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Thai yoga massage has been around for millennia. This very ancient form of bodywork uses elements of compression, rocking, stretching, and various yoga poses to create a therapeutic response. But there are a few key distinctions which set it apart from a traditional Swedish or deep tissue massage. If you’re new to massage or if you’re trying to decide which is best for you, knowing what to expect may make that decision a little easier to make. Let’s take a look at some of the main differences between a Thai massage and a table massage.

  1. No table: One of the main differences between Thai massage and a table massage is that Thai massage is done on a mat on the floor. A traditional Swedish/deep tissue massage is done on a massage table.
  2. No need to undress: Thai massage is done fully clothed wearing loose, comfortable clothing. A full body table massage is usually done with the client partially or fully undressed, underneath a sheet and cover.
  3. No lotions or oils: A Thai massage does not use any crèmes, lotions, oils, or gels. Whereas a table massage can use any of the latter in its application.
  4. Techniques: A Thai massage will often use elements or compression, rocking, stretching, breath work and range of motion to create its therapeutic effect. A table massage may also use elements such as these but mainly focuses on techniques such as kneading, stroking, effleurage/petrissage, and friction for breaking up of adhesions and knots.
  5. Energetic component: A Thai massage incorporates energy line work through the use of palming and thumbing of the Sen lines in the body. A traditional Swedish/deep tissue massage does not work these energy lines specifically.
  6. Stretching: As mentioned already, Thai massage uses a great deal of stretching to address areas of tension and to relieve energy blockages. A table massage may also incorporate stretching but not to the extent that a Thai massage does.
  7. Positions used: In traditional table massage, most will lie face down (prone position) or face up (supine position) for a majority of their session. On occasion a side-lying position is used for targeted work. In Thai massage however, in addition to both the prone and supine positions, the side-lying, semi-prone, and seated positions are used as well.

Given these differences, one form of massage may be better suited for you than the other. Although both have their therapeutic qualities, personal preferences and expectations may have a significant impact on how the work is received. Also, each practitioner may have his or her own unique style, which will influence the work as well. No matter which form of massage you choose, make sure to seek out a knowledgeable, well-trained, and licensed professional to ensure you’re getting the best possible work available.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, Certified Thai Yogi, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

It’s been widely speculated that the origins of reflexology date as far back as 5000 years to China. As part of Traditional Chinese Medicine (TCM), some form of hand and foot therapy was being practiced alongside herbal therapy, acupuncture and qigong. Its roots have also been traced back to ancient Egypt through pictographs dating to 2330 B.C. Commonly referred to as the “Physician’s Tomb” for its depiction of several medical procedures, the pictographs were found at the burial site of a high ranking official named Ankhmahor. One of the images depicts two practitioners applying pressure to the hands and feet of two other people, with the inscription loosely translating to “Do not let me feel pain” and the response, “I will act as you please.”

Other cultures such as those of India, Japan and the Native Americans, have also used some form of pressure therapy to the feet as part of their tradition. The Native Americans for example believe that because our feet make contact with the earth, that we are connected to the whole of the universe through the energies that pass through them. In Europe, a form of pressure therapy known as “zone therapy” was being practice as far back as the 14th century.

In 1898, an English Neurologist by the name of Sir Henry Head discovered what are now known as “zones of hyperalgesia” or “Head’s Zones.” In a series of experiments, Head was able to demonstrate a link between diseased organs connected to a specific “zone” of skin by nerves and a hypersensitivity to pressure in that zone of the skin. Around this same time the work of two notable Russians: Ivan Pavlov – a physiologist, and Vladimir Bekhterev – a neurologist & psychiatrist, made their contribution through what are known as “conditioned reflexes”. Pavlov and his work with classical conditioning were able to demonstrate a causal link between a stimulus and a response. Bekhterev’s work was very similar in nature to Pavlov’s, although he referred to this link as an “association reflex.” Bekhterev however has the unique distinction of coining the term reflexology in 1917.

The first instance of a “reflex action” being attribute to massage occurred in Germany in the late 1890’s. What the Germans referred to as reflex massage was being widely practiced as a way of treating various diseases. A German doctor by the name of Alfons Cornelius had experienced first hand the therapeutic effects of a reflex action while recovering from an illness. He noted that during his massages, focusing on the tender and painful areas helped to significantly reduce his pain levels and speed up his recovery time.

It wasn’t until the work of an American physician named Dr. William Fitzgerald, that the reflexology that we know and practice today took form. Fitzgerald was the head of the Nose and Throat Department at St. Francis Hospital in Hartford, Ct in the early 1900’s. Commonly regarded as the father of zone therapy, Fitzgerald discovered the anesthetic effects created through the application of pressure to the fingers and toes. A series of ten longitudinal zones for the hands and feet, where found to run the length of the body from the fingers and toes all the way up to the head. Through the use of clamps, pins and rubber bands which he used to apply pressure to the digits, Fitzgerald was able to map out the distinct areas on the body where the anesthetic effect took place. He soon realized that could relieve pain and the underlying causes of the pain using this technique. Fitzgerald became so skilled at this that he was able to perform small surgeries using his technique, which he referred to as zone analgesia. Along with colleague Dr. Edwin Bowers, Fitzgerald co-wrote the book “Zone Therapy” in 1917. In it they discuss the general principles behind this therapy. The idea being that areas of the body found along specific zones will be linked to one another through energy that flows through that zone. The zone therapy that’s used today in reflexology is largely based on Dr. Fitzgerald’s pioneering work.

Another physician by the name of Dr. Joseph Shelby Riley was so fascinated by Dr. Fitzgerald’s work with zone therapy, that he went on to refine and use his techniques in his own practice. Riley was the first to create detailed diagrams of reflex points on the feet. He also discovered the eight horizontal divisions governing the body. It was his assistant however, a physical therapist by the name of Eunice Ingham, that finally charted the reflexes we use today in reflexology. Ingham has been called the “Mother of Modern Reflexology”. It was Ingham who focused on the feet as a means of treatment. By applying the techniques used in zone therapy, she meticulously checked and rechecked the reflexes until she had created a detailed map of the body on the feet. After writing her first book, “Stories The Feet Can Tell” in 1938, she tireless promoted the practice of reflexology throughout the general public. Along with her nephew Dwight Byers, which she often practiced on, the two of them helped bring the modern practice of foot reflexology to the forefront.

Another key contribution worth noting came around the mid 1960’s. In 1965, Ronald Melzack and Patrick Wall published an article in the journal of “Science” entitled, “Pain Mechanisms: A New Theory”. In it they describe how the body transmits and inhibits pain signals through a gate response found in the spinal cord. This theory would go on to explain one of the possible ways that this anesthetic affect was being created in the body. The theory was called the “Gate Control Theory” of pain.

The body’s normal response to pain is to inhibit it through the use of endorphins; the body’s natural pain relievers. Endorphins are endogenous opioid compounds produced by the pituitary gland and the hypothalamus in response to strenuous exercise, excitement and trauma. And they are as strong as any opiate out there, including morphine. As a matter of fact, the word endorphin is actually an abbreviated version of “endogenous morphine”. When you stub your toe for example, pain signals are sent to the brain where they are processed by the thalamus. During this time, the first wave of endorphins is released into your system. But there’s a curious thing that happens along side this. Our immediate reaction is often to reach for the area in pain to try and soothe it. Ever wonder why that is? Somehow it helps to diminish the pain and the gate control theory can explain why.

The gate control theory states that a competing signal can essentially block pain signals from reaching the brain. Nociceptive pathways or pain pathways, have two different types of nerve fibers. A-Delta fibers are myelinated pathways that conduct pain signals to the spinal cord at approximately 40mph (fast, acute, sharp pain). C-fibers are unmyelinated pathways that carry signals at approximately 3mph, (slow, continuous, throbbing pain). Sensory neural pathways however, are myelinated but also larger in diameter, which essentially means they can transmit signals faster than both pain pathways. Basically, sensory information reaches the spinal cord faster and takes precedent over pain signals. This explains why rubbing your toe seems to miraculously help ease the pain. When the sensory input reaches the spinal cord it stimulates inhibitory inter-neurons, which act as gates that can close and suppress the pain signals. It’s a complex interplay and not an all or nothing phenomenon, which is why we still feel some pain. Interestingly enough, the theory goes a step further. Melzack and Wall also state that “the psychological condition and cognitive content of the mind” can affect our experience of pain. This includes emotions, thoughts and our overall outlook! This could explain why pain is such a subjective experience.

