally defies the purpose of any bodywork treatment.  Therefore, the therapist needs to focus his or her energy in a relaxed manner and concentrate on what he or she is doing in the moment.
6. Timing and Flow of Work:  All treatment protocols comprise a number of segments.  In most cases, the body parts that need to be treated define these different segments: Face, anterior arms and legs, chest belly, neck, shoulders, posterior arms and legs, back and buttocks.  The sequence varies depending on the treatment style or on the therapist’s intuition.  Timing and flow of work simply means that treating one part flows naturally into treating the next so that the treatment feels like a organic whole.  Also: that there is no rush at the end to squeeze in a few more strokes because the book says so.  
7. Ability to Utilize Anatomical Knowledge: Nothing is as disappointing as being treated by someone who does not know much of anything about the human body, for example has no clue as to where a muscle is attached or begins and where it is inserted into the bone.  Treatments conducted without any or with insufficient knowledge of anatomy necessarily lack precision.  They are painful to endure.  Unfortunately, at least in India, there are still therapists working even in expensive spas who lack anatomical precision.  When you encounter someone like that, ask for your money back.
8. Use of Efficient Posture and Breathing: Bodywork is hard work.  It can even be backbreaking work.  Many therapists have injured themselves while unskillfully treating others.  Only awareness of posture and breathing can prevent these injuries from happening.  Likewise, from the vantage of the client, a therapist who lacks awareness of posture and breathing cannot deliver a good treatment.  His or her movements will lack both elegance and strength.  Without coordination with the breath, movements cannot have elegance.  Without good posture there is no strength in the movements because they do not originate in the therapist’s center of gravity.

Gagori Mitra-Gupta on Her Experience with the Tibetan Yoga of NadiPrana and Its Impact on Her Work as a Therapist

When I wrote this short piece to be published in LifePositive the Indian magazine for holistic living several years ago, I could not anticipate that whatever I was about to commit to paper would be proven even more true many times over in the years to come than it had been back then.  As a matter of fact, the practice of the Tibetan yoga of NadiPrana has kept and continues to keep me at peace with myself and relaxed in the face of mounting challenges and growing work-related stress.  I would not want to miss this aspect from my life - ever again. 

"I t was my teacher Choyin Dorje who initiated me into NadiPrana in the course of my introduction to my chosen profession as a bodyworker or bodymind therapist. (Even today, I do not like the word massage therapist because it has a false ring to it, as it gives rise to misleading associations.)  For me, working with Tibetan yoga has been a voyage of unending self-discovery.  From the correction of a bad posture and relief from backache, to greater self-esteem and a sense of peace and groundedness even in the unavoidable turbulences of my everyday life – the journey of NadiPrana keeps unfolding…  It is so encompassing, it even teaches me to have compassion with my moments of despair and self-pity and all the other things I have been conditioned not to like about myself.  Although I often still take myself far too seriously, in the years that have passed since this first encounter with the practices, I have been able to see the humor in certain situations instead of the “tragedy”.  For all of us, this is a big step."  

"The proof in the pudding is always in the eating – the proof of a spiritual path is always in walking the talk.  It all comes down to the ability, “to let come whatever comes and to let go whatever goes”.   The energy flow stimulated by the NadiPrana exercises has helped me to experience freedom from grasping, at least occasionally.  This also supports me in my other work with my clients as a bodymind therapist and orthopedic muscle specialist.  If I feel essentially free from my own load imagined or real, I am in a much better position to help my clients shed their physical or psychological burden."

"NadiPrana is an emerging yoga of healing.  It has roots and links with the glorious past of Siddha practice in ancient India, which later was transmitted into Tibet where it flourished in mountain hermitages for centuries.  It also encompasses elements of energy circulation and other practices from Chinese Taoist yoga.  Because in its present form the system is a modern day creation, it is taught in public mainly from the bodymind therapy approach of energy balancing, integration of resisted emotions and feelings, relaxation and overall stress release.  In all areas of life it provides for clarity and a sense of ease and greater vitality." 

