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Reprinted from Volume 41, No. 4, pp. 44-53 of Massage Therapy Journal by permission of American Massage Therapy Association(r), (c) Copyright 2003

key elements of
connective
tissue massage

This method, when applied correctly, will help relieve chronic tension, promote deep relaxation, enhance self-awareness and improve posture.

By John Latz
Photographs by Matthew Pace

Dr. Ida P. Rolf's work is the foundation of my technique, connective tissue massage (CTM), which I developed and now teach to massage therapists. After long and thoughtful study, I refined and extended her principles of alignment and movement to create a dynamic approach to myofascial release. Now for the first time, Dr. Rolf's timeless contribution of true fascial manipulation is accessible to all bodyworkers. In this article, I will attempt to clarify, according to Dr. Rolf's ideas, exactly what constitutes fascial manipulation and how it is done.

  

Based on my 17 years of practicing the Ida P. Rolf method of structural integration, I am convinced that the real skill of fascial manipulation is best accomplished by utilizing appropriate body mechanics. These body mechanics are elegantly simple in their application, and virtually effortless to provide. My experiential discovery of this fact from my own work compelled me to share this experience. Connective tissue massage gradually came together over 13 years as an easily learned systematic approach.

I initially trained in structural integration at the Rolf Institute« in 1985. Like many bodyworkers, I started working too hard, fatiguing myself and achieving inconsistent or spotty results. Gradually, I developed my expertise as I embodied Dr. Rolf's work. I realized that each time I received fascial work I became more structurally integrated in my own body. This helped me feel increasingly grounded, powerful and connected in my work with clients. My innate, intuitive ability to receive, learn and translate fascial contact in this way allowed me to progress rapidly. In other words, whatever I felt in my own body fascially, I could immediately utilize with my clients.

My own structural evolution, and my experiential understanding of how fascia changes, combined with Ida Rolf's ideas, helped me create a system of body mechanics to achieve mastery of fascial manipulation. I wanted to share this valuable hands-on knowledge, so I decided to formally teach CTM in 1989. Not only would the many benefits of fascial work be readily available to massage therapists and their clients, but CTM is an ideal foundation for further study of Rolf's method of structural integration.

Understanding Fascia
To understand the technique of CTM, it is important to first appreciate some facts about fascia. When I teach CTM to students, I explain that all of the structures in the body are surrounded, protected and supported by connective tissue. This matrix connects, or binds together, the body's organs and systems, and at the same time provides compartmentalization between them. The fascia is a continuous elastic sheath that provides structural support for the skeleton and soft tissues (i.e., muscles, tendons and organs). As it surrounds the muscles, it is referred to as the fascial envelope, which is primary to the CTM work.
 

Fascia is the organ of posture. Nobody ever says this; all the talk is about muscles. Yet this is a very important concept...especially the anatomy of fascia. The body is a web of fascia. A spider web is in a plane; our body's web is in a sphere. We can trace the lines of that web to get an understanding of how what we see in a body works.
-Dr. Ida P. Rolf

Dr. Rolf's original research on the characteristics of fascia identified its different biochemical states. She referred to these states as "gel" and "sol." She described the gel state as having a low hydration level in which fascia often shortens and becomes adhered to surrounding layers of tissue. Tissue in this state feels thick and dense to the touch. The fascia quickly begins to sol when the chemistry of the fascia changes. In its sol state, fascia is better hydrated, more elastic, and more easily stretched and lengthened. The goal in CTM work is to facilitate the gel-sol change to most effectively manipulate the client's fascia.
 

Top: In the front position you lean through the front of your body and push from the back leg, extending through the heel of your hand. Bottom: In the side position you lean through the side of your body and push from the back leg, extending into your forearm.

Criteria Of Fascial Work
I frequently encounter students who do not entirely comprehend the process of fascial manipulation. Rolf was very specific about certain criteria of which a practitioner must be conscious. The following points regarding fascia will help to clarify this.
 

Top left: The oblique entry of contact in CTM work ensures the fascial manipulation is both comfortable and effective for the client.  Top right: CTM utilizes slow, intentional lengthening movement through the practioner's body to facilitate dynamic fascial change in the client.  Bottom: CTM requires the practitioner to remain relaxed, even while working deep fascial layers.

1) Elasticity Of Connective Tissue. Connective tissue has a unique quality of elasticity, allowing it to be elongated. This requires a precise level of energy and palpation skill to effectively make changes in the tissue. Rubbing, kneading, massaging or compressing the tissue will not change or elongate the tissue. Fascia and muscle are distinct types of tissue requiring totally different approaches of palpation and manipulation. I refer the reader back to Rolf's terms, gel and sol, regarding the specific nature of connective tissue. When connective tissue receives appropriate contact and sufficient energy, it changes immediately. This dynamic characteristic ensures that a practitioner is either working on muscle or fascia, but not both at the same time.