This last theory has wide implications for the therapeutic effects of touch therapy such as massage, Reiki and in particular, reflexology. Firstly, the sensory input created when pressure and movement are applied to the feet and hands help to close the gates, lessening the effects of pain. Secondly, the psychological effects of stress reduction can help generate feelings of ease and comfort, and ultimately give us hope that relief is within sight.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Massage therapy is commonly used for relaxation and pain relief, in addition to a variety of health conditions such as osteoarthritis, fibromyalgia, and inflammation after exercise. Massage therapy can also be an effective therapy for aspects of mental health. Recent research suggests that symptoms of stress, anxiety and depression may be positively affected with massage therapy.

Here are some recent research findings which highlight the role of massage therapy in mental health and wellness, compiled by the American Massage Therapy Association.

Massage Therapy for Depression in Individuals With HIV

Research published in The Journal of Alternative and Complementary Medicine indicates that massage therapy can reduce symptoms of depression for individuals with HIV disease. The study lasted eight weeks, and results show massage significantly reduced the severity of depression beginning at week four and continuing at weeks six and eight. American Massage Therapy Association President Winona Bontrager says of the study, “This research suggests that regular therapeutic massage could be a useful tool in the integrated treatment of depression for patients with HIV.”

Massage Therapy to Reduce Anxiety in Cancer Patients Receiving Chemotherapy

Research published in Applied Nursing Research shows that back massage given during chemotherapy can significantly reduce anxiety and acute fatigue. “This research demonstrates the potential value of massage therapy within the full cancer treatment spectrum, particularly during the often mentally and physically exhausting chemotherapy process,” says American Massage Therapy Association President Winona Bontrager.

Massage Therapy for Reduced Anxiety and Depression in Military Veterans

Research published in Military Medicine reports that military veterans indicated significant reductions in ratings of anxiety, worry, depression and physical pain after massage. Analysis also suggests declining levels of tension and irritability following massage. This pilot study was a self-directed program of integrative therapies for National Guard personnel to support reintegration and resilience after return from Iraq or Afghanistan.

Massage Therapy for Nurses to Reduce Work-Related Stress

Research published in Complementary Therapies in Clinical Practice shows that massage for nurses during work hours can help to reduce stress and related symptoms, including headaches, shoulder tension, insomnia, fatigue, and muscle and joint pain. “This study affirms the important role massage therapy can play in the work setting, in this case to ease stress for health care providers who, in turn, can better provide optimal patient care,” says Bontrager.

Article reprint from amtamassage.org, research roundup.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

One of the major underpinnings of Thai yoga massage is its deep roots in Ayurvedic medicine. This Indian healing practice approaches health from a point of living in harmony with life and what is. The word itself, Ayurveda, is derived from two Sanskrit words meaning life (ayur) and knowledge (veda). By applying this life knowledge we can create harmony and restore optimal health. Ayurvedic principles can be applied to just about all facets of daily living, from diet and exercise to our mental and emotional habits. In Thai yoga massage for example, a person’s dosha (doe-sha) will determine the intensity and speed of their session.

A dosha refers to one of three primary energies that are believed to circulate through the body. We all have all these three energies coursing through our bodies, but one tends to dominate. This dominant energy is our natural, default dosha, which ultimately determines our overall temperament and constitution. According to Ayurvedic tradition, the universe is made up of five elements: earth, fire, water, ether and air. Everything in the universe, including our bodies, is made up of these five elements in various degrees. The tridoshas are the five elements represented in the body. Ether and air combine to create the vatta dosha or air principle. Fire and water form the pitta dosha or fire principle. And finally earth and water come together as the kapha dosha or water principle.

Since these energies are in constant flux, it’s important to understand the general characteristics of each dosha in order to restore balance. Too much of one energy for example, can create a particular set of symptoms while too little of another will create a different set of symptoms. Most of us will recognize elements of each dosha in ourselves but we all tend to lean more towards one.

Vatta: The elements of ether and air form the vatta dosha (air principle). Vatta types are active and energetic. They can lean towards nervousness and generally tend to avoid confrontation. Physically, they’re either short or very tall. Vatta energy creates movement in the body through the nervous system and energetic body. Most western type diseases come form an imbalance in vatta energy. Here are some other general characteristics of vatta types:

  • thin bodies
  • dark complexions
  • dry, rough, cracked skin
  • coarse hair
  • light sleepers
  • get cold easily
  • tire easily
  • quick thinkers
  • sensitive, alert
  • restless minds

Pitta: The elements of earth and water form the pitta dosha (fire principle). Pitta types are passionate and assertive. They can be warm and friendly but can also be very competitive. They tend to be of medium frame and moderate build. Pitta energy is responsible for circulation and relates heavily toward metabolism and digestion in the body. Other characteristics include:

  • medium, muscular bodies
  • reddish complexion
  • thin hair
  • moist skin
  • hot/sweaty body type
  • passionate
  • big appetites
  • detail oriented
  • easily angered
  • short tempered

Kapha: The elements of earth and water form the kapha dosha (water principle). Kapha types are stable and grounded individuals. They are generally calm and consistent and lean towards inactivity. Physically, they have heavyset bodies with a broad chest and shoulders. Kapha energy is very water-like and associated with the lymph, phlegm and moisture in the body. It’s known for binding and holding things together, physically and mentally. Here are some other key characteristics:

  • Strong, stout build
  • fair or pale complexion
  • smoothe or oily skin
  • lush, thick hair
  • slow digestion
  • sound sleepers
  • excellent stamina
  • patient and slow to anger
  • stable body & mind
  • happy & healthy

The doshas are often in one of three states:, balanced, over-active, or depleted. In order to create balance we must first determine which dosha we are and then tailor our lifestyle accordingly. Too much air or vatta energy can lead to mental, nervous or digestive disorders, low energy and weakness. An overabundance of fire or pitta energy can lead to inflammation or infection. An excess of water or kapha energy can lead to an over-production of mucus, edema, and being overweight. Pitta types for example can suffer from heartburn from an over-indulgence of spicy foods. Adding more alkaline-based foods such as broccoli, kale or other leafy greens can create balance. The important thing to remember is that like energies will create excess and opposing energies will restore balance.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

These days digital media consumes so much of our attention that we’re no longer noticing the subtle signs our bodies are sending us. Whether its checking email, responding to texts, updating social media, you name it, logging in all this screen time has now become the new norm. And love it or hate it, it’s having an affect.

Neuroscience has shown that the brain cannot tell the difference between an image it sees in the physical world and one that it sees in our mind’s eye. They essentially affect the same regions of the brain. If we stop and think about it for a moment, the implications of this are profound. Let’s imagine we’re out on a hike. It’s a beautiful day, we’re out in nature, and then we spot a bear off in the distance. What happens now is our body kicks into fight or flight. Our senses become heightened, our heart starts to race, and our breathing changes. These are all normal physiological responses to a life or death situation. Now close your eyes and imagine that same scenario playing out in your mind’s eye. If you really put yourself there, you’ll notice that your breathing will become shallow and your body will tense – essentially the same physiologic response, albeit a less intense one, as the real deal!

This fight or flight response releases a cascade of hormones and neurotransmitters designed to kick your system into overdrive. You either fight off the potential threat or if that’s not possible, you flee. This stress response was not meant to be a chronic and ongoing thing. The longer these stress hormones remain in your system, the more deleterious their effects become on the body over time. So what does this imagined scenario have to do with body awareness and learning how to develop it?

Whenever we check in with our bodies we develop a capacity to pickup on these often overlooked signs. Are we holding ourselves unnecessarily? Is our breathing shallow or labored? Are we feeling an ache or pain somewhere? Paying attention and listening to the body takes us out of our heads and away from all the noise of daily living. The quickest and most effective way to do this is to pay attention to the breath. By noticing the breath we can tune into the body’s autonomic nervous system. This branch of the nervous system regulates our heart rate, blood pressure, our digestion, and of course our breathing. All of these are critical functions of the body, which for the most part go unnoticed. And the breath is the only one that we can actually influence directly. This is why sages have referred to the breath as the bridge between the body and the mind.

Developing body awareness can take on many forms. Most common of course is meditation. Creating a daily practice of introspection has been scientifically proven to be effective in lowering blood pressure, reducing stress levels, and generating an overall sense of happiness. But it can also take the form of physical activity, such running, cycling, yoga, and swimming. Obviously, some of us may have more limitations than others. But even if it’s just walking, the effects are a boon to our physical and mental well-being. Receiving bodywork is another way of developing body awareness. How often have we gone in for a massage and discovered how sore and tight certain areas were? Areas we had no idea were holding on to tension.

