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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.

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 as 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.

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.

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.

How does one know they’re getting a reflexology session and not just a foot massage?

In some cases it can be quite obvious. Even if you’ve never experienced a professional reflexology session before, if you’re getting the same three techniques for the entirety of your treatment, chances are you’re just getting a foot rub. And although there is some overlap with massage, a reflexology session typically includes a fair amount of detailed work aimed at targeting the ‘reflexes’ on the feet. This is usually done with a technique called ‘thumb walking.’ Reflexologists use their thumbs to outline and work along specific areas of the body represented on the feet via their reflexes.

One of the first things you should inquire about is the therapist’s qualifications. Are they ARCB certified? The American Reflexology Certification Board (ARCB) is the national governing board that oversees the certification of professional reflexologists. Although massage therapists are qualified to do reflexology, the training in most massage therapy programs is limited in scope and practice. The ARCB requires an additional 200 hours of training in order to become a nationally certified reflexologist.

Since one of the aims in a reflexology session is to target specific areas of the body via their reflex zones, your therapist should speak with you before your session to determine which areas are in need of attention. Just about every part of the foot corresponds to a specific organ, gland or body part. And in most cases the reflex zone is very much a circumscribed area on the foot. For example, if you’re having digestive issues and need specific work along your descending colon reflex, the corresponding reflex is about 1” – 1.5” on lateral aspect along the bottom of your left foot. Or if you’re having sinus congestion and could benefit from having those reflexes worked on, the toes should be given particular attention during the course of your treatment.

Of course it always helps to have a rudimentary understanding of the reflexes and where they are located on the feet. But even if you don’t know or are uncertain, ask your therapist. A knowledgeable therapist won’t hesitate to answer your questions and help provide you with a safe and effective reflexology treatment.


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.

It’s been said that where attention goes, energy flows. Whether our attention is directed inward, for example on a thought or emotion, or outward such as listening to a friend or watching a movie, the things we pay attention to affect us in a very real way. In certain situations we may have little say over the things that require our attention. Work, family, school, are just a few of things that demand our attention on some level. And despite our best efforts to manage all these facets of our lives, we often wind up feeling overwhelmed by it all. Our psyches become so cluttered by all the demands on our attention, that very little is left over for ourselves. As a result, the body and mind fall into disrepair. We get sick, we suffer an injury, we become depressed, and the list goes on and on.

The body and mind need our attention if they are to remain healthy and vibrant. And what is attention other than, energy. Reiki is one word we can give this energy but it’s also been referred to as ‘Chi’ in China, ‘Ki’ in Japan, and ‘Prana’ in India. These words point to the life force inherent in all things. It’s in the foods that we eat, the liquids that we drink, the air that we breathe. It’s the very essence of who we are. We transmit this energy to others every time we speak to someone, look at someone, touch someone, or even by listening and giving our attention to someone.

Reiki is but one way of channeling this energy for the purpose of healing. There are three guiding principles a Reiki practitioner follows: Gassho, Reiji-Ho, and Chiryo.

Gassho literally translated means “two hands coming together”. In India this is known as “Namaste”, which means, “I greet the divine within you”. Before any healing session, a Reiki practitioner will enter a meditative state as a means of quieting the mind and focusing attention. With eyes closed, the hands are placed together in front of the chest. Attention is then focused on the point where the two middle fingers meet.

Reiji-Ho loosely translates means, “methods of indicating Reiki power”. From a Gassho position, the practitioner will ask for Reiki energy to flow through them. Then they ask for the recovery or health of the recipient on all levels. And finally, the folded hands are raised to the third eye in front of the temple and guidance is requested.

Chiryo means “treatment”. Once Gassho and Reiji-Ho are complete, the treatment can begin. A Reiki practitioner will then follow his/her intuition as they begin with the laying on of hands. There are many hand positions that can be used in each area of the body. Sometimes the hands are lightly touching the body; sometimes they are hovering slightly above. Dr Usui, the Buddhist monk who developed Reiki into a healing art form, had many techniques that he used in his treatments. The use of the breathe, the mind’s eye, symbols, and mantras, and of course the hands were all means he used of focusing the Reiki energy into the body.

Touch then becomes one of the most powerful and effective ways of transmitting this healing energy when done with the intention of healing. Unencumbered by words or concepts, communication through touch takes on transcendent quality. Instead of directing the energy through use of the mind, a Reiki practitioner’s hands become the conduit for it, allowing it go to wherever it is needed. It’s at this point the healing power of touch affects us in a very real way. Our attention is drawn to the hands and body, and the energy begins to flow.


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.

Love it or hate it, everyone has an opinion when it comes to stretching. Yet we all do it instinctually. Whether it’s the first thing we do in morning when we get out of bed or the last thing we do after being hunched over our desk for hours. The point of contention arises when stretching is done purposefully, as part of a regimen — either before or after an activity, or as a practice all its own. Whether you fall into this latter category or not, there are a few things we should know about stretching before we make up our minds on its efficacy. In this first post on stretching, we’ll be discussing the anatomy of a stretch.

