Massage & Bodywork columnist Cindy Williams walks us through her popular two-part magazine series on the sacrum. From its energetic relevance to its structural complexity, Cindy helps us navigate working in a sensitive area. She prepares MTs for overcoming challenges and helps to signify client visible signs of client apprehension, both verbal and physical. Cindy guides listeners in working on this pivotal region and provides techniques for practitioners and take-home exercises for clients.
The sacrum is held with a reverence because of its energetic, structural, and nervous system significance. Working to create positive change in this area can help balance your clients. Listen as Massage & Bodywork columnist Cindy Williams equips MTs with the information needed to foster a safe working environment for both MTs and clients, removing fears of working in this area.
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00:48 Darren Buford: Welcome to the ABMP podcast. My name is Darren Buford, and I'm the editor-in-chief of Massage and Bodywork magazine and senior director of communications for ABMP. I'm joined by my co-host Kristin Coverly, licensed massage therapist and director of professional education for ABMP. Our goal is to connect luminaries and experts in and around the massage, bodywork, and wellness profession in order to talk about the topics, trends, and techniques that affect our listeners' practices. Our guest today is Cindy Williams. After earning a degree in sociology from Indiana University in 1997, Cindy stumbled upon her calling as a massage therapist and bodyworker. She completed massage school in Boulder, Colorado in 2000, and has been actively involved in the massage profession since that time. She has spent the last 20 years in private practice as a school instructor and administrator, curriculum developer, and mentor.
01:40 DB: In 2010, she joined the ABMP education team as a school liaison, then continued her work as a content writer and facilitator for ABMP's Instructor on the Front Lines program. Cindy writes the Classroom to Client column for Massage and Bodywork magazine, as well as various feature articles for Body Sense magazine. She currently works as a freelance educational content writer, combining her training in massage and polarity therapies with her extensive background as a yoga practitioner and instructor. She loves teaching how the body operates holistically and how each component of the individual must be addressed in order to create change. She is very passionate about her work. Hello, friend.
02:19 Cindy Williams: Well, hello there, Darren, great to be here.
02:21 Kristin Coverly: Hi, Cindy.
02:22 CW: Hi, Kristin.
02:23 DB: Cindy, we wanted to bring you on the podcast today to talk about your two most recent columns in Massage and Bodywork magazine, and that's in the May/June and July/August issues of the magazine, and both regard the sacrum. I know you're really passionate about this area, so let's dive right in. Why is the sacrum seen as sacred?
02:42 CW: Yeah. Well, first of all, it's good to look at what sacred means in the first place. So when something is sacred, it's held with great reverence and respect and awe because it's so significant. So that's why the sacrum is considered sacred. It is significant for a lot of different reasons. So it's a coming-together point of really powerful energetic and structural and nervous system function. So when there's imbalance in this area, it can impact the entire rest of the body very significantly. And so knowing that when there's imbalance and it can impact in a negative way, it's good to know that we can actually create positive change by working this area and creating balance. The other thing to know is that it also sits between the first and second chakras, although mostly at the second chakra, which is often referred to appropriately as the sacral chakra. This is where our life-giving reproductive organs are located, and of course, these organs have the amazing ability to create life. And I say, what is more sacred than life itself?
03:54 KC: Why is it important to understand its complexities?
03:58 CW: Well, Kristin, it's like anything, the more you understand it, the more effectively that you can work with it. You wouldn't try to repair a car if you didn't know the parts of a car and how they work both independently and together. You'd probably make things worse and you'd probably have a car that didn't run at all. So it's just really important always to understand things. That way you can be more effective with them. So when you realize how the sacrum inter-relates with the whole body, there's no way you would proceed in a session without addressing it even in a small way. And unfortunately, it is often an untouched area entirely, I think. I've seen this in students in my classrooms in the past that it's an area where they even get uncomfortable touching it just because of where it's located. But skipping it, it's just a really big problem because it is so significant, it's so, so complex, and it has such far-reaching effects to the entire body. So it's really a massively missed opportunity and linking things together no matter what area the body you're treating.
05:07 KC: Cindy, what's your personal connection to the sacrum? Do you have any experience or history, or what makes it such an important area of the body for you personally?
