Understanding the motor points of the neuromuscular system and their corollary—tonic acupressure points—increases efficiency in helping clients relax and deepen into a sense of calmness and well-being. In this episode of The ABMP Podcast, Kristin and Darren speak with Mary Kathleen Rose about the difference between motor points and tonic points, how deep a motor point is, what a point should feel like for both the practitioner and client, and why proper communication to the client during a session is important.
Contact Mary: firstname.lastname@example.org
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Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.
Therapists who are drawn to Precision Neuromuscular Therapy are problem-solvers who want to learn new approaches, but also understand the “why” behind the “what”. This desire resonates with our emphasis on the problem-solving process, rather than the teaching of a singular technique or approach. Led by founder Douglas Nelson, each PNMT instructor is a busy clinician with decades of practical experience.
We have taught hundreds of hands-on live seminars for more than twenty years, emphasizing precise palpation and assessment skills. PNMT online courses are another rich source of discovery and deeper understanding. Also available is a video resource library (PNMT Portal) with hundreds of videos of treatment, assessment, pathology, and practice pearls.
Learn more at www.pnmt.org
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0:01:02.6 Darren Buford: I'm Darren Buford.
0:01:07.2 KC: And I'm Kristin Coverly.
0:01:08.9 DB: And welcome to The ABMP Podcast, the podcast where we speak with a massage and bodywork profession. Our guest today is Mary Kathleen Rose. Mary has been actively involved in the holistic health field since the 1970s, a pioneer in the field of touch therapies for the elderly and the ill. She is an added advocate for the needs of special populations. She is the developer of comfort touch and is internationally known for her work in bringing safe, appropriate and effective touch to hospice, hospital in home care settings. Mary is the author of, "Comfort Touch: Nurturing Acupressure for the Elderly, the Ill, and anyone in Need of a Caring Touch; Comfort Touch of the Hands & Feet, A Guide for Family Caregivers," and producer of the video DVD, "Comfort Touch Massage for the Elderly and the Ill and Bereavement, Dealing with Grief and Loss." For more information, visit comforttouch.com. Mary is also a long-time contributor to massage and bodywork magazine, and we're here today to talk about our most recent feature article, Get to the point, understanding muscle motor points and their relationship to tonic acupressure points. Hello, Mary and Hello Kristin.
0:02:13.7 Mary Kathleen Rose: Hello, I'm so happy to be here.
0:02:14.0 KC: Mary, we're thrilled to have you here and podcast listeners, Mary is local to Colorado, near the ABMP offices, so we are all physically sitting together in the podcast recording room, which doesn't get to happen very often, so this is really special. Not only for us to be together, but for us to have you on the podcast, we're thrilled that you're here. Mary, we're really excited to talk to you about our topic today, the muscle motor points and their relationship to tonic acupressure points, but since this is your first time on the podcast. Let's start at the beginning, tell us a little bit about what first interested you in bodywork, what made you interested in becoming a practitioner?
0:02:52.0 MR: Well, it was way back in the last century. [laughter] I was interested in the growing holistic health movement in the '70s as a back-to-the-land person in Montana and raising goats and chickens and a kid, and just exploring all the things about health and wellness. And then I left Montana, came to Colorado and someone suggested that I go to massage school. And I said, "No, no, no, no. That's not for me." And then I took a little walk, I went, "That's exactly what I need to do." And so I started, I went to school 1984, in Boulder.
0:03:33.8 KC: I love it. Yes, we both went to the same school.
0:03:36.4 MR: Yes.
0:03:37.0 KC: Called Boulder School of Massage Therapy, when you went. Boulder College and massage Therapy when I went.
0:03:40.1 MR: Yeah.
0:03:40.6 KC: And one of the things that makes that such a unique program is you blend learning some of a more western-based modalities, hands-on massage therapy modalities, but also you learn some eastern bodywork modalities, including Shiatsu. So tell us how that opened your mind? What was that like for you?
0:03:58.2 MR: Well, I was so happy when I got in the Shiatsu class and realized that this was a whole new world for me and one that really spoke to me. So in... And in my class there were this kind of the understanding this was something that we took to kinda broaden our perspective, but it really took hold for me, and I took every continuing education class I could, after that I studied privately with the three different teachers I had, and realized that this was something I knew I wanted to do for a very long time. And interestingly, at the time, my sister had an exchange student from Japan living with her, so I would of course, practicing on my sister all the time, and this young woman saw me and said, doing bare foot Shiatsu, 'cause that was the form we used, it was a mat on the floor is using the feet, and Maurice said, "Oh, my grandmother taught that to me."
