Key points

• Whatever your technique, there is a delicate dance to creating space without destabilization, in going deep without feeling invasive.

• Our role as healers is not always about taking all the barriers away, but sometimes inspiring a new way to dance around a challenge.

v“I believe that we learn by practice. Whether it means to learn to dance by practicing dancing or to learn to live by practicing living, the principles are the same.”—Martha Graham¹

When people come to a therapist, either in manual or movement disciplines, there is a desire to function and feel better, not just in the moment on the table, but out in the world. An elite athlete will want to take care of their body to optimize movement performance, but we are all practicing for life through our daily work in it. Being able to reach the box on a top shelf may be as meaningful to one person as pitching the perfect game is to another. If your client can’t pick up their grandchild or move through the day without pain, their world is limited in a significant manner. As part of our job, we try to make meaningful space in and for their bodies.

In many ways, life expands and contracts to the possibilities or restrictions that surround it. This may be on the level of the body in its internal system, or with others. If I am in pain and I don’t move well on either a micro or macro level, my world is limited in some very real manner. Pain (emotional or physical) changes movement. We hopefully are guiding, and not dragging, our clients through the metaphorical pathways. The work is still their own movement pathway to “hike” or explore. 

The work you do as a massage therapist or bodyworker is important because your clients are trusting their traumas and tissues to the safe space of your hands. Whatever your technique, there is a delicate dance to creating space without destabilization, in going deep without feeling invasive. Beyond the hour on the table, your work carries into their movement. Assist their range of motion in their ankle and hip, and suddenly their running stride may get easier. Working to soften contraction in the torso may allow opening from the holding of emotional grief from a family loss and allow a different breath pattern to emerge.

Evolution of Movement

The practice of manipulative therapy has been recorded since 400 BCE in Europe, although it is rather likely that humans have always used therapeutic touch in some form.² So, let’s explore a bit more about what movement your client might care about when they head back into their world and just how we got there.

Movement traditionally has been about getting from one place to another or the physical labor needed to accomplish a job. Basic actions such as walking, running, throwing, chopping, carrying, squatting, and swimming cover a lot of ways humans have traditionally moved and still inform the largest actions in active and athletic movement. The human body in motion uses broad connections through the body, which is why, in part, myofascial mapping is having such a moment. We are realizing that everything connects to everything else, and particularly in movement, the sum of the parts creates action.

Becoming bipedal (standing on two legs and not necessarily upright) has some unique challenges. While other primates occasionally stand, our short, broad ilia help us balance and walk in this unique position. Although human walking is efficient, human running takes tremendous energy in comparison.³ However, we are designed to ambulate for long distances, and indeed much of the world still negotiates some part of their day on foot. Other bipedal mammals include macropods (think kangaroos and wallabies) who are experts at hopping and are known for the fascial elasticity in their tissues.

The Achilles tendon is an important part of the equation for elastic and fascial efficiency in the body. To note, “Several clinical populations have increased metabolic cost of walking. For some of these populations, a likely contributor to their high energetic cost of locomotion is an inability to exploit the ‘spring in their step.’ This could be due to uncoordinated activation of plantar flexor muscles (e.g., individuals with stroke, spinal cord injury, or cerebral palsy), plantar flexor weakness (e.g., elderly), or simply the lack of muscles and tendons to effectively time and release elastic energy storage (e.g., amputees).”⁴ If one joint is affected by decreased range of motion and strength (i.e., plantar flexion at the ankle), something else must compensate, such as the hip joint.

It begins to make sense that foot problems you see in your practice (or that you may experience yourself) are so common if we are meant to move well but can’t always get there. At least a quarter of Americans have experienced plantar fasciitis, which is attributed to everything from overuse to underuse, and from standing too much to running too much. 

There is a question of balance for your clients. Modern life as we know it involves a lot of sitting—for the office worker, student, and more. But there are still plenty of people doing manual labor—from the baker hauling flour and goods to the delivery person carrying loads of boxes between driving from location to location. Think about your current clients and you may also realize how many are recovering from the structural challenges of their daily life to move well for their jobs, but also for their downtime. In movement, we often train drills for a specific sport or activity, or practice the skill needed (consider an occupational therapist’s work, which is all about retaining or developing meaningful life and work activities). And there are some movement activities that nearly everyone engages in—from standing to eating. However, our clients need to have resiliency in their tissues because movement is rarely predictable. 