The body has an amazing capacity to adapt. If we’re tense our bodies are tense. Where this manifests in the body is different for every person. This is why cultivating a practice of body awareness is so helpful in staving off the effects of stress, not only of the body, but the mind as well. Setting aside some time for oneself can be a challenge in itself, so start small. Pick three opportunities throughout your day to pause for a few seconds, and take one conscious breath. Ahh… For those few seconds, place your full attention on your breath. Notice how the breath feels coming into the body. Make sure to breathe with your whole body. Allow the abdomen and chest to expand as you fill your lungs with air. Then with the same focus, notice how the body naturally contracts as the breath leaves your body. This ingoing and outgoing of the breath is the basic rhythm of life. The yin and yang of existence. All this, in one conscious breath! Make this your practice throughout the day and before long you’ll start feeling its positive effects on body and mind.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Thai Yoga Massage (TYM) is an ancient form of bodywork that combines elements of yoga, Tai chi, and massage. Its origins are rooted in Ayurvedic medicine and date back 2500 years to India and the Buddhist temples of Thailand. Often referred to as “Assisted Hatha Yoga,” the practice is performed on a mat on the floor with the client wearing loose comfortable clothing to facilitate ease of movement. Practitioners guide the client through various yoga poses and stretches while palming and thumbing the energy lines of the body, known as Sen lines. The slow, rhythmic movements used in TYM create a flow that gently balances the body’s energy lines, while increasing range of motion, improving circulation, and relieving chronic muscular tension.

The founder of Thai Yoga Massage was an Indian, Ayurvedic doctor by the name of Jivaka Kumar Bhaccha. His renown for treating kings and noblemen led him to become the Buddha’s personal physician. The Buddha’s teachings eventually became a huge influence on Jivaka and his work. When Buddhism spread to Thailand, the practice of yoga and Ayurvedic medicine also followed. TYM, also known as Nuad Boran in Thailand, took shape in the Buddhist temples of Thailand and was passed down from master to apprentice through oral tradition. Because Buddhist philosophy is so enmeshed in the practice of TYM, practitioners view it as the physical application of “metta,” which translates into – loving-kindness.

Thai Yoga Massage has since evolved into two main styles, the northern and the southern. The Old Medical Hospital in Chang Mai, Thailand has become the main hub for the northern style and Wat Pho in Bangkok, the center for the southern style. Although the two share a lot in common, they differ in how the energy lines are worked. The northern style involves palming and thumbing of the Sen lines and is generally a bit more active with its stretches and yoga poses. The southern style is more relaxed in its approach and uses a technique known as plucking to stimulate the energy lines via the nerves. These days, more and more practitioners are combining elements of both styles making it harder to distinguish between the two. In addition to these techniques, practitioners of both styles will often use their forearms, elbows, knees and feet to work the body.

There are a few other key distinctions worth noting between the different styles of Thai massage, namely the pacing and amount of pressure used. These elements do have a stylistic component to them but more often than not are influenced by the individual practitioner. Some may choose to use a quick and vigorous pace to work the energy lines of the body, while others will work in a slower, more deliberate manner. The other element is how much pressure is used during a session. Originally, Thai massage was widely administered as a form of medicine for various types of malaise throughout Thailand, so relaxation was not considered its main objective. In the hands of a few master practitioners however, the application of pressure could vary greatly from a light to deep touch depending on the client and the area being worked on. Working in this fashion takes into account both our physical and energetic bodies and becomes meditative in nature.

Traditional TYM focuses a good amount of time on the legs and lower body. The reason for this has to do with how much time Thai people spend on their feet. A majority of them spend their day working on their feet. By contrast, most westerners spend most of their day sitting in a chair in front of a computer. They also tend to be taller and heavier and have more upper body issues. At Brooklyn Reflexology a form of northern Thai massage, which addresses both the lower and upper body is used. An emphasis is placed on flow and fluidity of movement to help create a deeply therapeutic affect on the body, mind and spirit.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

When considering muscular imbalances in the body, it’s important to remember that some muscles are mechanically predisposed to being short and tight, while others are prone to being weak and inhibited. It’s no coincidence then that most people complain of neck and shoulder tension, while you never hear anyone say, “my abs are feeling too tight…” For this reasons, muscles tend to fall under two main categories: postural and phasic.

Postural muscles by their very nature are designed to keep us balanced and upright. A perfect example of this is the paraspinal muscles. These long, mound-shaped muscles on either side of the spine have to work continuously to keep the spine erect. These muscles are built for endurance and have a high threshold for sustained contraction and fatigue. But like everything else, they have their limit and can easily fall victim to over use.

Phasic muscles on the other hand were designed primarily for movement. The glutes for example, help to extend the hip and leg when we’re walking. So if we lead a fairly sedentary life, these muscles can easily become weakened and atrophy. Phasic muscles are easily fatigued and don’t have the endurance that postural muscles have. To understand why this is, we have to consider something known as “fast-twitch, type II muscle fibers” and “slow twitch, type I muscle fibers.”

Phasic muscles contain a high density of fast-twitch muscle fibers. They rely primarily on anaerobic metabolism to fuel their contraction and for that reason, can easily be fatigued. Anaerobic simply means, without oxygen. So whenever these muscle fibers are recruited, they’re relying primarily on a metabolic process that does not use oxygen, such as the body’s glycogen stores. As a result they produce waste by-products, which can impair muscle contraction, which in turn leads to fatigue. Fast-twitch muscle fibers are usually involved in rapid and intense movements of short duration. Think of weight lifting, throwing a ball, or sprinting.

Postural muscles are imbued mostly with slow-twitch muscles fibers. These slow-twitch fibers rely on aerobic or oxygen-based metabolism and have a high threshold for fatigue. Low to moderate intensity activities such as walking or jogging rely heavily on the aerobic nature of these slow-twitch muscle fibers. Any activities involving endurance, whether it be walking or running a marathon, require oxygen as fuel. This is why we become fatigued even during low to moderate activities done over a prolonged period of time. As oxygen stores become depleted during our workouts, we start relying more on anaerobic metabolism as a fuel source.

There’s a third type of fast-twitch muscle fiber that uses oxygen as a fuel source and is resistant to fatigue, much like the slow twitch muscle fibers described above. To distinguish between these two very different types of fast-twitch muscle fibers, they’re often referred to as “fast oxidate, type IIA” and “fast glycolytic, type IIB” – which is described above. In the order of recruitment, these fast oxidate, type IIA muscle fibers are often called upon last to do their job (the first being the slow twitch type I, and the second being the fast glycolytic type IIB). Another distinction worth noting amongst these different types of muscle fibers is their color. The slow- twitch, type I are rich in oxygen and are therefore red in color. The fast-twitch, type IIA are red to pink. And the fast-twitch, type IIB are white/pale due to their low oxygen stores.

Imbalances between postural and phasic muscles can become pronounced leading to a condition known as “upper crossed syndrome” — when it involves the upper body, and “lowered crossed syndrome” — when it involves the lower body. These syndromes are a result of short and tight muscles going unchecked by their weak and inhibited counterparts. In the case of lower crossed syndrome, we have an exaggerated forward tilt of the lumbar spine, something known as a hyperlordosis, created by tight lower back muscles (erector spinae & quadratus lumborum), in addition to tight hip flexor and adductor muscles (iliopsoas, rectus femoris, tensor fasciae latae, adductors). The weakened abdominals, glutes and hamstrings are no match for these strong postural muscles. To bring balance here, one would have to focus on strengthening the weakened muscles and stretching the tightened muscles.

upper-crossed lower-crossed

Below is a list of key postural and phasic muscles:

Postural Muscles (prone to tightness):

Gastrocnemius, Soleus, Tibialis Posterior (lower leg)

Hamstrings, Rectus Femoris (upper leg)

Iliopsoas, Tensor Fasciae Latae, Piriformis (hip)

Erector Spinae (cervical & lumbar), Quadratus Lumborum (lower back)

Upper Traps, Levator Scapulae, Sternocleidomastoid, Scalenes, Suboccipitals (upper back and neck)

Pectoralis Major (chest)

Flexors of the upper limb (i.e. Biceps)

 

Phasic Muscles (prone to weakness):

Peroneals, Tibialis Anterior (lower leg)

Vastus Medialis, Intermedius & Lateralis (upper leg)

Gluteus Maximus, Medius & Minimus (hip)

Rectus Abdominus (mid-section)

Serratus Anterior, Rhomboids, Lower Traps (shoulder & upper back)

Short cervical flexors (i.e. Longus Capitis & Longus Cervicis)

Extensors of the upper limb (i.e. Triceps)


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Some Recent Research: Massage Therapy for Reducing Pain, Anxiety, and Muscular Tension in Cardiac Surgery Patients.

