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There are many times in clinic where a more overall stress reduction protocol is called for. This is particularly the case for conditons such as fibromyalgia, chronic fatigue, rheumatoid arthritis and IBS. The following are some ideas but be creative and adapt as necessary.

Preparatory work• Begin with some deep grounding and

relaxation work for your client. In horse stance lay both your forearms on either side of the spine. Lean your weight in gradually sinking down a bit deeper with each out breath of your client. Wait and hold the pressure as you feel your client gradually starting to relax and slow their breath

• Double palming: Now work both erector spinae at the same time by using a double palming technique while kneeling on the table in proposal stance

• Shu points: Now work the acupressure “Back Shu” points (also known as associated points). The back shu points are found 1.5 tsun lateral and level with the spinous processes of each vertebrae (1 tsun = client’s thumb width). Each back shu point corresponds to an organ in Chinese medicine and the points are used for treatment of chronic conditions. Start at the associated point for the lung (BL 13) which is level with T3 (to find T3 come to the root of the spine of the scapula and draw a line back to the spine. Alternatively count down 3 vertebrae from the prominent C7 which usually sticks out a bit on the back of the neck).

Using supported thumbs work bilaterally coming down one vertebrae at a time to work all the associated points

advancedcpdadvancedcpdadvancedcpdadvancedcpdMassage Fusion: The Jing Method for the treatment of chronic painThe following extract is taken from the exciting new book “Massage Fusion: The Jing Method for the treatment of chronic pain”. “Massage Fusion” is an essential companion for any massage therapist interested in treating common pain issues. Co-written by regular ‘Massage World’ contributors, Rachel Fairweather and Meghan Mari, the authors offer a practical and dynamic step-by-step approach to gaining results with persistent client problems such as low back pain, neck pain, headaches, carpal tunnel syndrome, TMJ, stress related conditions and stubborn sporting injuries.

The extract below is taken from one of the practical chapters illustrating a suggested step by step protocol for treating chronic pain and stress related conditions. The Jing method is based on a unique formulation of advanced techniques using the ‘HFMAST’ formula:

H The use of heat or coldF The use of fascial techniques – both direct and indirect methodsM Treating muscles with precise trigger point therapy – specifically treating

ALL the muscles around an affected joint to release trigger pointsA Acupressure. Treating relevant acupressure pointsS Stretching – using stretching techniques such as static, PNF or active isolated stretchingT Teaching the client self help strategies that lie within the massage therapists scope of practice.

This would include for example self trigger point treatment, simple breathing techniques, stretching or mobilisation exercises

Preparatory work over the drape Double palming down erector spinae

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Fascial Work• MFR cross hand stretches: these can

be performed in many areas over the back. Place your crossed hands adjacent to one another in the area to be released – they should be a few inches apart at this point. Sink down until you have a sense of being on the deep fascial layers that runs around and through the muscles. Then put a stretch on this tissue so you have a sense of tension between your two hands - like a piece of material being stretched to a barrier. If you tune in with your sense of listening touch, after a while you will start to feel the sensation of the tissue starting to move beneath your hands. Make sure you maintain the stretch and “follow” the tissues until you feel the sense of tissue release described in the fascial chapter - this whole process takes around 3-5 minutes so you will need to be patient! Repeat cross hand stretches on anywhere that is needed.

• Leaning in with forearms: In horse stance, use the medial side of your forearms to lean into the tissues in different places on the back. This can feel deeply relaxing for your client.

• Apply wax or other medium

• Single forearm effleurage: Stand in horse position at side of table, knees bent, spine

relaxed but straight. Shift your weight onto the leg nearest the low back area. Use the soft medial part of your forearm to work into your client’s low back, making sure your wrist is floppy and not tense. Shift weight onto your upper leg for a light return stroke.

Continue gradually working deeper into the musculature layer by layer.

Cross to the opposite side of the table to work the other side.