05:17 CW: Ooh, that's a really good question. Well, I several years back was having some... Well, I do have low back pain anyway from an injury that I sustained, and so the exercises, for sure, I will use to kind of keep things moving. But even more so prior to the time that I sustained that energy, I was having a bit of, I don't know, I guess I could say a lull in life where my work had gotten stagnant, I was in full-time private practice and teaching at the time, and so I was just feeling like my creative juices weren't flowing, my work had gotten a little rote. When you're seeing a lot of clients, your practice is really super busy, it can be easy to fall into a rut. And so I just happened to stumble upon this course on breathing techniques for... They were actually, it was called ovarian breathing. [chuckle] So it was all down there in the reproductive, sacral area. And so these breathing techniques, basically I would just breathe in...
06:25 CW: To my reproductive organs and the whole sacral area, and I would see that breath illuminating that whole area and I would hold, just let that energy infuse, and then as I exhaled, I would release anything that was stagnant. And I got to where I was doing those breaths maybe five, 10 rounds every day. And let me just tell you, that suddenly my creativity was just exploding. I don't know... I'm not going to say that I know how it all works, because honestly, I really don't. I just know that it does work. And so, yeah, between the physical of having an injury where I had compression fractures in my lower spine throughout the side joints, I had a bulging disc between L4, L5, and then also just, again, those energetic components of challenges with creativity. Yeah, those were all things that have just really, really worked for those different areas of my body.
07:26 DB: Cindy, can you tell us about the sacrum's energetic significance?
07:30 CW: Yeah, absolutely. And I wanna say that a lot can be said here. [chuckle] You could do a whole weekend workshop, I think, on the sacrum, but I'm gonna do my best here to keep it simple. So first of all, a life force moves through us, that comes from above and moves down along the spine. So it can be called chi, xi, or prana, depending on the origin of the philosophy that you are studying, but all the same, it is a universal life force that enters into our bodies, it does so from above through the crown of the head, and from there, it becomes more and more dense as it turns from an expansive, more etheric state into eventually a really dense, earthy state. The deeper it gets into the body, the denser it is in quality. So as it travels the length of the spine all the way to the base, when you get to the base, which is where the sacrum sits, that energy is in a really dense state.
08:33 CW: From there, it has to shift course and return back up through the spine so that it can cycle back through into more expansive energy. Alright, so, because of the density, if that energy gets stuck in this area, again, because of the complexities of it being a coming together of energetic, structural, and nervous system function, when that gets stuck there, it can create an imbalance that affects everything from organs to obviously muscles... It can create problems in below into the lower body, it can create problems emotionally, mentally, it's just a really significant area. So when that energy gets stuck, we have to make sure that it's moving, so our job is to help get that energy flowing back through. You can think of it this way as well. If your energy gets stuck there in the sacral area and it doesn't have its ability to truly flow back through the return cycle through the upper chakras, then all those other chakras are getting depleted of their energy, so nothing is truly optimally functioning in that situation.
09:43 CW: And you can aliken it to the way that blood moves through the body, as blood moves through arteries and then has to exchange then into the veins so that it can return to the heart. If we don't have movement in our bodies that creates that exchange and pumps that blood back to the heart, then everything in the pathway gets depleted of its life-giving nutrients. So it's the same thing on an energetic level. So I would say the last thing to say about that is just keeping in mind the sacral chakra itself, that it embodies experiences of pleasure and creativity, emotional expression, feelings of being nurtured and safe. And so when we experience insufficient giving and receiving of pleasure, if a client has experienced sexual trauma, if a person has been denied nurturing or freedom of emotional expression, this area can become blocked and it causes problems, again, on all levels, physical, mental, and emotional. One of the ways that we can keep this area in motion is to provide ourselves just tremendous amounts of self-love and self-care. It's one of the greatest ways to keep that energy moving.
10:50 KC: That's a beautiful explanation of the sacrum's energetic significance. How about its structural significance?