A study published in The Journal of Thoracic and Cardiovascular Surgery reported that during a randomized trial, researchers found massage therapy was more beneficial for cardiac surgery patients who were experiencing pain, anxiety and muscular tension when compared to cardiac patients who were involved in the same study and received an equal amount of rest time.

Study methods: There were 152 adult patients recently admitted for cardiac surgery involved in the study. The participants were randomly put into two groups: one received massage therapy after surgery while the control group was simply offered rest time. Of the 152 patients who participated, only 146 of them went on to receive rest time or massage due to complications, such as cancelled surgery or being waitlisted.

Pain, anxiety, relaxation, muscular tension and satisfaction were measured with visual analog scales. Prior to day one of the study and after its conclusion, participants’ heart rate, respiratory rate and blood pressure were also measured. Researchers gathered additional information by holding focus groups and listening to the participants’ feedback.

Protocol: Participants were given a total of four massages or rest time sessions over a six-day period, beginning on day three or four and then again on day five or six after surgery.

Results: For those volunteers who received massage, there was a 52 percent reduction in pain in comparison to the participants who received an equivalent amount of rest time, who saw no major improvements.

On day three and four, participants receiving massage therapy reported a 58 percent reduction in anxiety, and this reduction increased on days five and six. Both groups saw significant improvement in relaxation on days three and four, but only massage was effective on days five and six. Additionally, a 38 percent reduction in pain was also noted on days five and six in the massage therapy group.

This trend continued throughout the study, with massage patients reporting greater relaxation scores and a 54 percent reduction in muscular tension. Participants offered rest time did see a reduction in muscular tension on the third and fourth days, however the results were not the same on days five and six.

References

Braun L.A., Stanguts C., Casanelia L., Spitzer O., Paul E., Vardaxis N.J., Rosenfeldt F., Massage Therapy for Cardiac Surgery Patients—a randomized trial. The Journal of Thoracic and Cardiovascular Surgery. 2012 Dec; 144(6):1453-9, 1459.e1. doi: 10.1016/j. jtcvs.2012.04.027. Epub 2012 Sep 7.

Article reprint from Massage Therapy Journal, Fall 2013


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

If you’ve ever gone for a deep tissue massage only to be let down by the amount of pressure used, then you’re not alone. A majority of people equate ‘deep tissue’ with ‘deep pressure.’ The opposite can also be said of a Swedish massage. If you’re someone who likes only light to moderate pressure, then chances are you’ll go with a Swedish massage. So why is it that people get less than what they expect from their massage? The reasons can be as varied and as simple as: your therapist’s individual style or strength; your therapist’s training and experience; the amount of communication between therapist and client; and not least of which, some common misconceptions.

Just about everyone expects a firm touch when they go for a deep tissue massage. The term ‘deep tissue’ though can be a misnomer. A deep tissue massage is designed to target the deeper layers of muscles in your body and not necessarily to deliver deep pressure uniformly. This is misconception number one. The amount of pressure used in a deep tissue massage can vary greatly, from a light, superficial stroke designed to warm up the muscle, to a deeper, more focused application of pressure used to release adhesions. This is such a common misconception that even some therapists fall into the trap of using more pressure than is needed. By contrast, a Swedish massage is designed to target the superficial layer of muscles, which in some cases may not require as much pressure. So how do you ensure you’ll get the best massage for your money? The key is communication.

Another common misconception is that it’s better to remain silent for the sake of propriety. “The therapist knows how much pressure to use, even if I’m silently screaming in agony.” You may be thinking…, not me! But you’d be surprised at how many people suffer in silence. Your therapist should establish those lines of communication by asking you your preferences and checking in with you periodically throughout the massage. Some areas may require more pressure than others, so it’s at these moments when communication is crucial. There may also be a disconnect between what your body is saying and what your expectations are. Some therapists may use your body’s reaction to guide them in the amount of pressure they use. If you tense up or your breathing becomes shallow and subdued, then chances are the amount of pressure you’re getting is at or beyond your threshold.

Since pain is such a subjective matter, one person may prefer that feeling and another may not. The question of how much pressure to use has now become more complicated. From a purely therapeutic standpoint, the body never lies. If your muscles are splinting and tensing up, it’s your body’s way of saying ‘enough!’ Of course, depending on the circumstances, that may change and often does. If for example, you’ve recently strained a muscle or are dealing with chronically tight muscles, your body may react to ‘too much pressure, too fast’ by tensing up. In cases such as these, it may be a matter of warming up the tissue sufficiently or using a different technique, which can then allow you to go deeper. But generally speaking, trying to push through this resistance with a ‘take no prisoners’ approach may actually do more harm than good.

Some therapists may have a system they use to help modulate the pressure to your liking. Some may not. The important thing to remember is that you speak up and let your therapist know what your preferences are. If you clearly communicate this and you still don’t get what you’re looking for, then it may be a matter of finding the right therapist. In light of all these variables, not everyone is a good match. Do your research and find the therapist that suits your needs.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

The following was a treatment plan submitted during our clinical training at the Swedish Institute in NYC. It provides detailed, step-by-step instruction on a western style, medical massage approach for clients dealing with severe rheumatoid arthritis. While it might be more on the technical side, it should underscore the amount of consideration taken in a clinical setting where massage is administered every week, for a 6-8 week period.

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Goals for treatment should include: increasing flexibility and range of motion (ROM); relieving aches and pains related to muscle stiffness; increasing circulation – especially in clients with cardiovascular issues; reducing inflammation and joint pain during chronic flare ups/remissions; reducing contractures and adhesions; reducing anxiety and depression related to RA.

Bolstering to the knees, hip/lower back, and cervical spine may aid in relieving undue stress at these joints. Staying within a client’s pain threshold and using care to not apply overpressure when performing ROM, should also be observed. Some clients may develop osteoporosis, so caution should be taken with the amount of pressure used during a session.

Starting in supine, so as to better perform ROM and stretching techniques, we would begin at the arms. Moving the shoulder joint through coronal abduction/adduction, flexion/extension, medial/lateral rotation several times in order to warm up the joints and increase ROM. Moving down to the elbow and performing flexion/extension, supination/pronation, and finally the wrist with flexion/extension, radial/ulnar deviation, and circumduction. Taking the client through these gentle movements is invaluable in breaking up any fibrotic changes that may have taken place.

Applying myofascial release with passive stretching to the wrist flexors, biceps at the forearm, and pectoralis major at the shoulder, is a great way to promote length along these potentially hypertonic muscles. Resisted isometric tests (RIT) to the clavicular and sternal fibers of pectoralis major, followed by circular friction, will help to open up the chest and promote deeper breathing in this restricted area. Trigger point work, especially to the flexors of the wrist, may help to break up adhesions and promote blood flow to the area. Passive extension of the digits of the hand along the MP & DIP joints will promote lengthening in flexor digitorum superficialis and flexor digitorum profundus, respectively. Care should be taken with any ROM techniques at the wrist and fingers, since arthritic flare-ups and local osteoporosis are very common in these areas.

At the knees and ankles, gentle ROM would be performed. Cross fiber friction along the patellar ligament and muscle stripping of the quadriceps would promote length in these muscles. Mobilization of the patella itself, if not too painful for the client, would help to break up any fibrotic adhesions related to joint degeneration. Muscle stripping the tendons of the plantar-flexors and peroneals, would promote length and increase ROM. Cross fiber friction to the tendons would help to realign any scar tissue that may be present. Deep effleurage and petrissage to the foot will help to relax the client and increase blood flow to the extrinsic muscles of the foot.

In prone, vibration up the paraspinal muscles, followed by some myofascial release, would promote a deep state of relaxation and provide a nice warm-up of the area. Circular friction along the attachments for levator scapulae and upper trapezius would help to separate and realign its fibers. Muscle stripping and cross fiber friction to the erector spinae would help to release any adhesions related to muscle imbalance. At the hip, deep petrissage and circular friction along the fibers of quadratus lumborum would help to increase circulation and alleviate any pain resulting from contracture of this hip hiker muscle. Finally, RIT to the Hamstrings followed by myofascial release along its fibers would increase inhibition and allow for a deeper stretch of the fascia and its fibers.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Rheumatoid arthritis (RA) is an autoimmune disease which causes chronic inflammation of the joints of the body. Systemic by nature, it can also affect surrounding structures such as muscles, tendons/ligaments, blood vessels, and organs. The most commonly affected sights, however, include the small joints of the hands and feet, elbows, ankles, and knees. Women are three times more likely to be affected and its onset commonly occurs between the ages of 40 and 60.