Walking As An “Indicator Species” 

We are beginning to appreciate that movement tells a lot about the functioning of our clients, particularly walking or other means of ambulation. Watch how your client walks or moves (including via wheelchair or other means) into your space and onto your table to see their ease and movement qualities. Walking may be the most important movement to pay attention to first.

In a biological system, indicator species are those sentinels or watchdogs that detect risks. Think of the classic canary in the coal mine, where these birds were introduced to test for the presence of carbon monoxide and other toxic gases.⁵ If their delicate systems showed sickness, then the miners would likely soon become ill. The canaries were used as an early warning system for an invisible threat. In her book, A Field Guide to Getting Lost, Rebecca Solnit notes that the mere act of walking could be considered an indicator of the overall health of our human system.⁶ If the body system can’t sustain comfortable walking (or other means of ambulation), it may mean something else in the whole system is at risk.

Walking is one of the prescribed exercises that is important to improving balance and physical functioning in older adults. Weight-bearing can influence bone density but also increases synovial fluid, making joints function better. 

A National Institutes of Health article on gait disorders in adults and the elderly summarizes many of the same points:

“Walking is a common activity of daily living and at the same time a very complex one . . . A person’s gait pattern is strongly influenced by age, personality, and mood . . . Walking is a sensitive indicator of overall health status and the self-selected walking speed closely correlates with individual life expectancy . . .”⁷

Beyond all that, many of your clients may walk for mental health as much as for exercise. For myself, this is certainly a truism. However, it takes effort to get to a safe, free space to walk in, or shoes that help instead of limit movement. Beyond feeling OK to take a walk, many clients seek active ideas on how to access places they can go, and it is useful to network with those in the movement professions as well as to be aware of space to suggest.  

Functional and Free-Living Movement 

Recently, I have seen several riffs on social media on the general theme of rejecting training for the summer body and instead training for functional independence and aging well. The emergence of the modern gym is a relatively recent invention that would have puzzled our ancestors. However, “functional training” has developed in gyms to help you move in the rest of your day-to-day life, whether lifting a piece of furniture or getting a box off the shelf in the basement. In some variations, functional training is interpreted to enhance the movement needed in training human survival—be that living in the woods or in the grid of suburbia. 

The term “free-living” movement has also recently appeared and is used to describe “physical activity.”⁸ However, this usually comes with the caveat that this is not “exercise movement” but the movement we already do daily, such as household cleaning, running to the store, moving around where we live, or any other activity that is important to our day-to-day lifestyle. As already noted, free-living movement may have more importance than gym time, and for that reason is growing beyond its physical activity definition. As we’ve observed with walking, free-living movement can be a health outcome predictor and in some studies is discussed as providing insights into the relationship between movement and health outcomes such as reduced risk of chronic diseases, better cognitive abilities, and improved mental health.⁹

The Art of the Anatomical Body

It is curious that our modern anatomical texts, for the most part, portray static versions of the body, because historically, human anatomical art has placed the body in an environment and certainly in the context of movement. Think of the first stencils of hands that have been found around the world. It is a level of self-awareness that “the body itself is the tool . . .”¹⁰ Much of the art of anatomy, particularly in the Renaissance, drew on learning the anatomical body to understand movement. 

Works by well-known artists like Leonardo da Vinci (1452–1519) and Michelangelo (1475–1564), as well as several of the famous anatomical wax models, including those of Ercole Lelli,¹¹ pictured the body frozen as if mid-animation. I have looked at an early carving in the church of Santo Spirito in Florence, Italy, attributed to an 18-year-old Michelangelo that he carved in gratitude for the church allowing him to dissect in its basement. Already full of talent, he would develop this much further in sculptures like the famous David, which highlights the body ready for action. Likewise, the wax models of Lelli are posed in lifelike gestures and the famous Vesalius plates depicted images of dissected bodies posed against the Italian countryside. In fact, the plates, when lined up side by side, create one continuous vista. If we study any of these artworks, we realize the muscles, fascia, bones, nerves, viscera, etc., are all in relationship to each other and are there to serve the movement they are articulating. 