10:58 CW: Yeah, so the structural significance of the sacrum basically is that it's the center of gravity in our bodies. It is the place from which we move. So if we have postural anomalies here, then we're not gonna be moving efficiently. So think of it this way, at the sacrum, right in the center of our bodies, okay, it's at the base of the spine. So it has the entire weight of the spine sitting on top of it and it has to balance delicately on a couple of little points, or I should say three spots, basically. [chuckle] So that force, that weight that then transfers down through the spine then transfers through the pelvis to the right and to the left to each hip bone and down the legs, all while gravity is also pulling down on our structure.
11:51 CW: So naturally with all of this pressure and weight, there can be a lot of pressure in this area, and since we're dispersing now in two directions, to the left and to the right through the pelvis into the hip joints, if one side's off, naturally the other side is gonna be off as well. So we really have to work to create as much balance as possible here. Because of the ways that we sit, stand, walk, lift things, really generally move in our lives, it's all too easy to get out of balance. So that's why it's often a common area of strain, disc issues, nerve compression, that then affects the hips, thighs, legs, and feet, but not just below. You have to consider that if the sacrum is off, then it's gonna throw off the vertebrae, and we've got so many nerve roots coming out of our spinal column, that again, this affects organs, this affects our upper limbs, it can affect our neck, and it's just really far-reaching.
12:52 CW: I would say, the last thing I wanna say there, that we have to keep in mind too, that the sacroiliac joints don't fit together perfectly. They're not as straightforward as say, like a ball and socket joint that, "Ooh, this fits in here, really good," it's actually these two irregular surfaces that are not meant to move a lot, definitely a little bit of course, but they're held together with this dense connective tissue, basically a host of ligaments that hold them like packing tape, [chuckle] so even a slight misalignment between the sacrum and ilium bones, can throw everything off, above and below. So, again a lot happening here.
13:29 DB: Let's take a short break to hear a word from our sponsors.
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14:21 DB: Now, let's get back to the podcast. Cindy, as we take our tour through the body here, what is the significance of the sacrum, in relation to the nervous system?
14:32 CW: Well, that again, a lot could be said, but I'm gonna keep this super duper simple. This is the primary point of interest, because it is home to three parasympathetic nerves, whereas the other parasympathetic nerves, arise from the cranial region, okay. So when we work the sacrum, when we rock the sacrum, when we hold the sacrum, we are assisting a parasympathetic, or a relaxation response. Even more significant, is if we are holding, rocking, moving the sacrum, as well as holding the cranial region, the occipital region, we are bringing into balance, we are bringing into relationship, those parasympathetic nerves that arise from the cranium, with the parasympathetic nerves that arise from the sacrum. So, we... Because we live our lives in such a commonly sympathetic state like [15:30] ____, reactive to the world that's around us, it's very important to keep in mind, our ability to call forth that parasympathetic response, and create that balance, on the nervous system level.
15:46 KC: Okay, let's shift a little bit. Talk about clients.
15:49 CW: Alright. [chuckle]
15:51 KC: So, my guess is that, oftentimes, clients have a lack of knowledge, or information, about the sacrum and it's importance. So how do we explore with them, that this is a region worth working on?
16:03 CW: That is a great question, and such an important one. So, I really wanna stress that, first and foremost, you absolutely have to educate yourself, on how it relates with the concern that your client is coming in with. This was a primary way that I became knowledgeable about the body, after graduating from massage school. You have so much that you learn in school, and it's just the tip of the iceberg. So what I would do is, after a client's first session with me, I would do a bunch of research, I'd go home, I'd look at anatomy books, read literature from authors I highly regarded, I'd read something and then close my eyes and envision it, I'd move my body in ways, to help me feel what was happening in the client's body, what the client might be feeling, and having this embodied process, and this knowledge, really equipped me with the ability to explain to my client, with pictures, with animation, I'm a very animated person. [chuckle] My students used to call it my charade acts, but it would help me to truly explain what could be happening, so that they understood how I could help them.
17:14 CW: And the conversation, I would always make sure that the conversation was conveyed with genuine care and concern, a true desire to be helpful, and that it would be backed up with information, on why I'm choosing this specific therapeutic approach. So, suddenly, instead of them thinking, "Oh no, she's getting close to touching my butt," [chuckle] they're thinking instead, that I really care about helping them, to feel better. I would say something like, "Hey, let's give it a shot, see if it helps. And if you feel uncomfortable any time, you just say the word, and we are moving on." So putting the clients in charge, equipping them with the information and conveying a specific, genuine intent of care and concern, it really just shifts the energy and creates a sense of safety, in working this area.