"NadiPrana does not teach us to suppress the senses, but instead fine-tunes the senses to the degree that they open up and bypass their purported limits.  Freedom is always inherent in them, once we are able to notice.  It is not the senses that have us fettered to painful illusions, it is the tight grasp the mind keeps on them, which causes us to identify and suffer."  

"NadiPrana’s main aim is to quickly inspire and engender in the practitioner a direct experience of the vibrant reality of the different sheaths of the energy body.  Its purpose is to gently melt the grasping mind, which permeates the physical structure.  NadiPrana skillfully reaches this goal and will take a slightly different route for each and every individual who engages in its practice.  In NadiPrana several seeming opposites reveal themselves not to be opposites.  For example, we may discover that when we let go of our ego through feeling whatever arises in the moment.  Also our sense of personal sovereignty unexpectedly increases, although the sense of an aggressively defensive ego has actually dissolved.  We may also come to realize that we can enjoy every aspect of our lives, and yet remain free from bondage."

Orthopedic Muscle Sculping Relieves a Patient from Undergoing Knee Replacement Surgery – A Case History

The following is an example of how a good bodyworker can address a serious condition in a client, in this case primarily with regular deep tissue or orthopedic muscle sculpting sessions.  Orthopedic muscle sculpting has been used to help relieve people of refractory joint pains, especially when associated with stiffness, limiting the range of motion, and movement in general.  Muscle sculpting, in addition has also been used successfully to prevent the need for knee joint replacement surgery.

Eventually, the protocol to be presented here in greater detail, including case history and treatment plan, was successful.  This success did not come easy, though, as it took almost one year to complete the full treatment, with an interval of two months after six months, and forty orthopedic muscle sculpting sessions in the course of the first six months alone.  And it took more than just the bodywork.  The treating therapist in this case also happened to be a general physician, and she therefore integrated other therapeutic modalities into the treatment plan.

The patient, whom from now on we shall refer to as Deepika, was a sixty year old housewife and mother of five who when she first consulted the therapist voiced the following complaints:

• Pain and swelling in the right knee for the last 5 years
• Not able to squat
• Not able to walk for more than 100m without support
• Not able to climb stairs
• Persistent stiffness & pain in the knee after waking in the morning and in the evening after completion of the day’s chores
• Heavy pain for the last six months despite regular intake of heavy-duty painkillers and wearing a splint
• Suffers from chronic fatigue & depression
• Has been suffering from heartburn & hyperacidity for the past 12 months
• Was advised to undergo knee replacement surgery a month ago

Deepika had been a homemaker all her life, with very little contact to the world outside the framework of family.  She had never smoked, and never consumed alcohol.  Her diet was mostly non-vegetarian, with an intake of 3-4 glasses of water per day, and plenty of sugary chai.  With 88Kgs at 5 feet of height, Deepika was also seriously overweight.

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Cursory observation revealed that she walked with the help of a stick, putting most of her weight on the left knee, as the right knee remained constantly guarded.  The right knee was swollen.  The leg was kept in a flexed position even while standing.  Deepika’s mostly maintained a stooped posture.  With this and other body language signs, she gave the impression of being emotionally insecure, quite frightened actually of everything. 

Through palpitation it was further discovered that the swelling was of the same temperature as the surrounding skin, except for the part right over the knee joint.  The muscles of the knee joint felt hard like stone.  This hardness extended into the thigh and the gastrocnemius; upward also further into the gluteus, the pelvis and lower back; as well as downward into the Achilles tendon, ankle joint and the foot.

Specific orthopedic tests confirmed that flexion and extension of the right knee were limited in range, and quite painful for Deepika to attempt.  The left knee was found normal in its range of movement.  X-ray of right knee showed changes typical to osteoarthritis, i.e.: decreased joint space, sclerosis of the articulating ends of femur as well as tibia, etc.

The following treatment plan was offered, with the foal of avoiding knee replacement surgery, if at all possible:

• Orthopedic muscle sculpting sessions 1 ½ hour each twice a week, for a minimum of 6 months
• One ozone injections per week for ten weeks into the right knee (2cc at a concentration of 20 microgram per milliliter)
• Infra Red Heat therapy on the right knee after every treatment session
• Daily supplementation with active calcium and magnesium salts, as well as capsules containing chondroitin sulphate and glucosamine
• Initially use of two walking sticks instead of one, in order to also relieve the left knee of the extra burden.
• Weight management through a diet plan with the intention to help Deepika achieve a more ideal weight for her height of 50 Kgs to 60 Kgs.