2) Oblique Angle Of Contact. In order for fascia to be stretched as previously mentioned, it must be contacted at an oblique angle (less than 45 degrees). Rolf was adamant about this point, stating that the tissue responds and lengthens only when the downward, compressive force is eliminated. For example, shortened fascia, like wrinkles in a sheet, can be pulled out and lengthened only when we put a more forward, stretching movement into the tissue. The oblique angle of entry to the body maximizes this stretching quality, while minimizing any invasive or compressive contact.

3) Continuity Of Fascial Planes. Fascia lies in broad, continuous planes in the body. This quality of continuity allows for transmission of structural change via these planes. An example is wearing a wet suit, which represents the superficial fascia. You could pull or stretch the "fascial wetsuit" from any part of it and affect the entire structural fabric. Conversely, without contacting and accessing these long planes of connective tissue, a practitioner would be working only on isolated spots. It deserves emphasis that the individual muscles are not our focus. Instead, our primary considerations are the relationships of long, broad fascial planes to one another. This allows us a creative and effective means whereby fascial work in one area affects the entire body.

4) Fascial Layering. Another important characteristic of fascia is the way it organizes the body through an elaborate three-dimensional webbing of layers. Within this continuous network, Rolf taught us to address the fascial layers one at a time, progressing from superficial to deep. Only after the more superficial layer has become more elastic, supple and lengthened is it appropriate to work on the next, deeper layer.
Top: Pulling or stretching the "fascial fabric" from any part of it will affect the entire structural fabric.  Bottom: This schematic, of a cross section of the thigh, shows the elaborate three-dimensional and continuous network of fascial layers that organize the body.

It is a violation to touch the deeper layers of fascia without first having worked the surface layers. Without initially achieving a superficial release, the body shuts down to the energy input, and armors its defenses. Ultimately, the client will likely experience the work as harsh or painful. Without honoring the fascial layers, practitioners may try to "muscle" their way through resistant tissue, without achieving any positive results. In contrast, the fascial matrix changes readily when energy is added with a clear and conscious intention.

Principles Of CTM
Body Mechanics

The first principle of CTM body mechanics involves leaning a controlled amount of body weight into the client. Through its application, I ensure contact with the appropriate layer of fascial resistance, and it is therefore painless for the client. It is also effortless for me because I am utilizing the force of gravity. As I lean, gravity literally pulls my weight into the client. This involves no muscular effort on my part.

This controlled leaning is effective only when I hold my body in a particular alignment. Alignment is the second principle of CTM body mechanics, and refers to the vertical line around which a body is organized, according to Rolf's structural integration model. Her concept of this line runs from the sole of the foot through the ankle, knee, hip, shoulder, ear and top of the head. I maintain my line regardless of whether I am working in a front or side position.

The third principle of CTM is movement, which is elongation along the alignment. It is like doing yoga. Nothing shortens in my body while I am working. When I move in CTM body mechanics, I lengthen in a vertical dimension through the bottom of my feet and out the top of my head, extending through my arms. I make my body bigger and longer, and my fascia expands in all directions simultaneously. This "spanning" of my tissue continues into the fascial body of my client, whose fascia lengthens and expands as though it is a continuation of mine.

The next principle of CTM body mechanics is the use of oblique angles of contact. As we mentioned previously, fascia lies in broad, continuous planes in the body. In order to lengthen a broad sheet, we need to contact it from an oblique angle, which takes the downward thrust out of the contact and puts in a more forward, stretching movement. While a downward thrust would immobilize the tissue, the oblique angle mobilizes the tissue so it can be lengthened.

The ability to stay soft and relaxed in my body and hands comprises the final principle of CTM body mechanics. This ability to be relaxed and open while working ensures I remain noninvasive, even when contacting deeper layers of tissue. My effectiveness is improved because my client is able to remain open to receive the work. In fact, fascial manipulation is effective only when I am relaxed while working. In addition, I am able to better listen through my hands to the proprioceptive information I receive when I am relaxed. Intuitively, I understand the force and direction necessary to best respond to my clients' needs.

It should be noted that these five principles of CTM body mechanics are interrelated and depend on correct usage of each principle simultaneously. Elimination of any one of the principles compromises all of the body mechanics. Similar to any athletic endeavor or movement skill, good form is essential to achieve optimum results. Grounded in simple physics, these CTM body mechanics keep me more centered, present and aware while I am working.
 