18:04 DB: So I think you're saying, over-communicate.
18:07 CW: Yes, there's no such thing as over-communication. [laughter]
18:12 DB: So you mentioned it, at the beginning of the podcast, but let's circle back around. When you're working with a student, or with somebody who's a new practitioner, who could be very intimidated with working with this area. How do you approach teaching that, or working with a new practitioner? And this is such a vulnerable region. And that could be anything, from communication skills, to draping techniques. Can you walk us through that, a little bit?
18:39 CW: I can, absolutely. So first of all, I wanna say that you can't really get good at anything you're uncomfortable with, unless you practice. So like practice, practice, practice. It's not a teaching something in theory, it's teaching something in real life ways, so, as much as my students would like roll their eyes at me or like, "Oh, do we really have to do this?" I think in the end, they were always grateful that I forced them through the discomfort of having to go through these practices of touching a specific area that they might be uncomfortable with, using the words... I don't just tell them what to say. I then say, "Now, say it yourself. Now, say it again. Now, practice it again and again and again." So whether you got that opportunity in school or not, it's never too late. You practice with a colleague, you find a previous instructor that will allow some tutoring still post-graduation or maybe a family member or a client that you feel super comfortable with. You just say, "Listen, this is something I feel awkward with and I need to practice." And you let the words come out of your mouth, you stumble over them. You practice draping and you do it wrong and you do it wrong again until you get it right.
20:00 CW: So I'm just a fan of don't be afraid of getting something wrong, especially, with someone you feel safe with. Get it wrong until you get it right, just don't stop because of the discomfort. It's more important that you learn the skill. I mean, nobody learns a skill without messing it up several times before they get it right. So I think it's important that you really learn the anatomy and you envision what it is that's under your hands because that also takes it from something fearful to something purposeful like when you're going towards the sacrum, which is right by the glutes, you're thinking more of the muscles and the bones and the ligaments that creates this more therapeutic purpose and you'll have again, purpose rather than fear in your touch.
20:44 KC: Okay, so our therapist is ready. They've practiced. They're ready to start doing the work in a session, what about the client? What should a therapist be aware of and pick up from a client, whether that's just in even in the conversation before the session, we're doing a little pre-session planning or during the actual hands-on work itself?
21:02 CW: Absolutely, good question. Well, when you're discussing it prior to the session, you'll probably notice if there's apprehension. You'll see maybe a furrowing of the brow, a look of skepticism, pretty straightforward facial expressions of doubt and concern, like "You wanna do what?" But I think that it's good. Again, if you're equipped with picture, that helps them to understand what you're asking them. You know if they're really uncomfortable, they might sweat or their hands might be shaky. They might avoid eye contact. And of course, if you explain therapeutically and with visuals what's happening or what you wanna work and why and they're still totally uncomfortable, then don't do it or start completely over the drape. That's another thing, too. So as Darren said, over-communicate, a big fan of just equipping clients with an understanding of why I'm doing what I'm doing in more than words, but in visual. During the session, you'll see things like a clenching of the glutes, the stiffening of the legs or maybe clients keeping their legs really tight together, it's also common.
22:12 CW: Ooh, another one is fists. Hands might be clenched into fists. That's something I think a lot of therapists miss out on, especially if the hands are under the drape. It's good to keep an eye out for the hands. I think clients sometimes don't even know that they're clenching their own fists. In the end, any type of muscle tension is a clear clue of discomfort. And then I often will say to students, "Think of what your body would do if you were feeling uncomfortable like think of something really uncomfortable right now and feel what's happening in your body." The more we can put ourselves in the shoes of our clients and embody those experiences, then the more we'll be able to see them and our clients visually. I also really enjoy rocking the sacrum before I would even undrape a client. It gets them a little comfortable with the touch that I'm going to be applying, but while completely covered. And as I mentioned before, just even sacral rocking, in general, is so relaxing so that can help kind of take the edge off of things and release a little bit of that guarding from the pelvis right out of the gate.
