Distal vs. Proximal Work

By Art Riggs
[Q & Art]


Dear Art,

You and several other writers in Massage & Bodywork often demonstrate strokes moving in a direction away from the heart. I was taught to always work toward the heart and don’t feel comfortable working in the opposite direction. Can you please explain your rationale? Is your direction really safe?

—Which Way To Go?




Dear WHich Way,

Early in my education, I learned that any test question that used the word always was most likely a red light to mark the answer false or to choose another option. Your question illustrates a common theme that arises in this column. I will address the tendency of unquestioning adherence to inflexible rules in a future column, but will say now that we all need to constantly examine our techniques and belief systems in light of new information, or we risk stagnation, boredom, and less effective work.

The common knowledge you mention is due to the emphasis early Swedish massage had on moving superficial venous blood and lymph in its normal direction of flow. Although this is indeed a good reason, some teachers imply that working in the other direction is harmful, thereby scaring their students from doing any distal work. Yet, working distally is very beneficial in implementing the goals of other bodywork systems, such as therapeutic/medical massage, structural work for posture or improved joint function, and even in subtle work to help the flow of energy outward from the core. What’s necessary is a clear understanding of your therapeutic goals. An excellent bodyworker will take the best of many different philosophies and apply them in varying degrees with each client, as the need arises.

Here’s a passage from one of my favorite anatomy teachers, Gil Hedley, that reinforces what I’ve heard from every medical and anatomy expert I’ve checked with regarding the safety of working distally: “From an anatomical perspective, you can do damage in any direction with bad work, and you can do good in any direction with appropriate contact. If you are a machine programmed to touch, like one of those massage chairs, that might be a case where it would be best to set the program in a particular direction, as the power to discriminate is absent. But in a conscious practitioner, working with a generally healthy client, the direction that’s best to work in is the direction that gets results.”1

Although there are, indeed, many reasons for working in a proximal direction, there are many other benefits when it comes to not limiting yourself with hard and fast rules. It’s really pretty simple: I often get excellent results working distally. Most of the problems that our clients present with are a result of short and tight muscles that cause pain or prevent proper movement. It just doesn’t make sense to bunch these muscles by always pushing them into further shortening. Especially for deep work, it just plain feels better to work in a distal direction.

Here are some of the advantages of thoughtful, distal stroke direction:

• Since most muscles attach proximally in order to exert force proximally, working distally lengthens short muscle fibers and fascia for lasting relief from contraction which limits joint function and causes discomfort.

• It frees and lengthens nerves that have shortened along with the muscles.

• It decompresses joints and releases tight ligaments for better osseous function.

• Possibly the most important benefit is that working distally helps train our clients to override protective holding and reprograms movement patterns as they release in the direction of lengthening and relaxation.

So, by all means, continue working proximally with clear goals, but rest assured that you can also safely work in the opposite direction to achieve additional benefits. As with all of our work, the key to effective therapy—and the fun of creative thinking—is to let the needs of our clients dictate our therapeutic practice.

  Art Riggs teaches at the San Francisco School of Massage and is the author of Deep Tissue Massage: A Visual Guide to Techniques (North Atlantic Books, 2007), which has been translated into seven languages, and the seven-volume DVD series Deep Tissue Massage and Myofascial Release: A Video Guide to Techniques. Visit his website at www.deeptissuemassagemanual.com.


1 Gil Hedley presented the most exciting anatomy class I’ve ever experienced, and I highly recommend his teaching and DVDs. Check out www.gilhedley.com.