Proper alignment is critical to effectively manipulating fascia in the CTM body mechanics.

When I apply all of these principles, I use my entire presence to promote change in a client. Working this way is effective for the client, and virtually effortless for me. This is because the experience of true fascial contact is one of "letting go"-for my client, as well as myself. I am able to let go because I am working with the gravity field, and my client's fascia responds to my intention by softening and lengthening. This allows the liberation of long-held patterns of shortening and restriction.

Within this dynamic, a new boundary is defined. The boundary created is safe and appropriate, not forced upon my client. Rather, it is welcomed, with clients often remarking that my touch feels "just right" or "just what I need." The CTM body mechanics allow me to work with a person more sensitively.

Learning CTM
It is important to understand that learning fascial palpation and manipulation is not a cognitive experience. Rather, it is a developed tactile, kinesthetic awareness. This awareness occurs as you learn to embody the CTM body mechanics. Each student is encouraged to explore the feeling of length and extension inside themselves, and to experience his or her body weight in a spatial relationship to his or her client. The process requires your body to "remember" this sensation, not your mind. Learning CTM challenges a student in a unique way, and this necessitates instruction from a qualified teacher. It cannot be learned by reading descriptions or watching a video.

When I teach CTM, all of the learning is experiential, hands-on instruction. I work with every student, specifically sharing the palpation and manipulation experience, so each person has a kinesthetic reference. Feeling fascia is a highly refined skill that can be learned only through private hands-on instruction. It is imperative for students to receive quality work, which ensures immediate recognition of inappropriate contact. Another method I employ to help students understand the subtle energetic quality of fascia is allowing them the opportunity to practice on me and my assistants. It allows us to monitor their progress and give direct personal feedback. This learning approach empowers students and helps integrate their experience.

Sharing The CTM Work
In CTM, fascia is the guide, with the fascial relationships determining the sequence and progression of a session. The goal of the work is to lengthen clients' fascia so their bodies become longer and more open. A session does not necessarily dwell on a localized area of pain or discomfort, nor does it focus on symptomatic release strokes as its primary goal.
 
Top: The first principle of CTM body mechanics is leaning controlled body weight into the client.  Bottom: Fascia lies in broad, continuous planes in the body, and requires a broad contact with the hands or forearm in order to be stretched.

When I maintain all the CTM body mechanics principles, I am able to meet the individual needs of every client. I begin a session by palpating the area I want to address in order to determine where fascia is shortened. Rather than having a preconceived idea about a client's tissue, I let his or her fascia show me what it needs. I am guided by proprioception and open to intuition. In areas where I encounter particular resistance from the tissue, I adjust my body alignment to modify the depth, speed or direction of fascial contact. Within these subtle modifications lies the creative art of fascial manipulation.

Benefits Of CTM
Virtually everyone can receive connective tissue work and experience its many benefits. CTM helps relieve chronic tension, promotes deep relaxation and enhances self-awareness. It also facilitates significant improvement in posture. The CTM work incorporates many of Rolf's ideas about structural alignment. Her theory of fascia being the organ of posture certainly holds true in the CTM experience. People report feeling longer, lighter and more open throughout their bodies. This new alignment requires less effort to maintain because the body is beginning to approach a more balanced vertical relationship with gravity. Within this improved body balance, dramatic changes in flexibility are common, as well as ease of movement for even the most chronically tense clients.

A CTM session can be organized to focus on a particular client complaint (e.g., neck tension, carpal tunnel syndrome and sciatic pain). It can be helpful in preventing, as well as rehabilitating, many types of injuries. Fibromyalgia, arthritis, multiple sclerosis and other disorders affecting the neuromusculoskeletal system also can be addressed with connective tissue work. In fact, many fibromyalgia patients report receiving a substantial reduction of symptoms as a result of CTM work.

Using connective tissue massage, manipulating fascia is effortless. Applying this technique bridges massage therapy with Rolf's structural integration work, which has the potential to radically transform the massage profession.

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John Latz is the founder of the Institute for Structural Integration (ISI), and the developer of connective tissue massage. ISI is the exclusive organization offering CTM training. Founded in 1992, ISI offers workshops in basic and advanced CTM, as well as a complete program in structural integration. He can be contacted by phone at: 305-754-0983, or via the Internet at: [www.johnlatz.com].


 

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Institute for Structural Integration
7700 Center Bay Drive
North Bay Village, FL 33141
Phone: 305 754-0983
Email: john@johnlatz.com

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