
Active engagement techniques incorporate active client movement with specific massage treatment applications and can be applied to virtually any region of the body. In this episode of The ABMP Podcast, Whitney Lowe explores some of the key physiological benefits of active engagement and why they have become a powerful tool in manual therapy.

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.
Website: anatomytrains.com
Email: info@anatomytrains.com
Facebook: facebook.com/AnatomyTrains
Instagram: www.instagram.com/anatomytrainsofficial
YouTube: https://www.youtube.com/channel/UC2g6TOEFrX4b-CigknssKHA
0:00:00.2 Whitney Lowe: Hello everyone and welcome to the ABMP Podcast. I am Whitney Lowe, Director of the Academy of Clinical Massage, where we specialize in innovative educational solutions for massage therapists who focus on treating pain and injury conditions. Today, we're diving head on into an exciting and highly effective approach in manual therapy called active engagement techniques. These techniques combine client movement with targeted massage applications, resulting in some remarkable benefits for both the client and the therapist. Whether you've heard of these techniques before or you're just getting started to explore them, this episode will give you the tools and understanding to begin integrating them into your practice. Let's start by defining what we mean by active engagement techniques, or we'll call them AE techniques for short.
0:00:51.4 WL: At their core, these methods integrate active client movement with with precise manual therapy techniques that are applied at the same time. Here's an example. Imagine your client is experiencing tightness and pain in their hamstring muscles. Instead of simply applying pressure to the muscle while it's at rest, you might have the client actively flex and extend their knee while you provide targeted pressure and specific techniques along the muscle. This combination of movement and massage not only helps to improve tissue pliability, but but also encourages neuromuscular re-education and some fascinating and beneficial effects in the nervous system as well.
0:01:29.3 WL: It's important to note that a techniques aren't entirely new. They share similarities with other established approaches in the manual therapy world, and you may have heard similar names such as active release techniques, proprioceptive neuromuscular Facilitation or PNF, or Muscle energy Technique, or MET, among others. There's a lot of similarity in different methods or similarities in these different methods to what we do with active engagement techniques. But the core part of this is just getting a good understanding of what happens during client movement and how we can apply massage techniques while we're engaging in that movement. What sets AE techniques apart is their versatility and accessibility. These techniques can be adapted to a wide range of client conditions and therapist skill levels as well. So why are they so effective? The answer lies in the combination of active movement and the therapist applied pressure, which engages the body in a way that passive techniques simply can't. It's a collaborative approach where the client plays an active role in their own therapeutic process. So in a lot of instances, these techniques may not be the most ideal thing. For example, if you have a client who just wants to come in and relax and not have any other things going on, this may not be the best approach for them.
0:02:48.8 WL: But these methods are highly effective and very beneficial. If Somebody has a specific thing that they're looking to come address, especially if it's a pain and injury complaint that they're trying to get resolution for. Now, let's explore some of the key physiological benefits of these AE techniques and why they've become such a valuable tool in manual therapy. First is the enhanced proprioceptive and neuromuscular re education process. Proprioception is our body's ability to sense its position and space. When you combine massage with client movement, you activate the nervous system in a way that improves proprioception. This can be particularly helpful for clients recovering from injuries or those with chronic pain, as it helps restore normal neuromuscular patterns. These methods are also really helpful for improving tissue pliability and they may aid in reduction of adhesions. Soft tissue adhesions can limit movement and cause discomfort. The dynamic nature of active engagement techniques may help break down these adhesions more effectively than static pressure alone. We say may help because at this point it's just theoretical as to why we seem to get the results that we do, since there's very little research that has been performed with these techniques to actually demonstrate that this is occurring.
0:04:06.6 WL: The combination of movement and manual pressure may also help the treatment as it reaches deeper into these layers of tissue, which might have binding and restriction that prevents them from sliding and gliding in relation to each other. Active engagement techniques allow for reduced effort on the part of the therapist, and this is a big one that's a benefit for so many practitioners. A big plus for this is that active engagement techniques often require less physical effort to perform. The client's active participation means that you can apply less force while still achieving greater results. For example, if a client moves their arm while you focus on the rotator cuff muscles, their motion helps stretch and engage those muscles, reducing the strain on you. One of the reasons this works is that a muscle that is actively contracted has an increased degree of density, so that pressure that you are applying penetrates more effectively and you don't need to use as much pressure to reach deeper levels of that muscle. We do tend to see great benefits and increased range of motion and flexibility with active engagement techniques as well. This is perhaps one of the more immediate benefits that clients experience by actively moving during the treatment.