RA often impacts multiple joints in an insidious, bilateral fashion (that is, if the right wrist is affected, the left will be as well). Sufferers often experience episodic flare-ups followed by remissions, which can last weeks to years. During flare ups, symptoms can range from fever, chills, fatigue, muscle pain, loss of appetite, to joint inflammation (redness and heat) and joint stiffness – which in most cases gets progressively worse.

In extreme cases, the condition can lead to gnarled and distorted deformities of the joint, loss of range of motion (ROM), and chronic pain. Inflammation of organs such as the heart and lungs can cause serious cardiovascular disorders and invariably results in organ failure. It has also been known to cause a condition called Vasculitis (inflammation of the blood vessels), which if not treated properly, can lead to necrosis of tissue. Since RA is a degenerative joint disease, it is not uncommon for suffers to eventually develop some form of muscular atrophy and local osteoporosis surrounding the affected joints.

The causes of RA are unknown, although it is thought to be a genetically inherited condition. Triggers such as streptococcus infections, viral and other bacterial infections, as well as smoking in some cases, are all believed to play a part. For some unknown reason, the body’s immune system attacks the synovial membranes of the body. Antibodies (RA factor) and inflammatory mediators produced by lymphocytes and white blood cells are produced and proliferated throughout the joint spaces and synovial linings. An inflammation response ensues, causing the synovial lining to thicken and swell. A substance called “Pannus”, which is produced by the cells of the lining, slowly erodes away the joint capsule, the articular cartilage, and eventually the bone. As a result, scar tissue develops and forms an ankylosis. Whether it be a fibrotic ankylosis restricting the ROM of a joint, or a bony ankylosis which fuses the bones together, the results can be debilitating.

The emotional and psychological implications of the condition are commonly fraught with chronic pain and daily limitations. During flare-ups, sufferers often experience pain in the morning and after prolonged periods of inactivity. This fact makes getting up in the morning and facing the day a particularly daunting task. As a result, sufferers tend to group their errands and tasks into as few activities as possible – so planning and forethought is of major importance. Socially, people with RA tend to curtail their interactions and engagements with others out of sheer necessity. Dancing, playing sports, or even going for a stroll, take on a whole new meaning. Emotionally speaking, this decrease in contact with others can take its toll on some.

Common treatments for RA can include taking aspirin and cortisone to reduce inflammation to anti-biotics and physical therapy for long-term sufferers. Immunosuppressants such as methotrexate have become popular in preventing further joint degeneration. NSAIDS, gold salt injections, and various other anti-inflammatory drugs have been used to alleviate pain. And as we will see, a treatment plan during periods of remission to help increase circulation, ROM, and decrease stiffness and pain at the affected joints.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Whether it’s the changing of the seasons or more long-term, chronic feelings of anxiety and depression, recent research is showing that massage therapy can help improve mood and reset circadian rhythms, which can lead to better sleep and more energy.

Improved Mood

A randomized study of 34 women with stage 1 or 2 breast cancer examined how massage therapy impacted depression and anxiety levels. The massage therapy group received a 30-minute massage three times per week for five weeks, which consisted of stroking, squeezing and stretching techniques to the head, arms, legs, feet and back. The control group received no intervention. Study participants were assessed on the first and last day of the study, and assessment included both immediate effects measures of anxiety, depressed mood and vigor, as well as longer term effects on depression, anxiety and hostility, functioning, body image and coping styles. A subset of 27 women also had blood drawn to examine additional measures.

The immediate massage therapy effects included reduced anxiety, depressed mood and anger. Longer term effects included reduced depression and hostility, as well as increased serotonin values, NK cell number and lymphocytes. Serotonin, a neurotransmitter with functions in various parts of the body, works to regulate mood, appetite, sleep, memory and learning.

Better Sleep

In another study examining the effect of massage therapy on the adjustment of circadian rhythms in full-term infants, researchers measured the rest-activity cycles of infants before and after 14 days of massage therapy, starting at 10 days old and again at six and eight weeks of age.

Rest-activity cycles were measured by actigraphy, and 6-sulphatoxymelatonin excretion was assessed in urine samples at six and eight weeks of age. The concentration of 6-sulphatoxymelatonin in urine correlates well with the level of melatonin in the blood, and melatonin is what helps control sleep and wake cycles.

At 12 weeks, nocturnal 6-sulphatoxymelatonin excretions were significantly higher in the infants receiving massage therapy than those in the control group, suggesting that massage therapy can enhance coordination of the developing circadian system with environmental cues.

References

Hernandezreif, M. 2004. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. Journal of Psychosomatic Research, 45–52.
Ferber, S., Laudon, M., Kuint, J., Weller, A., Zisapel, N. 2002. Massage therapy by mothers enhances the adjustment of circadian rhythms to the nocturnal period in full-term infants. Journal of Developmental & Behavioral Pediatrics, 410–415.

Article reprint from Massage Therapy Journal, Spring 2016


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In some cases, the affects of heel pain may have a different source. As previously mentioned, tight calf muscles can often predispose you to developing plantar fasciitis. A byproduct of this are trigger points. Trigger points are tiny contractions in the muscle fiber which form as a result of over-use, strain, trauma, or shortened and tight muscles. Trigger points refer pain to other areas of the body. In the case of the lower leg, there are several muscles which could be referring pain to the heel and long arch of the foot – the same area where plantar fasciitis pain occurs. Let’s take a look at the first image below.

Soleus TP

This image depicts a trigger point in the middle of the soleus muscle. The soleus is a large calf muscle that plays a major role in plantar flexing your foot. The muscle is accessible half way down your lower leg and attaches itself to the foot via the Achilles tendon. If the muscle is tight, it will keep your foot plantar flexed (toes pointing down) and limit the amount of dorsiflexion (toes pointing up) available. This limitation will invariably put a strain on the muscles and fascia of the foot.

Quadratus Plantae TP

This second image shows a trigger point in the quadratus plantae muscle — a deep intrinsic foot muscle. Pain from a trigger point in this muscle can be a sharp, stabbing pain preventing you from putting your full weight down on your heel.

Gastrocnemius TP

And lastly, another common site of plantar fasciitis pain is along the medial arch of the foot. A trigger point in the medial head of the gastrconemius muscle can often refer pain to this area. Your gastrocnemius muscles are the superficial muscles found on the upper part of the lower leg. These muscles are very strong, powerful muscles which also attach to the foot via the Achilles tendon. They are often recruited in activities such as sprinting and jumping due to their capacity to lift your entire body weight.

It’s important to remember that while true plantar fascitiis takes time to heal, the effects of trigger points in these muscles could perpetuate pain in the area long after the condition has resolved itself. Along with treating the symptoms of referred pain, trigger point therapy has the added benefit of addressing tight calf muscles, which could be contributing to the condition. So whether you’ve been diagnosed with plantar fasciitis or are dealing with foot pain of some kind, in addition to your conventional treatments, trigger point therapy in combination with reflexology should be a part of your recovery plan.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

We rely on our feet to take us just about everywhere. So if heel pain is causing you to curtail your daily activities, this can be a huge problem. In the first half of this article, we’ll look at the most common form of heel pain — plantar fasciitis.  In the second half, we’ll consider how the effects of trigger points in the lower leg muscles can be a contributing factor and/or the cause of your heel pain!

Plantar fasciitis is a fairly common condition that causes pain and inflammation in the fascia which cover the bottoms of your feet. These tough bands of connective tissue run from your heel bone to your metatarsals and provide a good amount of arch support. Micro-ruptures can form due to repeated pulling, stress, and/or trauma to the area. If not treated properly, the condition can become chronic and lead to the formation of a heel spur, which can then cause further irritation and pain.

Plantar fasciitis typically affects those who have relatively: high arches (pes cavus), flat feet (pes planus), tight calf muscles, or tight, ill-fitting shoes. It can also occur in people who spend most of their day on their feet, those who are overweight, and runners who suddenly increase their activity level. Excessive pronation of the foot, running on sand or uneven surfaces, and inadequate arch support from worn out shoes can also be contributing factors.

The major signs and symptoms include:

– Pain at the heel when weight bearing

– Morning stiffness and pain that decreases with activity

– Tenderness along the medial arch when pressure is applied

– Pain when standing on your toes and /or walking on your heels

– Numbness along the outside of the foot

– Occasional swelling over the heel

– X-rays that reveal bone spurs where the fascia attaches on the heel bone

If you’ve been diagnosed with plantar fasciitis, chances are that most conservative methods should help alleviate the condition in a majority of cases. Such remedies may include:

– Rest, along with an over the counter NSAID to help with pain and inflammation

– Ice and myofascial massage to the affected area

– Orthotics and/or new shoes with good arch support

– Stretches for lower leg and foot muscles

– Night splints

In severe cases when the condition is particularly chronic and debilitating, your doctor may prescribe cortisone shots. While the shots may help to manage the condition, they are not a cure. It is crucial to be proactive and stave off any possible long-term effects by doing your homework. This will help speed up the recovery time significantly.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist,  ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In part one of Anatomy of the Foot, we covered the basic structure of the foot — from the three sections and three arches, to the bones and their ligaments. In part two, we’ll get into the muscles and tendons that make the foot move.