Why do we care about how our bodies are represented in art? In simple terms, it can change how we visualize what we can do in movement. Consider the art in your treatment space. Is it representative of the body in motion? Images are also a powerful means to create spatial concepts in movement.

Conceptualizing Space in the Architecture of Body and Movement

Shape matters deeply, whether we are discussing the curve of a bone, a winding staircase, or the spiral of a boxer’s punch. The more you are familiar with the broad patterns in movement, as well as all the specific names of the parts, the more you will begin to understand where your work on the table impacts the movement of your client.

Hypermobile people often need stabilization as well as strength, and with too much range of motion around the joints, they can find themselves in pain and discomfort after manual work or even too strenuous a movement session. Good space isn’t always more space. Sometimes good space is the balance of what is needed in the whole system.

The shape of tensegrity structures is familiar to many of us. After all, many an office is decorated with a basic tensegrity model or even a fancier tensegrity pelvis to teach clients about the movement. Tensegrity structures are components of science, math, and movement.¹² While you may be familiar with Buckminster Fuller’s popularization of this form (with a nod to his student Kenneth Snelson), many in the manual world may be unaware of the use of the same shape that was developed by Rudolph Laban to explain movement based on a similar concept. Directional pulls and counter-tensions form a tensegrity-like visual¹³ in his 1950 book, The Mastery of Movement, describing his system of notation. Laban sought to map the inner motivation of movement and its bodily expression. Like a tensegrity structure, movement is always shifting and changing, but in a well-balanced system, there is the ability to access many different movement qualities and efforts.

Narrative-Based Movement Medicine/Creating Good Space

Narrative-based medicine (NBM) is based on the work of Michael Balint, a Hungarian psychoanalyst, and the concept that the story of the patient is important to the care and outcome of the work.¹⁴ While there are medical professionals trained specifically in this approach, the concept has relevance on the table as well as in the moving narrative of a client. 

The field of dance/movement therapy (my first work in the domain of movement as a method of change) came out of the world of modern dance, which itself was deeply exploring themes of psychotherapy. Martha Graham studied Jungian therapy, and themes of mythology and narrative underline much of her work. Others, like Blanche Evan, followed the works of psychotherapist Alfred Adler. Throughout this work, the body and mind connect, and one impacts the other. In other words, change the movement of the body and the emotional body also may change.¹⁵

If we create a sense of body positivity and possibility, there is space for our clients to move into their healthiest mental version of themselves. Make part of the story you hear with your clients be about their movement.

Trusting Movement 

Ask your clients to envision something they love—the simpler the better. Maybe it’s an ice cream cone on a hot summer day. Watch how they embody the movement around what they are describing. This is sensing, and it can be a powerful tool. Beyond the basics of noting how they feel about this experience, watch whether their body is more coordinated. Are they excited? Enthusiastic? One of my graduate school teachers talked a lot about how things get stuck both physically and emotionally in the body. The challenge of all that is to move things through. Looking at what gets your clients excited about their life is likely what will motivate them in movement.

Movement for Growth

Many of our modern movement practices spend time mindfully checking in with the body without judgment. In the same vein, creating a safe space to allow the client to feel their body is critical. Be mindful of allowing some time for your client to settle into your table. I appreciate the therapist who spends time adjusting temperature, blanket layers, sound, and more to set the stage for inviting manual work. If the client guards against touch, the experience will impact the safe space to let movement be open for relating to others. Appropriate touch and acceptance on a body level can lead to appropriate movement expressions.