0:05:22.5 WL: They not only stretch tight muscles, but also engage their nervous system to recognize and adapt to these new movement patterns. One of the more fascinating theoretical ideas of why we're getting such good results with active engagement techniques has to do with pain reduction through the gate control theory. Incorporating movement with massage can stimulate the nervous system in a way that clear closes the gate essentially on pain signals. That's because the proprioceptive sensations associated with the movement are travel faster along nervous tissue and they arrive at the brain faster than the nociceptive or pain signals do. And this essentially allows them to close the gate on some of those other signals that are coming in afterwards. This essentially aligns with what we know about the gate control theory where non painful stimuli can override and reduce the perception of pain. One of the things that I like a lot about these active engagement techniques is their ability to help access hard to reach muscles. Certain muscles, like the tibialis posterior, which is located on the backside of the tibia and very deep and hard to reach, can be challenging to treat, especially with just static techniques alone.
0:06:36.0 WL: Think about trying to treat somebody who's got posterior shin splints or chronic pain associated with plantar fasciitis that's coming from dysfunction or tightness in the tibialis posterior muscle. It's very important to address and treat that muscle, but it's really hard to get to. Increasing the muscle's density by using an active engagement technique allows for more precise and effective pressure to be applied to the backside of that tibia and get access to the tibialis posterior. The active engagement techniques also help us encourage safe movement and neural integration. For clients recovering from pain or injury. One of the biggest hurdles is regaining confidence in their ability to move without fear and without pain. These active engagement techniques provide a safe and controlled environment for reintroducing movement patterns, which helps integrate these patterns back into the nervous system. You can start with very gentle and very easy movement applications along with the techniques that you apply and that can help them get back to that activity and feel safe with those movements much easier as you're beginning to get those movement patterns reestablished. Now, to use active engagements effectively, it's really important that you have a strong understanding of kinesiology and along with your anatomy as well.
0:07:54.2 WL: So remember that kinesiology is the study of movement and it provides the foundation for understanding how muscles, joints, connective tissues work together. So in massage school, you may have had to memorize lots of muscle actions and wondered when you would ever really use that information. I'm telling you right now, this is when you start using it because you will not be able to get your active engagement techniques to work effectively if you don't have a good understanding of the different types of muscle actions and what they're doing during the different movements. Let's break this down just a little bit further. So remember that each muscle in the body performs certain specific actions like flexion, extension, abduction, or rotation. And knowing these actions allows you to guide your client through the movements that maximize the effectiveness of your active engagement techniques. Now, when we use the active engagement techniques, we're going to be using different types of muscle contractions. So it's important, in fact, crucial, that we recognize the different types of muscle contractions. So let's review those again just briefly. Concentric contractions are those in which the muscle shortens. Its two ends are brought closer together as it contracts.
0:09:04.6 WL: This is what's happening to the elbow flexor muscles like the biceps brachii. When you lift a weight during an elbow curl, an eccentric contraction occurs when the muscle is lengthening under tension. Usually this happens during deceleration or resisting gravity. Anytime you're trying to slow the motion of the body in a certain direction, that's an eccentric action that's most likely being engaged. An example would be when you're slowly lowering a weight back down to the ground. If you've done that elbow curl for your elbow flexors and biceps brachii, lifting it up to your shoulder as you slowly lower it back down to the ground. That is the eccentric action of that muscle. An isometric contraction is where the muscle is getting a stimulus to contract, but there is no movement occurring. So the muscles not changing in its length, but you're just holding a static position. Like if you're doing exercise movements and you're holding a plank position, that would be considered an isometric contraction with no movement but significant neuromuscular activity that's happening now. Each of these contraction types plays a unique role in the active engagement techniques. For example, certain techniques, like those aimed at encouraging muscle lengthening, usually use an eccentric contraction along with the massage technique, as that's the type of movement where the muscle is increasing in length as well.
0:10:26.1 WL: Let's take another example. If you're working on a client with limited shoulder mobility, understanding the role of the rotator cuff muscles, like the role of the infraspinatus and teres minor as lateral rotators, you might want to think, how might I work that muscle with active engagement techniques, as the muscle is shortening during the lateral rotation or as it's lengthening during the medial rotation. So recognizing the type of motion that's occurring and how you can engage those different types of muscle contractions with your client in the position that they are in on the table is a great deal of creativity that comes along with these Active engagement techniques, but it also really requires you to have a very good understanding of what's happening with different types of muscle actions in different positions. I also want to make a comment to note that we oftentimes oversimplify muscle contraction information when we had to study it and learn it in school. So, for example, you look up in a book, what is the action of the biceps brachii muscle? And your book is going to tell you flexion of the elbow. And that is true for a concentric contraction.
0:11:34.7 WL: But the biceps brachii is also involved in elbow extension. If you're slowly lowering a weight down to the ground, that's an eccentric action of the biceps brachii. So it's elbow extension. So you can't just go by those definitions alone that you had to memorize. You really have to analyze the nature of the movement, where your client is in relation to gravity and where they are in relation to other types of resistance that are being offered in order to make your active engagement techniques work effectively. And many times we'll find that we use active engagement techniques with additional load resistance, like with resistance bands, or with our hands using manual resistance to give some degree of resistance against a movement while they either shorten or lengthen the muscle. So you need to have a good working understanding of kinesiology and the different motions and actions of these muscles in order to get them to work most effectively. So precision is the real key in these active engagement techniques. As we said above, mastering kinesiology and recognizing the different types of muscle actions is going to be a first crucial step. And then you not only want to engage your techniques that you're using by that understanding of kinesiology, but look at the wide variety of methods that you have at your disposal.