23:20 DB: There's definitely a difference between the ability... And this may be an instance where a practitioner is working with a client that they have a relationship with, that they've worked numerous sessions before where you can over-communicate or you could do that at the beginning of the session. I specifically had an instance during a session where I didn't know a practitioner was going to approach the sacrum and then did, but asked me in that woozy massage state. And now, there's this crazy power differential and I'm like, "What do you wanna do?" And then kind of I almost felt like at that moment relented into that work and then was uncomfortable and then felt even more uncomfortable than saying something. It was like too far gone in the session. So it's one of those... I would just... There's no question here other than the safety of practitioners, there's certainly the pre-informational session before the session and then there's the during the session, especially if it was a new client perhaps, who may be like, "You're gonna do what?"
24:26 CW: Absolutely, and that's just generally should be, should be a part of every single session that you have with any client because everybody's gonna come in with something new each time or something a little bit different. You always negotiate what the session is going to look like. "Okay, here's what I hear you saying you need today and so here's the way in which I'm going to address it." And yeah, it is. It is an absolute... People should know right out of the gate before they ever get on the table what your game plan is for that day every single time. I do think a lot of practitioners get comfortable with clients and then they stop doing that, but if you're really gonna have your work have a purpose and a good therapeutic outcome, you never make assumptions, and on either side. So yeah, I love that you said that, Darren, 'cause it's so important.
25:23 KC: And I think what can happen, too, especially with therapists, who've been practicing for a while with the same group of clients, they just get very comfortable, with everyone being in the know about the type of work you do and the areas of the body you work, and then when a new client comes into the mix, you're almost out of training. You forget to have those conversations again, like you were so good at doing in the beginning, when you were getting a lot of new clients all at once. So I think it's just keeping that presence of mind and reminding ourselves, "This is a whole new experience for this person, we are taking a step back and coming in again fresh."
25:58 CW: I absolutely agree with you, Kristin, that is a really good point.
26:02 DB: Cindy, what do MTs miss, by not working this region?
26:05 CW: Well, in my opinion, everything. It's just such a pivotal place in the body, as I've mentioned, if the pelvis is off, everything is off. It would be, in my opinion, like addressing symptoms of carpal tunnel syndrome, by massaging the hand and wrist, skipping the forearm and elbow, and then massaging the biceps, and then skipping the shoulder joint. There is a crazy feeling of disconnection, and it misses acknowledging and working the body as a whole, continuous, interconnected being. So yeah, I'm just gonna say, everything.
26:40 KC: And that's a perfect answer. [laughter] Says it all. So okay, what about working in this region? What are some effective techniques that therapists can apply when they're working with the sacrum?
26:54 CW: Good, yeah, so as I mentioned before, probably my number one favorite is sacral rocking. It's so sweet and relaxing, and you would do that with your clients, prone. I generally will start the session with that, but you can also do it in the midst of the session, and basically, you just take your lower hand, you're facing the table, you place it over the sacrum and you just a very slight back and forth, and then, slowly make it a little bit larger, waving back and forth, and then my upper hand, I generally will put on the upper back or at the cranial region, and I just do some nice rocking. And then directly addressing the tissue would involve lengthening strokes over the sacrum, from superior to inferior, and you could be standing at the top of the table. I love to do a myofascial stretch of the entire spine, before I even applied lubricant to my hands.
27:46 CW: I'll start up around C5, C7, apply enough pressure to engage that superficial fascia, and then slowly glide down the spine toward the sacrum. Now, what happens is that many practitioners will stop at like L4, but if you just keep going over the sacrum and then hold at the bottom, ask your client to take a nice deep breath or two, and gosh, people love this, you're like putty in their hands. Now, of course, when you get down on the sacrum, you'll wanna take your hands kind of over the drape, so that you're not taking your fingertips under the drape, and then of course, your hands are in an uncomfortable spot, there is a little bit of a finesse to that technique, once you get to the sacrum, but as long as the heel of your hands is pushing down and lengthening that sacrum, that's really wonderful. And then, of course, know which muscles connect to the sacrum, and what direction the fibers run.