0:05:02.8 MR: And so it was really a traditional form of Shiatsu that was practiced in the home, taught from parent or grandparent to child, and it just felt to me like there's something about being in the home. I've always had a thing about, and this was a little bit counter to what was going on at the time of, "Let's be professional, let's go have an office, let's work here and there." I've always been a homebody unapologetically, and so massage this practice in the home just made sense to me, and much of my practice has been my own office, in my home and also working in other people's homes. So that really developed this whole idea of working in hospitals hospices, so yeah, but I owe so much credit to what was then BSMT and their barefoot Shiatsu programme.
0:05:57.1 DB: I love the coincidences, not coincidences that life brings to all of us, and I'd... It's just amazing that you happen to have that exchange student there. [laughter]
0:06:05.4 MR: Yeah.
0:06:07.2 DB: That you even further probably cemented in your brain like, "I do wanna do this." Let me ask you though, when you were in school and you're learning western and eastern techniques, do you see the differences or the bond between? Are you starting to see similarities or are you starting to think about how your own practice would develop out of learning those?
0:06:26.5 MR: Well, what I did in the first year of my practice, because of course, I was trained in Swedish and integrative massage, which was a very specific style and approach to massage from the school that I went to. And so the first year out of school, I did about half and half, I did. I worked with people on a table, Swedish massage, lotions, oils, and then I also continued with barefoot Shiatsu, as one of the very few people in my class who did, very few people continued with it, and I noticed, what I noticed over time was that I always felt better, after I did barefoot Shiatsu because it requires a sense of balance, much like yoga. It's a full body practice, and it requires a certain focus that just always made me feel better.
0:07:17.9 MR: And I also noticed that it seemed that my clients that I worked with had longer lasting results from it, because it's very calming, but it's also energizing. In the massage school, conventional massage was taught here, and anatomy physiology was taught here, one part of the course, and then over here was Asian bodywork, and the two did not mix in my education, However, when I started working with hospice, and that led also to working in other medical settings and my continued interest in study of anatomy, I thought, "Wait a minute, people are talking about muscles over here, they're talking about meridians over here, and how do the two match?"
0:08:06.7 MR: And I really did not see them connecting in what I saw of most massage education. So that was my piece and that was what led to this article. So this article has been in development for many years, I started noticing that these tonic acupressure points, which are once very commonly, if you've ever had an acupuncture treatment, you've probably had several of these points addressed, and so what I noticed was, "Mmm, they seem to be anatomically related to something specific in the study of anatomy, and that is motor points." And so over the years, I've taught comfort touch all over the country, and I would ask students, "How much time and attention did you have learning about muscles in massage school?" Give me an answer, Kristin.
0:08:58.4 KC: 75%. [laughter]
0:09:00.1 MR: Okay, and...
0:09:01.7 KC: For the program.
0:09:05.9 MR: How much, [laughter] did you learn about motor points in that training?
0:09:07.3 KC: 0% Mary. [laughter] 0.0 yeah. [laughter]
0:09:07.8 MR: And you are right there with 99% of massage therapists in the country. Is that curious? We've learned as a massage therapist in the massage therapy profession, we've learned a lot about the things that physical therapists have impressed upon us about the importance of assessment and treatment, and yet the one piece in physical therapy that we have not adopted is the understanding of motor points. And so if you've ever had treatment in by a physical therapist, you may have had a treatment with a TENS unit, and so that was another part of my experience was treatment for various things, and I'm going, "Hmmm, they're putting this electrical current, right?"
0:09:53.4 MR: Oh, and right there. And so I studied motor points, I loved, I searched through the massage literature for something about motor... Non-existent. Physical therapists seem to be a little protective of the information, I could not get their motor point charts, try as I might. So I started at just looking at what is a motor point, really simple, this is no big deal. A motor point is simply where the nerve activates the muscle. So logically, that is in the largest part of the muscle. So, and then I started noticing how some of these tonic acupressure points that I learned in Shiatsu related to the motor points. And the beauty of this was that this was the key. This was the link between the Eastern or Asian's aspect of anatomy and the Western. This was the missing link. And so that was the genesis of this article. [chuckle]
0:10:56.3 DB: I'm gonna jump in and ask one question before we go further, Mary, will you tell us when you're using the phrase tonic acupressure points, what specifically does that mean? How are they different from what we might think of as a "Regular old acupressure points."