0:12:55.7 WL: For example, we may use certain types of techniques that have a more broad contact surface, like the backside of the fist or the palm of the hand, or the broad contact surface of the forearm. We might use that broad contact surface during a certain type of muscle contraction or muscle action that the client is performing that spreads the pressure out over a much broader area and is often a great way to get started to start integrating some of these movement oriented techniques. But a lot of times you're going to want to work with a lot more precision and focus to the point of application of that pressure, which means you might use a thumb, a fingertip knuckle, or even a small pressure tool or something like that, so that pressure can be localized to a much smaller area.
0:13:44.7 WL: So when you combine the type of Application of that force, either broad or specific and small in its location, and the different types of actions that might be performed with passive movements or active movements or active movements with additional resistance. You'll see you're going to start multiplying the number of different ways you can do one simple technique with your clients in a really wide variety of different ways. So this gives you a great deal of flexibility and creativity and how you take just some very simple techniques and expand them into a lot of different tools that you might potentially use that your clients will find helpful and beneficial. So now that we've looked at the basic theory of active engagement techniques and looked at what the main things they might be able to do, let's talk about how to integrate those active engagement techniques into your practice. So first off, start by explaining to your clients what active engagement techniques are and how they work. And as I said earlier, you're going to have to get some.
0:14:48.8 WL: You're going to have to sort of determine if this is really appropriate for each client, because as we said before, if you've got a client that's just coming in for general relaxation massage, and they just want to unwind and relax, they may not want to get involved with doing a lot of active movement work because they really just want to relax. So it's not necessarily going to be appropriate for that person. But if you've got somebody who's trying to address some type of pain or injury complaint or some type of movement restriction or something that's limiting their capability to move, the more you explain to them why you're doing the things that you're doing and how this active movement encourages and helps what they're doing, they will greatly benefit from that and really appreciate it as well.
0:15:30.5 WL: So along with that is really assessing the client's suitability for doing something like active engagement techniques. Because not every client is a candidate for active engagement techniques. Now, they may be at some later stages of their problem, but not always at certain stages where they come in. So consider factors like their pain levels, the medical history, current physical condition. For example, clients with an acute injury may not be ready for the neurological muscular demands of active engagement techniques, because you're going to be actively recruiting those tissues that might be injured and that could flare up their pain even worse. Those techniques and methods may be very helpful for that client at a later stage, maybe when their healing is much farther down the process, but at the early stage when it's still in an acute level or just immediately post acute level, they may not be ready for those techniques. So trying to do some type of active engagement with them too early could really end up being detrimental to their condition. That's why assessment is so critical prior to treatment. In one of the previous podcasts, I talked about the necessity importance of of assessing your client, especially for evaluation of various different factors in the pain and injury conditions that they may present with.
0:16:46.4 WL: And this is why assessment drives the treatment decisions. So it's critical that we make good assessment decisions first in order to determine how we're going to be most effective in our treatments with them. So if you're new to active engagement techniques or this whole idea of incorporating movement along with your massage is really new and foreign to you. Just begin with some simple movements and gradually progress to more complex applications as your competence grows. So start with something that really obvious and real simple, like doing some stripping techniques during an eccentric contraction of the elbow flexors. When you've got, somebody with tight muscles in that area, maybe you want to work on the quadriceps group. For an athlete that's really trying to get back to good physical activities, let's do some really good stripping techniques with broad contact surface or specific applications right around the patella retinaculum during their knee flexion and extension movements. Those simple applications can really help you gain confidence and gain a greater degree of understanding of what you're doing with your techniques. As you apply those active engagement methods and as you build your confidence and as you build your knowledge and understanding of kinesiology, you're going to find this stuff as going to become much more second nature to you.
0:18:01.2 WL: And it'll come quite easily to you what you need to do in all these different situations. And then really the sky is the limit in terms of how you may choose to apply it. So remember active engagement techniques. Remember a dynamic and collaborative approach to massage. More than just doing work on a passive client, by integrating the client movement with targeted massage techniques, you can achieve enhanced treatment outcomes, reduce your physical effort, and empower your clients to take an active role in their healing journey. If you'd like to learn more about active engagement techniques, you can visit the Academy of Clinical massage website @academyofclinicalmassage.com for resources and training opportunities. There's lots of other places you can learn about these techniques as well. Thank you again for joining me on the ABMP podcast. Great to work with you. I'm Whitney Lowe and I look forward to seeing you next time. So let's get out there and keep advancing your skills.