28:42 CW: You can then apply any number of friction techniques at the attachment sites, along the belly of those muscles, cross fiber with fiber, you can do gliding strokes from end to end of the muscle, piriformis is a really significant muscle, when it comes to that transfer of energy and the connection from the sacrum to the hips, and here, really, is where is you can watch endless videos, and read articles upon articles from some of the absolute top experts in our field, and learn just I mean there's so much education available, that there are specific articles and specific webinars that address the sacrum, that address the hips. Don't try to reinvent the wheel, learn from people who really have long-term practices and have effective techniques. But the basics that you learn in school, foundational stuff, but you gotta know where the muscles are, and where the tendons are, and where the ligaments are, so when you follow, follow the map, so to speak.
29:45 DB: Cindy, there any self-care exercises that we could send clients with home after the session?
29:51 CW: Yeah, absolutely, and I am a fan of simpler, the better. They probably have a desire to do exercises, but not always the best follow-through, so when you give them something that's really relaxing and very simple, they're more likely to actually perform it. So I have become a big fan of the Egoscue Method. I'm not sure if you have heard of that. These are exercises that are very subtle but very powerful, and one, specifically, is called the static back or the knee pillow squeezes, in static back position. They really leverage the power of gravity, while the body, the sacrum, hips and low back are relaxed, right on their back, with their legs in a 90-degree position, and their lower legs from the knee down, on, say, an ottoman or a chair. And they would simply lie like that for about 5 to 10 minutes and it would benefit the sacrum, and help align the SI joints.
30:43 CW: I mean that's all there really is to it. Now, if you wanna add an element to that, you could have them put a pillow between their knees and have them slightly squeeze the pillow and then release, slightly squeeze and release, and this really opens up those SI joints, repeating that about 20 times or so, or if they start to feel any kind of fatigue, then they would stop. And then, alternately and oppositional to that, you could have them wrap a belt, or a yoga strap around their thighs, just superior to the knees, and then they would actually squeeze laterally, so, away from midline, and that is a counter to the medial squeeze of the knees. And so both of these really help to align the sacrum. And then the last one, that I really like, I actually learned in training, in polarity therapy and are called scissors kicks.
31:32 CW: And you just have the client lie on their stomach with their knees bent, again, in a 90-degree angle. And then they simply swing their heels and feet out and in and out and in, in like a kicking motion, lateral, medial, lateral, medial. And each time they swing medial, they just cross their ankles, one in front of the other, back and forth, okay? And so yeah, this just has movement from the hip joints that translates into the SI joints in the low back, should never be forceful at all, it's just a very gentle scissoring, lateral and medial, so easy-peasy. And I'll say it supercharges the energy at the base of the spine as well. So that dense stuff that we talked about before that can get stuck in the sacrum energetically, hoo! That just gives that nice little kick of movement to move that all the way back up through and into its expansive place.
32:24 KC: Perfect, and I'm gonna jump in with a Cindy Williams self-care recommendation testimonial right now because I currently for the last maybe three or four days, have been experiencing a really unhappy right SI joint, causing a lot of trouble. And from your July/August Massage and Bodywork magazine column, I did three of those exercises yesterday and again this morning. So I did the pillow squeeze, I did the scissoring... Scissor kicks... Scissoring...
32:53 CW: Scissors kicks, yeah.
32:54 KC: I did something with scissors. I also did the yoga strap, and let me tell you, significant improvement. This is just funny the way that this timing happened for the podcast. This is true talk. I needed those very desperately this week and they were truly helpful. So I can absolutely attest that this will be beneficial for therapists but the clients, too. So, thank you for sharing those in your column. It made a difference for me.
33:23 CW: Hooray. I am so, so happy to hear that, Kristin. Good stuff. Well, I didn't invent them, I'm just the messenger, so... And I think that's really important that as practitioners, the more we can just carry forth what we learn to each other and keep educating each other and keep really wanting the best for each other, that is just this positive ripple effect out into the world. And hey, let's stick with what we have control over and that's a goodness we do. So, yay.
33:55 DB: I wanna thank our guest, Cindy Williams, for joining us today. Cindy, where can listeners contact you if they have further questions?
34:21 DB: Thank you so much, Cindy.
34:23 KC: Thank you Cindy.
34:24 CW: Thank you for having me.
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