Tendons

Like the ligaments of the foot, there are numerous tendons that attach the muscles of the lower leg to the foot. Tendons are the cord-like structures that attach muscle to bone. Here are a few key tendons along with some common forms of tendonitis.

Achilles Tendon: One of the most recognizable tendons of the body, the Achilles tendon is located at the back of the heel and attaches the calf muscles of the lower leg to the calcaneous. This tendon helps to flex the foot downward and propel you forward. Achilles tendonitis can result from overuse of the tendon while running or jumping or from a tight shoe, which can put pressure on the back of the heel.

Peroneal Tendons: There are two peroneal tendons which attach the lateral muscles of the lower leg to the foot. These tendons run underneath the lateral malleolus (the boney knob on the outer ankle) and when overused, can often times lead to peroneal tendonitis. The pain is usually felt along the lateral malleolus and heel, and can also be related to a high arch or a supinated (rolled in) foot.

Tibialis Posterior Tendon: This tendon attaches one of the deeper lower leg muscles to the foot. The tendon runs underneath the medial malleolus (the boney knob on the inner ankle) and when overused can lead to posterior tibial tendonitis. Common amongst runners or people with hyper mobile or pronated feet, pain and swelling can occur along the inner part of the ankle.

Anterior Tibial Tendon: The tendon of the anterior tibialis muscle, located in the front of the lower leg, runs over the top of the ankle to attach itself to the bottom of the inside of the foot. Pain and swelling along the top of the ankle and foot could be a sign of anterior tibialis tendonitis. This can result from excessive downhill running.

Bursa and Bursitis: Bursitis is an inflammation of the bursa sacs which lie under tendonous joints and are designed to reduce the friction against bone. One of the most common sites for bursitis on the foot is just behind your heel under the Achilles tendon. Often referred to as a “pump bump,” this bursa lies underneath the Achilles tendon and can be irritated from a tight shoe. Retrocalcaneal bursitis, as it’s called, usually develops over time and is often more acute and localized than the pain associated with Achilles tendonitis.

Muscles

Of the twenty intrinsic muscles found on the foot, only two are located on the dorsal (top) part of the foot. Seven muscles are found on the plantar (bottom) part of the foot. And the other eleven (the interosseous and lumbricals) are found between the metatarsal bones.

Dorsal foot muscles: The extensor digitorum brevis and the extensor hallucis brevis are short toe extensors. The latter extends the big toe and the former extends the other four toes.  The interosseous muscles lie between the metatarsal bones and help to move the toes from side to side and also aid in flexion and extension. There are actually two set of these interosseous muscles. The dorsal component has four muscles and the plantar component has three. Technically these muscles lie between the metatarsals, but because they’re most easily accessible from the top of the foot, they’re usually considered dorsal muscles.

Plantar foot muscles: The plantar surface of the foot is home to three layers of muscle.

First Layer: The first and most superficial layer contains three muscles. First on the list is the flexor digitorum brevis muscle which lies directly in the middle of the foot and attaches the heel to the toes. This muscles aids in flexing (curling) the four smaller toes. The abductor hallucis muscle lies along the medial longitudinal arch and helps to abduct or rather, move the big toe away from the other toes. The abductor digiti minimi muscle, found along the lateral longitudinal arch, helps to move the little toe away from the other toes. These last two toe abductor muscles are crucial in making the minor adjustments necessary to keep your balance.

Second Layer: This layer contains five muscles. The quadratus plantae muscle attaches the heel bone to the tendons of a long flexor muscle. This configuration makes it a strong aid in flexing the toes. The deeper lying lumbricals, of which there are four, lie parallel to the metatarsal bones. These tiny muscles help to flex the 2nd-5th toes.

Third Layer: This third and deepest layer has two big toe muscles and one little toe muscle. The two big two muscles are the adductor hallucis and the flexor hallucis brevis muscles. The adductor muscle moves the big toe closer to the other four toes and the flexor muscle bends the big toe downward. The last muscle in this layer, the flexor digiti minimi brevis muscle, helps to flex the little toe.

Covering all these layers of muscle are two bands of fascia that run for the heel to the ball of the foot. When irritated, it can lead to a fairly common condition called plantar fasciitis – an inflammation of the fascia.

Movements of the Foot

Finally, let’s discuss the four major planes of movement of the ankle and foot. The foot is capable of making numerous adjustments along its 33 joints, all of which are necessary for maintaining balance. For the sake of simplicity, we’ll consider the movements of the ankle joint, which move the foot.

The four major planes of movement are: dorsiflexion, plantarflexion, inversion and eversion. Each of these planes has a degree of movement that is considered part of the normal range of motion (ROM) found at the ankle.

Dorsiflexion: When you lift your foot so that your toes are pointed upward, this is called dorsiflexion. About 20 degrees of dorsiflexion is considered normal.

Plantarflexion: Flexing your foot so that your toes point downward is considered plantarflexion. Typically, 50 degrees of plantarflexion is about average.

Inversion/Supination: When your foot rolls inward so that your toes are pointed toward the midline of the body, this is referred to as a supinated or inverted foot. There tends to be more variability in this plane of movement than the previous two, so a normal range is usually between 45-60 degrees.

Eversion/Pronation: This occurs when your ankle rolls outward and your toes point away from the midline of the body. Similar to inversion, pronation of the foot falls within a normal range, which is typically 15-30 degrees. This is notably less than inversion/supination.

As one can see, there’s quite a bit to consider when discussing the feet. Hopefully this short anatomy lesson will give you some working knowledge and better equip you in making informed decisions about the care of your feet.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

When you consider the fact that each human foot is comprised of 26 individual bones, 20 intrinsic muscles (located on the foot), 11 extrinsic muscles (located on the lower leg but operate the foot), 33 joints, over 114 ligaments, and two pea-sized sesamoid bones, you probably don’t give your feet much thought… until they start to hurt. The foot is an extraordinarily complex and rugged structure, perfectly designed to keep you upright and mobile. Let’s take a closer look at the anatomy behind the foot.

Bones

The foot is subdivided into three sections:

Hindfoot: This area consists of 2 bones: the talus, which articulates with the tibia and fibula bones of the lower leg to form the talocrural, or ankle joint; and the calcaneus, which forms the heel of the foot and bears the brunt of your body weight.

Midfoot: The five bones of the midfoot help stabilize and support your body and form the arches of your feet.  You have 3 cuneiform bones (medial, intermediate, lateral), a navicular and cuboid bone.

Forefoot:  The forefoot is comprised on 19 bones. There are 5 long metatarsal bones which attach to the five toes. Each toe consists of 3 phalanges except for the big toe, which only contains two.  That’s a total of 14 phalanges or smaller bones in your toes alone.

The Three Arches

The foot consists of three distinct arches: the medial and lateral longitudinal arches, and the transverse arch.

The medial longitudinal arch is the highest and most prominent of the arches. It extends from the heel on the inner part of the foot to the ball of the foot along the first three metatarsals.

The lateral longitudinal arch is relatively less pronounced and closer to the ground than its medial counterpart. It runs from the heel on the outer part of the foot along the 4th and 5th metatarsals.

The transverse arch runs across the metatarsal heads along the ball of the foot.

Together, these three arches form the shape of your foot and determine to a large extent how your weight is distributed across its surface.

Ligaments

The arches of the feet are formed and supported by the smaller intrinsic muscles as well as its numerous ligaments. Ligaments are tough bands of tissue that attach bone to bone and provide stability and protection to the area. Of the hundreds of ligaments found in the foot, there are a few which are of particular importance.

The Deltoid ligament: (also known as the medial ligament) This ligament originates on the medial malleolus (the large knob on the inner part of the ankle) and fans out to attach itself to the calcaneus, talus and navicular bones. The deltoid ligament is actually comprised of several ligaments designed to protect the inner part of the ankle from undue medial stress.

The Spring ligament: (also known as the calcaneo-navicular ligament) This ligament is located on the inner side of the foot and attaches the calcaneous to the navicular. This tiny little ligament is crucial in maintaining the medial longitudinal arch of the foot.