0:11:11.5 MR: So, in the body, they're on the meridian system, which has 12 pathways of energy would be the way in Asian bodywork they would speak of it. Along these pathways, which run throughout the body, there are about 600 points, but there's some that really stand out and they're in each of the different meridians, there are certain points that are used more commonly because they give greatest effect, and so it's kind of like, there are many, many muscles in the body, but we don't work on everyone, we, there's some, we could say major muscles that we tend to work on more. So it's a similar thing. So these tonic acupressure points that I came across this understanding somewhere back in my continuing education in studying Shiatsu and Asian bodywork, I came across this term, tonic acupressure points. And so tonic is a word that means something that is just good for the body.
0:12:12.1 MR: And one of the reasons I focused on them was, first of all, it just made for a more effective treatment overall, when I started working in medical settings, this became really important because when I first started talking to nurses and CNA's who wanted to learn comfort touch, one of the things they said, "We love massage. We think it's great. We just don't have time to do it." And I said, "Well, how much time you have?" "Five minutes." "Okay, well, what can we do in five minutes." And so my understanding of the tonic acupressure points coupled with the principles of comfort touch that I was beginning to develop, made it very efficient. Okay, you got five minutes. If someone's sitting in a wheelchair, put your hands on their shoulders right over that belly of the trapezius muscle, and that is accessing that motor point, whether your hands are just resting their softly or whether you're putting pressure specifically over the motor point. This is gonna help someone relax like that.
0:13:14.2 MR: So I notice the efficiency of this work, and I think this was a big realization for me, because in the massage profession, we are spoiled by time. We have a client on the table through a whole hour and a music playing and they can drift in and out of nirvana or whatever, while we work on them and in a medical setting, we do not have that luxury. And so we need to be specific, and I have also trained not only massage therapists, but a lot of people that work in medical settings, how can you incorporate this understanding into your practice of nursing? Just a well-placed touch can make a difference.
0:14:00.4 KC: Let's take a short break to hear a word from our sponsors. Anatomy Trains is excited to invite you to our latest in-person fascial dissection workshop, April 10 through 14, 2023 in Boulder, Colorado. Join Anatomy Trains author, Tom Myers and master dissector, Todd Garcia, on this voyage of discovery, visit anatomytrains.com for more information.
0:14:29.9 KC: Are you a massage therapist who loves to problem-solve? Do you see clients with challenging musculoskeletal issues? If so, then studying precision neuromuscular therapy will help to sharpen your decision-making skills and achieve better client outcomes. Our emphasis is on the problem-solving process rather than the teaching of a singular technique or approach. Led by founder, Douglas Nelson, each PNMT instructor is a busy clinician with decades of practical experience. Visit pnmt.org to explore our offerings of live seminars, online courses, or the video resource library, the PNMT portal. That's pnmt.org.
0:15:18.7 KC: Let's get back to our conversation, So Mary, you talked about the fact that the majority of motor points are in the belly of the muscle, the biggest part of the muscle. How do we find them? Is there something we can palpate? Do we just need to learn the locations? Tell us a little bit more about how we start the process of becoming familiar with them.
0:15:37.8 MR: I think that the study of anatomy is really helpful, it's understanding that muscle structure, where is the belly of the muscle, and they're really pretty easy to find, reach the top of your shoulder, and hey, it's right there. Reach to the belly of the brachioradialis muscle, right there, and there's a tonic acupressure point right there, the web of thumb and index finger, there's a belly of a muscle right there. So, and another one, I'll just say this one because it balances out. The belly of the tibialis anterior, which is another one of the tonic acupressure points. So understanding anatomy is very helpful now, in the traditional way of learning Asian bodywork, they don't talk about muscle anatomy, they talk about... They have other ways of defining where they are in mapping them out. However, I think we can improve the quality of even what we know in Asian bodywork by understanding anatomy 'cause they really work well together. It is another question I like to ask message therapist, "In your study of anatomy, how much time did you spend learning the origins, insertions, basically the attachments and muscles, how much time?
0:17:00.2 KC: Quite a bit.
0:17:00.8 MR: Quite a bit. How much... [laughter] And you had to memorize them, right?
0:17:06.4 KC: Sure did. [laughter]
0:17:06.5 MR: And how much time did you spend learning where the belly of the muscle is?
0:17:12.3 KC: Oh, that's interesting. What an interesting question. I don't think we technically learned it, we just palpated, felt it. Knew it. Yeah.