And these were the results:

1. After 4 sessions or two weeks of treatment, the pain in Deepika’s right knee decreased.  The muscles started to get loosened up, facilitating a smoother movement of the knee joint.  Deepika found it easier to walk.
2. For the first time in years, Deepika could put some weight on the right knee after 12 sessions, or six weeks of treatment.  She also could walk for longer stretches than before.  The swelling around the knee joint was considerably reduced by then, too.
3. After 20 sessions Deepika was able to flex the knee to 90 degrees and could keep that posture for 10 to 15 minutes.  At this point in the development, she started to use a bicycle for about half an hour per day, at low speed.  The swelling in the knee had disappeared altogether. Deepika also felt energetically and emotionally stable and stronger that before.
4. After 40 sessions or six months of treatment Deepika was able to walk without the support of a stick. She had also lost 18 Kgs and now weighed 70 Kgs.  She suspended the treatment for a while, however continued following the established diet plan.

When she consulted the orthopedic surgeon, he told Deepika that according to present clinical signs and symptoms she did not need knee replacement surgery any longer.

This is a textbook case of good bodywork in conjunction with other treatment modalities.

T’ai Chi Movements as a Useful Tool for Bodywork

In her recent interview Gagori mentioned that during her own training she learned to practice some basic T’ai Chi movements for better posture.  From the point of view of posture the value of practicing T’ai Chi with regard to improving a therapist’s performance during bodywork, springs to the eye as simply obvious. In this context, two benefits stand out in particular: T’ai Chi teaches the practitioner to move in a flowing, water-like manner, and to always permit the movements to originate from the body’s inherent center of gravity. 

It is clear that when your movements are flowing naturally and through the power of gravity also effortlessly, that the treatments that you give will be more enjoyable to the client.  Your flowing movements translate into the experience of a natural flow in the client.  They may jumpstart his or her own ability to be in and express life through his or her own genuine natural flow.  Whereas your freedom from belabored effort due to going with the power gravity, frees him or her from stress and allows for a deeper and more complete letting-go.  Natural power brings forth natural grace.  Flowing with gravity frees one from being the victim of its downward pull, or fall. 

The same dynamic applies to your giving a treatment.  When your movements flow out of your belly rather than being forcefully set in motion by will from your shoulders, arms, wrists and hands, you will encounter no resistance that makes it difficult to continue.  Rather than being burdened by giving a treatment, you may feel enriched, even empowered and gently exhilarated.

And then of course, you observe the secret instruction (which is not a secret at all) of always keeping your knees slightly bent in the typical basic T’ai Chi stance, while giving a treatment.  This makes sure that you remain grounded in a flowing way, and allow all negative energies to move through you and out.  Were your knees to remain locked when giving a treatment, these same negativities set free by the treatment would remain trapped in your system, your body and your mind, and instead of feeling invigorated after giving a session, you would feel drained.

As present-day master Hua-Ching Ni states, “ In all your movements, whether as a exercise or in daily life activities, the key to success is naturalness.  Nothing about T’ai Chi [or about giving a session of bodywork to a client] is artificial or superficial.  They are deeply related to your natural physiological structure, and how your energy flows through that structure…. Each movement of T’ai Chi describes a circle.  There are no abrupt or radical changes in direction, speed or style.  You just keep making circles: small ones, large ones; horizontal, vertical or slanted ones, in all directions.  All movements can be considered as one movement, because they are connected.  Whether you reach out or gather back. The pattern is cyclical.  Some circles are too small to observe, but in terms of energy flow they are a whirlpool.”

What Master Ni presents as an overall instruction as to how to practice T’ai Chi, can also be read as a perfect instruction for giving a massage or a session in another type of bodywork.  T’ai Chi and bodywork are a perfect marriage, a perfect match.