Let’s face it, some people are naturally more flexible than others. Women tend to be more flexible than men. The young are more flexible and limber than their adult counterparts; and there are several reasons for this. As we age, we progressively loose flexibility as part of the normal aging process. Degenerative changes within the muscle and/or joint capsules (arthritis) can lead to an inactive lifestyle. Inactive muscles will adaptively shorten and eventually become weak. Stretching helps to maintain a certain degree of flexibility, which in turn improves our range of motion. Range of motion (ROM) is the degree of movement available for any given body part or joint.

What is stretching?

So what exactly does it mean to stretch? Stretching is the act of placing a specific body part into a position that will lengthen a targeted muscle, muscle group and/or soft tissue structure. Soft tissue structures come in two varieties: contractile and non-contractile. Examples of non-contractile structures include: ligaments, menisci, and joint capsules. This type of soft tissue was designed to provide support and stability. Their primary job is to limit or control the amount of movement across a joint. Other types of non-contractile soft tissue include fascia, skin and scar tissue. Muscle and tendons are the two primary contractile structures. Tendons attach muscle to bone, and by extension only transmit the force of the contracting muscle across a joint to create movement. Since tendons don’t actually contract themselves, that leaves us with muscles as the primary target for stretching.

Every joint in the human body has a range of motion that is considered normal for that joint. Let’s consider the hip as an example. The hip joint has six planes of movement: flexion, extension, adduction (swinging leg across the opposite leg), abduction (swinging leg away from the opposite leg), medial rotation (rotating leg so knee is pointing towards opposite leg) and lateral rotation (rotating leg so knee is pointing away from opposite leg). For each given movement there is a degree or range, which is considered normal.

Range of Motion Available at the Hip:

Flexion: w/extended knee = 80-90 deg, (w/flexed knee = 110-120 deg)

Extension: 10-15 deg

Adduction: 30 deg

Abduction: 30-50 deg

Medial Rotation: 30-40 deg

Lateral Rotation: 40-60 deg

Some people will fall below this range, others slightly above it. Hip flexion (w/an extended knee) for example tends to be the most limited movement of the hip for most people. Think of bending over to touch your toes. If you have trouble doing this, chances are tight hamstrings, as well as tight gluteal and calf muscles are contributing to this limitation. Those who have suffered an injury or lead a sedentary lifestyle might find themselves in this category.

Stretching can be done actively or passively with the help of an aid or an assistant. Depending on the joint where the stretch is performed, you can see a noticeable difference in the amount of passive ROM available. The neck is perfect example. You can yield a greater amount of ROM at the cervical spine if it’s done passively. This is not always the case for every joint however. The hip joint generally yields the same amount of ROM whether it’s done actively or passively.

Tight, short, stiff muscles have a tendency to limit this normal range of motion, as well as contributing to some other issues, such as:

– Chronic muscle and joint pain due to constant tension

– Interference of proper muscle functioning

– A loss of strength and power

– Restrict blood flow and circulation

– Increased muscle fatigue

– Muscle strain or injury

What happens during a stretch?

Muscles are comprised of thousands of tiny cylindrical cells called muscle fibers. Each muscle fiber contains thousand of ‘threads’ called myofibrils. These myofibrils are what give muscles their capacity to contract, relax and lengthen. Within each myofibril are millions of bands of sarcomeres. Sarcomeres are made up of thick and thin myofilaments containing contractile proteins called actin & myosin. When sarcomeres are regularly stretched to their end point, the number of sarcomeres increase and are added to the ends of existing myofibrils. This is what increases the muscle’s length and ROM.

There are two primary reflexes that are engaged when you do a stretch: the “stretch/ myostatic reflex” and the “golgi tendon reflex”.

Stretch/Mysotatic Reflex: During the first few seconds of a stretch (6-10 seconds), tiny proprioceptive cells called muscle spindle organs (MSOs) are activated. MSOs located in the belly of the muscle contract in order to protect the muscle. Their primary function is to detect changes in the length and speed of the stretch and contract accordingly.

Golgi Tendon Reflex: After the first few seconds of a stretch, another set of proprioceptive cells called golgi tendon organs (GTOs) are engaged. Located near the tendons of a muscle, GTOs detect the amount of tension being exerted over a joint and automatically stop contracting in order to protect the muscle from being overloaded.

Knowing about these reflexes can help us to stretch in a much more effective and safe way. Here are two keep points to remember when stretching:

1. Move slowly into the stretch: In order to mitigate the effects of the stretch reflex, it’s important to move slowly into the stretch and only to the point of comfortable resistance. If you move too quickly or stretch to the point of pain, you will activate the stretch reflex and create resistance within the muscle.

2. Hold the stretch for  at least 10 seconds: After this initial period, the MSOs will cease firing and the GTOs will kick in. GTO activity will create inhibition in the muscle, allowing you to stretch further to a new end point.

In part 2 on stretching, we’ll discuss several different types of stretches, the benefits of stretching, and more pointers on how to stretch safely and effectively.


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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