The Collateral ligament: (also know as the lateral ligament) This ligament, found on the outer part of the ankle, is also comprised of several ligaments. The purpose of this ligament is to protect the outer part of your ankle from undue lateral stress.

The Calcaneo-cuboid ligament: This tough band of tissue attaches the cuboid bone to your calcaneous on the outer part of the foot. This ligament plays a role in supporting the lateral longitudinal arch of the foot.

Ankle Sprains: A sprain is an injury to a ligament and its surrounding structure. You may have also heard of strains. A strain is an injury to a tendon (and/or its muscle), which attaches muscle to bone. There are two common forms of ankle sprains: Inversion and eversion sprains. Let’s start with the most common.

Inversion Sprains: 90 percent of all ankle sprains are inversion sprains. An inversion sprain occurs when the tendons and ligaments of the outer ankle are over-stretched. This usually occurs when the ankle rolls down and inward. In inversion sprains, the most commonly affected ligaments are the anterior talofibular and calcaneofibular ligaments of the collateral ligament and the calcaneo-cuboid ligament. Pain and swelling may occur along the outer ankle.

Eversion Sprains: Although eversion sprains are less common, they tend to be more serious. An eversion sprain occurs when the ankle rolls up and outward. Commonly affected tendons are the deltoid and spring ligaments. Pain and swelling typically occurs over the inner ankle and top of the foot.

In the second part of Anatomy of the Foot, we’ll discuss the various muscles and tendons that operate the foot and some of the conditions that can affect them.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Nowadays the amount of stimuli and stressors we have to contend with in our day to day lives can be overwhelming. When you consider the fact that over 80% of all disease and illness is stress related, it becomes clear how crucial lowering stress levels can be.

It’s important first of all to make a distinction between ‘good’ stressors, which can be useful and productive, and ‘bad’ stressors, which can be harmful and destructive. A certain amount of tension in the body is necessary to prepare us for life’s challenges. Exercise is an example of a ‘good’ stressor. As long as we can manage the stressor, then it can have a positive effect on our lives. When the stressor becomes chronic or overwhelming however, then it can have the opposite effect.

Hans Selye first made popular the idea of a ‘General Adaptation Syndrome’ or ‘G.A.S.’ in his book, “The Stress of Life.” In it he describes the three stages we go through during a stress response. The first stage is the ‘alarm stage.’  It is here that the body’s ‘flight or flight’ response kicks in via the sympathetic nervous system. Under stress, the body prepares itself to take action by contracting muscles, dilating pupils, elevating glucose and oxygen levels, increasing circulation, and diverting energy stores away from low priority areas, such as the digestive and urinary systems. During the alarm stage, the hypothalamus releases two important neurotransmitters that make these changes possible: epinephrine and norepinephrine.

The second stage is known as the ‘resistance stage’ or adaptation response. During this phase, the body continues to fight off the stressor long after the alarm stage has passed. With the help of the hypothalamus, the pituitary and adrenal glands release cortisol and other corticosteroids into your system. These hormones help to increase blood pressure, cardiac output and gastric secretions by elevating the body’s blood sugar levels. Cortisol has an anti-inflammatory effect but it can also suppress the immune system in varying degrees.

The third and final stage is known as the ‘exhaustion stage.’ Exposure to long-term stress can have damaging effects on the body. If the stress response does not abate, cortisol levels can accumulate in the body and eventually start to weaken the heart, kidneys, adrenals, and blood vessels. The prolonged presence of cortisol can also inhibit the formation of new bone and lead to muscle wasting. It is during this time that the body becomes vulnerable to stress related disorders. Here are a few common stress related disorders:

– Asthma

– Irritable Bowel Syndrome

– Constipation

– Insomnia

– Rheumatoid arthritis

– Gastritis or Ulcers

– Hypertension

– Autoimmune disease

– Ulcerative Colitis

– Eczema

– Depression

– Coronary disease

– Crohn’s disease

– Psoriasis

– Headaches

– Stroke

So how does one maintain a normal and healthy stress response and prevent these conditions from taking hold? The key lies in a preventative care approach to health. Preventative care can take many forms, such as:

– Regular exercise

– A well balanced diet

– Meditation

– Rest & relaxation

– Adequate sleep

– Psychotherapy

– Massage

– Yoga

All these are positive ways in which we can cope with the stresses of our everyday lives. A preventative care approach to health helps create an awareness of our mental and physical well being. It brings balance into our otherwise busy lives.  When we’re in touch with how our bodies feel, we’re better able to detect when something is off or doesn’t feel quite right. This awareness is key. The quicker you can catch something, the quicker you can prevent it from taking hold.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

There are certain aches and pains that arise over time due to repetitive movements that can occur on the job, at the gym, or even at home. And whether we realize it or not, these aches and pains can be the result of a multitude of micro-tears to muscle, fascia, or tendon. These soft tissue structures become comprised from over use and eventually lead to inflammation. Let’s take a look at some of the contributing factors involved in this syndrome.

A lot of overuse injuries occur on the job. They can affect just about anyone from a manual laborer to an office worker. Whenever we perform repetitive actions such as in typing at the keyboard, lifting heavy objects, standing or sitting for prolonged periods, we run risk of overtaxing the soft tissue structures involved in those actions. Carpal tunnel syndrome for example can be the result of faulty mechanics, such as in prolonged extension of the wrist and hands while at the keyboard. It can also occur from micro-trauma due to repetitive movements done over time, such as in those who use power tools, paint, play an instrument or racquet sports — the list can be extensive. The median nerve which passes through the carpal tunnel of the wrist becomes compressed and inflamed, which can then lead to tingling, numbness, weakness and pain in the finger and wrists.

Another place where over use injuries can occur is at the gym or while playing sports. Athletes are notorious for developing tendonitis and stress fractures due to repetitive movements and over use. Runners for example are prone to developing conditions such as Achilles tendonitis, plantar fasciitis, and shin splints, especially in those who are poorly conditioned. People who play racquet sports or golf are susceptible to developing shoulder tendonitis in any of the rotator cuff muscles, golfer’s elbow (which is tendonitis of the forearm flexors attaching on the inner part of the elbow), or tennis elbow (which is tendonitis of the forearm extensors attaching on the outer part of the elbow). People who play soccer, basketball, volleyball, or any sport that requires starting and stopping, cutting movements, sprinting, or jumping can see overuse injuries ranging from patellar tendonitis (i.e. jumper’s knee, runner’s knee), to ITB friction syndrome which is caused by a tight iliotibial band frictioning the outer part of the knee. Chondromalacia Patella or Patellofemoral Syndrome occurs when the patella does not track properly in the patellar groove when the knee is extended under load. Think of doing squats or climbing stairs. The articular cartilage eventually gets worn away, resulting in pain and inflammation along the inner part of the knee.

These types of repetitive use injuries are not limited to the job or the gym. Most of us have hobbies that involve repetitive movements. Playing an instrument is a good example. Think of the muscles involved in playing the piano or the violin. Hours and hours of practice can eventually lead to pain and inflammation of the fingers, wrists, elbows and shoulders. How about gardening? Pulling up weeds or potting flowers can require us to maintain certain positions which can stress our knees, hips and low back. There’s even a condition known as blackberry thumb or gamer’s thumb. De Quervain’s syndrome, its clinical nomenclature, is a tenosynovitis (a tendon sheath inflammation) and repetitive use injury (RSI) of two key tendons attaching on the thumb. It usually results from an over use of the thumb and wrist while texting or playing video games.

Now that we’re familiar with some of the most common manifestations of repetitive use injuries, here are some of things we should consider as part of a preventative care plan:

  • Most over use injuries stem from muscle imbalances. Are we pushing ourselves too far, too fast in our training before we’re properly conditioned? Are we using good form when performing certain movements?
  • Certain jobs may require us to perform repetitive movements at work. If this is the case, are we taking periodic breaks? Can we switch sides so we’re not using the same hand, arm, or shoulder? Are we using faulty equipment to perform these tasks? Developing an awareness of these mitigating factors can go a long way in preventing an injury.
  • Warm ups and stretches. Whether we’re going out for a run or getting ready to play an instrument, a little warming up goes a long way. Gentle range of motion of the joints and targeted stretching of key muscles will help reduce the likelihood of a strain by increasing blood flow and oxygen to the area.

Signs and Symptoms:

If you think you may be dealing with a repetitive use injury, here are some common signs and symptoms:

Localized pain: Whether its Achilles pain, knee pain or shoulder pain, you’ll feel it acutely at the site of inflammation. The pain may be brought on from use of the inflamed muscle or tendon, as in an isometric contraction. It can result from stretching the inflamed tissue. And in advanced cases, the pain may be constant even while at rest.