Final Thoughts

“All living systems are homeostatic, yet they are never frozen still . . . there is ceaseless change in complexity, continual oscillation within the healthy, life-sustaining ranges. Life is ceaseless movement; stability is found in balance, not rigidity.”—Neil Theise¹⁶ 

Manual and movement workers and therapists alike recognize a drive to move toward growth. I’m constantly amazed at the creative ways the body works around a surgery or creatively adapts to challenges. Mental and physical suffering is usually about, for lack of a better phrase, being stuck. Our role as healers is not always about taking all the barriers away, but sometimes inspiring a new way to dance around a challenge. When we pause to reflect on the question “Movement for what?” we can answer that movement is for what matters in life. We create space for it all—daily walking, the hugging of loved ones, the tasks we do at work, and the passions we pursue. Life is movement. 

Notes

1. Martha Graham, “An Athlete of God,” NPR Historical Archives, originally aired in 1953, www.npr.org/2006/01/04/5065006/an-athlete-of-god.

2. Erland Pettman, “A History of Manipulative Therapy,” Journal of Manual & Manipulative Therapy 15, no. 3 (2007): 165–74, https://doi.org/10.1179/106698107790819873.

3. Robin Huw Crompton and Michael Gunther, “Humans and Other Bipeds: The Evolution of Bipedality,” Journal of Anatomy 204, no. 5 (2004): 317–19, https://doi.org/10.1111/j.0021-8782.2004.00299.x.

4. G. S. Sawicki, C. L. Lewis, and D. P. Ferris, “It Pays to Have a Spring in Your Step,” Exercise and Sports Science Reviews 37, no. 3 (July 2009): 130–8, https://doi.org/10.1097/JES.0b013e31819c2df6. 

5. John Haldane, “The Detection and Estimation of Carbonic Oxide in Air,” The Journal of Physiology 20, no. 6 (1896): 521–22, https://doi.org/10.1113/jphysiol.1896.sp000635.

6. Manuel Alejandro Fernández-Ruiz et al., “Octahedron Family: The Double-Expanded Octahedron Tensegrity,” International Journal of Solids and Structures 165 (June 2019): 1–13, https://doi.org/10.1016/j.ijsolstr.2019.01.017.

7. Rebecca Solnit, A Field Guide to Getting Lost (New York: Penguin, 2006).

8. Walter Pirker and Regina Katzenschlager, “Gait Disorders in Adults and the Elderly: A Clinical Guide,” Wiener Klinische Wochenschrift 129, no. 3–4 (2017): 81–95, https://doi.org/10.1007/s00508-016-1096-4.

9. Anna Myers et al., “Free-Living Energy Balance Behaviors Are Associated with Greater Weight Loss During a Weight Loss Program,” Frontiers in Nutrition 8 (September 2021): https://doi.org/10.3389/fnut.2021.688295.

10. Patricia Dobrez, “The Case for Hand Stencils and Prints as Proprio-Performative,” Arts 2, no. 4 (2013): 273–327, https://doi.org/10.3390/arts2040273.

11. Nadir M. Maraldi, “Anatomical Waxwork Modeling: The History of the Bologna Anatomy Museum,” The Anatomical Record 261, no. 1 (2000): 5–10, https://doi.org/10.1002/(SICI)1097-0185(20000215)261:1<5::AID-AR3>3.0.CO;2-U.

12. Fernández-Ruiz et al., “Octahedron Family: The Double-Expanded Octahedron Tensegrity,” International Journal of Solids and Structures.

13. Rudolf von Laban and Lisa Ullmann, The Mastery of Movement, 4th ed. (Alton: Dance Books, 2011).

14. Rita Charon, Narrative Medicine: Honoring the Stories of Illness (Oxford: Oxford University Press, 2008); George Zaharias, “What Is Narrative-Based Medicine?” Canadian Family Physician 64, no. 3 (2018): 176–80.

15. “Resilience,” Oxford Dictionary, accessed May 10, 2023, www.oxforddictionaries.com/definition/english/resilience.

16. Neil D. Theise, Notes on Complexity: A Scientific Theory of Connection, Consciousness, and Being (New York: Spiegel & Grau, 2023).

Fascia movement guidelines

• Create space: Lengthening the system before strengthening so we are not enforcing a negative pattern.