0:17:20.3 MR: Yeah. So, I'm not... In my work, I don't really care about origins and attachments, I care about where is the thickest part of the muscle, because that's really where people hold tension, because that is where the nerve activates the muscle. This is where you either calm the muscle or energize it. And this comes to my analogy that I use in the article is, if you're in a room and you need to turn off the lights, you can just go run unscrewing all light bulbs, or you can just flip the switch.
0:17:54.9 MR: And so a motor point is that switch and that makes it really efficient. You just go right for the point, and you know that. I think we've all had that experience as body workers, when you hit that point and people say, "Oh, how did you know? That was Where I hold on my tension." And you don't have to tell them this, but this is the secret, is that 95% of people will [laughter] put attention there, so these motor points are, if you know them, and really the best way to learn them is simply practice. In Comfort Touch, my approach always begins with broad pressure, broad pressure, too specific. And the broad pressure is really the most important for most people, because that's just calming, and then you can get more specific, so always start with a broad and then work with people's feedback, and especially because I work so much with elderly, the ill, hospice patients. It may just all be broad.
0:19:00.4 KC: And in this instance, when you're talking about broad and specific, you're thinking broad palm of the hand resting and then specific is actually palpating the point, putting a little pressure on the point itself. Yeah.
0:19:10.4 MR: And the key thing from a technical standpoint is that more specific pressure, even the broad pressure, it's the direction of the pressure perpendicular to the skin into the point that makes a difference. Not sliding one way... This is why we don't need to use oil. In fact, it's not a good idea, because we wanna be perpendicular to the skin as we go into the point. That just makes it much more efficient contact. Just think of what a acupuncture needle does. It goes straight into the point. So our touch, even though we're not going through all those tissue layers physically, but our intention is doing that, and that intention, knowing where that point is, 'cause it might be a quarter inch below the skin, it might be two inches below the skin. So visualizing it, visualizing the anatomy is very, very helpful.
0:20:08.2 KC: Do you like to use a specific finger thumb? What do you personally use when you're working with a client?
0:20:12.1 MR: Rarely do I ever use my thumbs. Rarely. Usually I use two fingers together. Usually my index, my middle finger, held over the point, and then just allow the pressure to sink in. And this is... In Comfort Touch, is a principal called into center. So going through all the layers of tissue. And one of the things we have to keep in mind anatomically is that while we learn all this that we do about muscles, between the muscle and the skin, we've got deep fascia, superficial fascia, layers of skin, there's a lot of layers between the surface and the muscle. Those are important players. There's so much going on right there in all that fascia. And so we're warming that on our way to the muscle. And the muscle is the end point. But we can't discount all that's between, because that's... It's rich with nerves and blood vessels and a lot of hormonal production, the immune system is there. So just the warming of the superficial fascia has great benefit too. So, therefore, that broad... The value of the broad contact.
0:21:30.8 DB: Mary, let me ask you, and this is just from a client perspective, what would you feel as the practitioner when you're on that point, and what might the client feel?
0:21:41.5 MR: Okay. What I feel is the belly of the muscle and kinda the shape and contours of it. And so I can feel that this is the thickest part of the muscle, so I'm palpating that. The client will feel, "Oh my gosh." They will feel... And so they'll feel like, "Oh, that's the point." And I feel the relaxation, I feel their breath change. That's what I'm noticing. Not so much that I notice a change in the point, but I notice their response to it. And because everybody's body tissue is different, we have to let go of our judgments about, "Oh, that's really tight." I never say that to a client, because it doesn't make any sense. Everyone, the density of people's body tissues is totally variable, and it really doesn't have anything to do with how they feel. So making... Me making a judgment about what that is that I'm feeling, it is really not that important.
0:22:47.5 MR: What I'm interested in feeling is their response to my touch and their breathing. If people are holding their breath because you're hurting them or something, [laughter] that's very different than when they go...
0:23:03.9 MR: Relief.
0:23:05.2 DB: So aside from the body... Watching the body's reaction, are you also communicating during...
0:23:08.0 MR: Absolutely. Absolutely.
0:23:08.5 DB: Okay. Can you tell us a little bit about that?