Tenderness: Minimal pressure to the area can often induce pain. In cases of acute tendonitis, the whole muscle may feel sore to the touch.

Limited ROM: Your mobility of the affected area may be limited and painful. Lifting your arm above your head for example may be hard to do in certain cases of shoulder tendonitis.

Swelling: Inflammation can lead to swelling and heat in the affected area.

Crepitus: Clicking or creaking sounds may be heard during certain movements of the affected area.

Treating over use injuries can require several approaches, not least of which is time to heal.

Treatments:

R.I.C.E.: If you’re not familiar with this acronym, then it maybe one of the only things you should remember when dealing with acute injuries.

  • Rest: In some cases as much two weeks may be indicated. The body needs time to mend the damaged tissue.
  • Ice: applying ice is a great way to reduce inflammation.
  • Compression: wrapping the injured area with and ACE bandage or brace will provide added support and help keep you mobilized.
  • Elevation: In cases of acute trauma and inflammation, elevating the area will help to reduce the swelling.

Proximal massage: Massaging the area directly above the injured site, for example the calf muscles in cases of Achilles tendonitis, will help to increase circulation and drainage to the injured site.

Range of motion exercises: Moving the affect area in a pain free and gentle way after the acute phase has passed, will prevent muscles and tendons from tightening up from under use.

Ice massage/Contrast bathing: Depending on where you are in the healing process, ice massage to the affected area will help reduce pain by decreasing inflammation. Later on in the healing process, heat can be introduced in conjunction with cold applications to create a pumping affect. This is excellent for removing waste byproduct trapped in the affected area.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Zone therapy is often considered the foundation for the theoretical and practical application of reflexology. In the late 1800’s, an English neurologist by the name of Sir Henry Head discovered through a series of experiments that there was a link between a diseased organ and specific areas of skin on the body. These areas often displayed a heightened sensitivity to pressure and touch that other areas did not. Twenty to thirty years later, an American doctor by the name of Dr. William Fitzgerald would take these findings and refine them into the practice of zone therapy used by reflexologists today.

Fitzgerald discovered that there were ten longitudinal zones on the feet and hands, which ran the length of the body. Five zones on either side of the body, with each zone corresponding to a section of the foot and hand that lead up to each toe and finger. See the diagram below. By applying pressure to these zones, Fitzgerald was able to create and observe an anesthetic effect in that part of the body. He became so adept at doing this, that he was able to perform small surgeries using his techniques.

zone therapy

Over the years reflexology has evolved into a finer application of these findings, but the underpinning of it has always been zone therapy. The practical application of zone therapy in a reflexology session can serve several purposes. If an area of the foot displays a heightened sensitivity to pressure, zone therapy can be used as a diagnostic tool for the organs and systems in that region of the body. Someone who is prone to chronic neck and shoulder tension for example may find that the toes, base of the big toe, and 5th metatarsal joint (pinky toe joint) are particularly sensitive. The good news is that applying systematic pressure to these zones will create an analgesic effect in the part of the body, essentially reducing tension and pain levels.

In addition, visual cues can provide a wealth of valuable information for what’s occurring in an area of the body. Bunions, calluses, and dry skin are just a few examples of these cues, which could ultimately signify a longstanding condition in a particular part of the body. The use of zone therapy can therefore help reflexologists ‘zone’ in on specific reflexes that may need extra attention. Having an open dialogue between the therapist and the client is also an integral part of the therapy. The simple reason fort this is that reflexology, or any form of bodywork for that matter, does not have to be painful experience to be effective. Research has shown that touch alone helps to release a flood of endorphins which the body uses to relieve pain. Staying within an individual’s pain threshold helps to relax the body while still creating the desired effect. The feet truly are mirrors of the body. And if we listen to them carefully and treat them accordingly, the health benefits could be immeasurable.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In this 5th and final post on the major muscle groups of the body, we’ll discuss muscles of the lower leg, the back of the thigh, and hip.

The lower leg can be divided into three compartments, the anterior (front), lateral (side), and posterior (back). There are a total of eleven muscles in the lower leg, all of which operate the foot. These muscles are referred to as extrinsic muscles, while the muscle located on the foot itself are referred to as intrinsic muscles. There are three in the front, three on the side, and five in the back. We’ll focus on two of theses muscles, which form the superficial layers of the calf.

Gastrocnemius: Located just below the back of the knee, the two bellies of the Gastrocnemius are what give the calf muscles their contoured shape. They descend about half way down the lower leg and are easily the most superficial and accessible muscle of the lower leg. Due to the fact that Gastrocnemius crosses both the knee and ankle joint, it can just as effectively flex the knee as it can plantarflex the foot. The lower portion of the muscle blends with another lower leg muscle known as Soleus to form the Achilles tendon. The Gastrocnemius is a powerful muscle capable of lifting your entire body weight, making it most active when running or jumping.

Gastrocnemius Soleus

Soleus: Sometimes referred to as the body’s “second heart”, the Soleus muscle plays a very prominent role in pumping blood back to heart. The upper portion of the muscle is buried beneath the superficial bellies of the Gastrocnemius, but its lower half is easily accessible and palpable. Although Soleus does not cross the knee joint, it does blend with Gastrocnemius to form the Achilles tendon. The main function of this muscle is to plantarflex the foot. Unlike the Gastrocnemius, which is known for its short bursts of power, the Soleus is a workhorse muscle, essentially working anytime you’re on your feet.

Hamstrings: The hamstrings as they’re commonly referred to, are the major muscle group found in the back of the upper leg and thigh. There are three distinct and individually named muscles, which surprisingly occupy less space at the back of the leg than one would imagine. The lateral portion of the Quadriceps and the medial Adductors fill in a big portion of the posterior thigh. Yet these three slender muscles are capable of performing several actions that affect the hip and knee in variety of ways.

Hamstrings

  1. Biceps Femoris: The most lateral of the hamstrings, Biceps Femoris has two distinct bellies. One belly originates at the sitz bones and the other shorter head, starts half way down the femur. Both heads then blend together to form a common tendon, which crosses the knee joint to attach on the fibula. This portion of the hamstrings can: flex the knee, laterally rotate the knee (when flexed), extend the hip, laterally rotate the hip, and tilt the pelvis posteriorly.
  1. Semitendinosus & Semimembranosus: The only major difference between these two muscles, which happen to form the medial hamstrings, are their insertion points. They both originate on the sitz bone and they both perform the exact same functions. Semitendinosus overlies the deeper Semimembranosus, but they both cross the knee joint. Instead of blending together to form on common tendon and one insertion point, they each maintain their tendon and attach at slightly different points on the tibia. The Semis can: flex the knee, medially rotate the knee (when flexed), extend the hip, medially rotate the hip, and tilt the pelvis posteriorly.

Moving up the leg and into the hip, we come to an area with many layers of muscle collectively referred to as the ‘glutes’. There is of course Gluteus maximus, which is the most superficial layer of the glutes and one that we’re all familiar with. Beneath this muscle however, lie two other muscles named “gluteus”: Gluteus medius and Gluteus minimus. Both these muscles are key players in moving as well as stabilizing the hip. Then we have the deep six’ lateral rotators – a grouping of six slender muscles that fan out around the head of the femur in the hip socket. As the name implies, they laterally rotate or roll the leg and hip out. One of these lateral rotators is called Piriformis.

Piriformis: If you’ve ever had sciatica or experienced sciatica-like pain, then you’ve probably heard of the Piriformis. The reason for this is that, out of the deep six lateral rotators, the Piriformis is the only one the runs directly over the sciatic nerve. The other five lie beneath it. If for some reason the Piriformis becomes strained or inflamed from overuse or trauma, that extra bit tension could compress the sciatic nerve causing an entrapment.

The Piriformis muscle originates on the sacrum and attaches to a part of the femur called the greater trochanter. As mentioned, it’s a strong lateral rotator of the hip and leg. When the leg is stationary, it can also rotate the body to the opposite side. For that reason, an activity or sport that involves quick cutting or twisting movements could potentially cause trouble for the Piriformis.

Piriformis

Iliotibial Band: Although technically not a muscle, this thick band of fascia covers the outer part of the hip and thigh and serves as central tendon for two muscles: Gluteus maximus and a muscle called Tensor Fascia Lata (TFL). The vertical fibers of the IT band originate and are an extension of both these hip muscles. This thick tendon like structure runs the length of the outer leg and inserts just below the knee on the tibia. The IT band essentially transmits the power of the Gluteus maximus and TFL to help move the hip and leg. More importantly, the IT band helps to stabilize the hip and knee when standing, walking, and running.

IT Band


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

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