• Hydrate: In simple terms, this is all about tissue hydration and helping ease the quality of movement. We can drink water, but to hydrate fascia we are discussing the stimulation of the hydrophilic fibers of the fascia. Lack of movement and things like chronic sitting can compress the fascial extracellular matrix (ECM) and prevent the interstitial space holding water.

• Challenge: Think of your major planes of motion (sagittal, frontal, and transverse) and mix it up and think of creating motions in the in-between areas of movement. Multi-vectors are a piece of this, but miss the movement dynamics that dancers and athletes in particular know are important for training. Namely, vary your speed and intensity.

• Pulse and rebound: Think of this in terms of encouraging elastic recoil. A modern dancer, for example, is trained in swing and release actions. Momentum can be an effective way to use less energy in the muscular system in particular. If we save calories through a highly efficient stride, for example, we can go longer with less effort.

• Generate gracefulness: Do this through coordination of the fascial system, which means less effort is needed in either movement or standing postures. This can be conceptualized as the myofascial connections dynamically balancing to create a distribution of stress or strain.

• Cultivate spatial awareness: By training spatial awareness, we increase the body’s proprioceptive fascial abilities. As awareness goes around, the felt sensation of the body grows (or perhaps just comes back into our scope); the importance of fascia as a sensory organization is important for both its orientation abilities and felt sensations.

• Build resilience: Resiliency is both physical and mental in being able to “bounce back” from stress, tension, or unexpected events and continue to function. Part of this is not holding patterns that no longer serve the body system after a trauma (again either physical or mental).

• Pandiculate: Laughing, yawning, etc., is a way to change the movement of the body. Yawn right now; even if you are in a crowded space and, suppressing your yawn, you are still getting sensation moving through your chest. If you have the free space to do so, take a “full” yawn, moving and reaching out into the space around you. Maybe you can feel the reach into the front of the pubis, or even into the entire front of the body. 

Pandiculation involves the soft tissues and occurs in most animal species. Luiz Fernando Bertolucci (2011) proposed that the stretch yawning syndrome, or SYS, which combines yawning with other body region pandiculation, may help the locomotor system “to maintain the animal’s ability to express coordinated and integrated movement by regularly restoring and resetting the structural and functional equilibrium of the myofascial system.”

Courtesy of Handspring Publishing ©2023, The Myofascial System in Form and Movement by Lauri Nemetz.

Movement Lab 

Take a few moments off the table to plantar- and dorsiflex through the ankle, and add in some circles. We now can appreciate how critical ankle mobility is to our walking. Lie down for a moment and take a small ball (in the range of 7–18 inches) and roll it behind your leg while dorsi- and plantarflexing and behind the ankle to feel more slide and glide in the whole of the leg. You can self-massage from the gastrocnemius to the hamstrings while moving in plantar- and dorsiflexion if no prop is readily available for a similar effect. Stand up and place the ball between the ankles and raise and lower the heels, to strengthen and increase range of motion. Finally, take a hand and interlace the fingers between your toes on the opposite side. Feel free to wiggle and rotate your foot in your hand. Switch sides.

Movement Observation

These four areas—space, time, weight, and flow—are central to Rudolph Laban’s work and used in many movement practices. Each area has an opposite quality. For example, the use of space can be direct or indirect, time can be quick or slow, weight can be strong or light, and flow can be tight or loose. Look at the qualities you or your client gravitate toward. How does that translate into their body structure and tissue quality? 

With a nod to Deane Juhan’s description that our “flesh is like silly putty that distorts when it is ignored,”¹ we are constantly working to move the body to direct the course of its formation. Part of that direction is creating resilience with the hallmarks of quick recovery and the ability to be elastic in form or spring back into shape.² By the time many of your clients make their way to a manual appointment, they are probably not feeling so springy anymore. Some suggestions in the sidebar “Fascia Movement Guidelines” (page 58) apply to both you and your clients. Are you also taking in movement to create healthy space in your body?

Notes

1. Deane Juhan, Job’s Body: A Handbook for Bodywork, 3rd ed. (Barrytown, New York: Barrytown/Station Hill, 2003).

2. Fran J. Levy, Dance Movement Therapy: A Healing Art, 2nd ed. (Reston, Virginia: National Dance Association, 2005).