0:23:10.8 MR: Absolutely. So one thing that I always say to people is that this should feel good, should feel comfortable. If anything is uncomfortable, let me know. That's a key thing that I say. And then as I touch them, I notice their non... The non-verbal cues, the breath, sometimes in their facial expression, if I'm looking at them. Let's say that I'm working with them seated. I notice their kind of general body demeanors. If you touch someone and it's hurting, they'll just tense up. And so I can notice the non-verbal things, but also, just simply ask, "How does that feel?" And to get really accurate feedback. People will say... Some people just don't wanna say anything that's at all critical, so they'll be afraid to give you feedback. So one of the ways around that is to say... Give them a choice, say, "What feels better? This or this?" So this amount of pressure or this amount of pressure? And people will give you... Immediately give you appropriate feedback.
0:24:20.4 KC: Mary, in the article, you specifically talk about 10 of the points, which you give great information on each. And listeners, if you haven't read the article, I would encourage you to go look at the images, read the descriptions. For a practitioner who is getting excited about this now listening and wants to try a point in their next session, which of the points, what one point would you recommend they start with in their next session, if you had to pick one?
0:24:45.6 MR: The belly of the trapezius. That is the number one point. And it actually acts on the whole body. If you have one minute to help someone relax, that's the point. And learning that point, and I give detailed information on how to do that, and I also have some videos on my YouTube channel, but the illustrations in this article will show you where it is. And moving your body to access it, the easiest way to work on it is with the client seated. And my favorite session that I like to receive, one of the practitioners that works with me, we begin seated. So she starts right with that muscle. And that's a third of the session is in the seated position with that arms, hands. You can access the back on a seated position. And then I'll lie down on the table for the rest of the session. But I really think the seated position is so underused, and for accessing that point, it is absolutely the best way to access it.
0:25:54.0 KC: I'm curious, this is a question I didn't ask when we were talking about how to actually work with the points, how long do you hold pressure specifically on a point? Or actually, let me rephrase that. How long do you typically spend in each phase of working with it, so the broad pressure, and then the specific point?
0:26:09.3 MR: One of the things I do is I work with the breath. So if I'm putting pressure on a point, I might inhale and exhale as I go into the point, take another inhalation, exhalation as I go a little deeper into the point, and then come back out. That may be all. If the client asks for more, I'll go for more. But really, it doesn't need to be more, usually than just a couple breaths worth of inhaling, going deeper into it. And again, I don't ask my client to breathe. I find that they will often breathe with me. If I take that breath, they'll do that. But the breath is a really good gauge, because it's an easy way to think of contacting as you inhale, and then as you exhale, just sinking deeper into it.
0:27:04.2 KC: Okay, Mary. We've been talking a lot about the benefit to the client, and of course, that's always our highest goal, but let's bring it on back to our own happiness and self-care. Obviously, these points are really powerful for us to use on ourselves as self-care, right? Tell us a little bit more about that.
0:27:21.7 MR: Yes. They're just instinctive to do on ourselves, especially, everybody, I think the most familiar point is the one in the web of the thumb and index finger. And that is one that we can always use, it... Do on ourselves. Same with the one in the belly of the brachioradialis. And so, large intestine, four and 10. The shoulder one we can get on ourselves. Other ones that I mention in the article that are not motor points, but they're at the juncture, the ones on the back of the top of the neck. They're at the juncture of... And this is... These set of four points actually are at attachments of muscles that come up, the tendinous sheath that comes over the top of the head, and then there are nuchal ligaments that are horizontal.
0:28:16.6 MR: So those points at the base of the skull you can easily do on yourself. And these are just... Everybody who sits at a computer could learn from these. And these are the points that help with... Help alleviate eye strain and headache tension, and just taking a moment to do those. Another one that is just a great one to know for, if you're a traveler is the pericardium 6, the one that's just above the wrist. And that is the kinda classic anti-nausea point. And I have taught that one to many people, on fellow passengers, on planes, people in the hospital that are nauseous after surgery, it's just... Yeah. That's just a classic self-care. So all of these points can be used as self-care.
0:29:13.3 DB: Listeners, I want to encourage you to absolutely check out the article in the November, December 2022 issue of Massage and Bodywork Magazine. You can find that at massageandbodyworkdigital.com. I wanna thank our guest today, Mary Kathleen Rose. To find out more information about Mary and the good work she's doing, visit comforttouch.com. Thank you, Kristin, and thank you, Mary.
0:29:36.3 MR: And thank you for having me. This has been fun.
0:29:39.1 KC: Oh, Mary, it's been so wonderful to spend this time with you. Thank you for being with us. And thank you for this really interesting information and educating all of us about motor points, something, like you said, we don't typically learn in our massage therapy education. So, really fantastic information.
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