• Power effleurage with hot stones: Heat is fantastic for most chronic conditions such as fibromyalgia and rheumatoid arthritis. If you are trained and insured in hot stone work this is a great time to introduce some dynamic stone strokes. Stand at the head of the table in forward Tai chi stance with a hot stone in each hand. Ask the client to take a breath in and let them know there will be heat coming- they should be be sure to tell you if it is too much. Apply the stones with a few quick strokes to the top of the clients upper arms first as this is a less heat sensitive area. Then glide down either side of the spine using your body weight to work into the erector spinae muscles with the stones. Glide down to the low back with the stroke, working slowly and deeply then come back up with a light return stroke and repeat. Breathe out as you work down the body and imagine qi flowing down your arms

• Deep Forearm work from the head of the table: This is a deeper technique so make sure you start with the other strokes

first to soften the area. From the head of table in Tai Chi stance, start with the ulnar edge of your forearm next to the spine (do NOT use your elbow but make contact with a more broad surface). Keeping your wrist floppy, lean in and work slowly down the erectors. Keeping a comforting hand on the sacrum while working as pictured can also feel god for the client.

• Client supine

• Stone placement: Place large heated stones on the centre line of the body: on the breast bone, solar plexus and belly. These energetically correspond to major chakra points, also anatomically to areas of transverse fascial planes. Place your hands on the belly and heart stone and wait, tuning into the rise and fall of your client’s breath.

• MFR Pelvic Transverse Plane release (“Tummy sandwich”): The majority of the myofascia runs vertically from head to toe but there are places where there are transverse continuities - rather like the hoops of a barrel. One such place is found at the pelvic diaphragm. Place one hand under the sacrum and the top hand between the umbilicus and pubic bone. Make sure the upper hand has the little finger side towards the pubic bone to prevent your thumb straying into the groin area inadvertently! Press the hands towards each other very slightly as if you are holding a water filled balloon. Wait for the signs of yielding and tissue release before following the tissue to the next barrier. This whole process could take up to five minutes or longer in some cases.

If you feel confident and sensitive with your listening touch you can carry out this technique with the hot stone still in place. If not remove it and replace afterwards.

• MFR solar plexus transverse fascial plane release: Repeat the above technique this time with your hands sandwiching the solar plexus area found just at the base of the ribs.

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Power effleurage with hot stones Solar plexus transverse fascial plane release

Myofascial cross hand stretches Single forearm effleurage

Leaning in with forearms

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• Leg pull: Fascial Leg pulls: Take the weight of the client’s leg in your hand. Make sure you have a soft grip. Lean back until you feel the tiniest bit of traction. Wait and hold and follow any movement that is initiated as a result of the stretch. Continue until you feel a softening and a fascial release which will almost feel like the limb is lengthening towards you.

• Wait for several releases, until there is no

more movement.

• If at first you do no get a sense of where the limb wants to move try initiating a very small movement - for example: giving the leg a little lateral rotation, internal rotation or compression and seeing where it seems to go more easily, It’s like you are saying to the leg “do you want to go this way? Yes or no?”

• Arm pull: Take the client’s hand in both your hands and grasp at the base of the palm whilst spreading the palmar fascia slightly. Place the arm on a slight traction. Now wait until you feel the arm start to move as if of its own accord. Make sure you are not consciously initiating a movement. Once you feel the response in the tissues then you can follow the movements whilst making sure to keep the arm on a slight stretch. Watch out for still points where the movement ceases as these are places you need to hold on a stretch until you feel the sensation of tissue release. Follow the arm into several barriers and releases until you feel the whole fascial chain has softened and let go.

• Working the conception vessel: The conception vessel in Chinese medicine runs down the midline of the body and is related to emotional issues. Working the area of the conception vessel in the chest region will help to disperse emotional tension that is held in the chest. Put your hands together in prayer position and work down the centre of the sternum in a rocking motion with the ulnar edge of your hand.

Working with the breathThe breath is often restricted in chronic health problems and releasing trigger points and adhesions in the muscles of breathing can be very helpful for the client.

• Working the diaphragm: With thumbs working bilaterally work up and under the rib with static compression s to help release the diaphragm. Work with the client’s breath - as they breathe out sink deeper into the tissues and treat any trigger points you find by waiting and holding for a release. Work laterally outwards moving a thumb width further each time.

• Stripping intercostals: Standing on the opposite side of the table in Tai Chi stance use supported fingers to strip in between the ribs to treat the intercostal muscles. Make sure you also work the lateral portion ribs so carry your stroke right round the body as far as you can. Continue to the pectoral area, working around breast tissue appropriately.

• Deep work to the posterior neck: Working the back of the neck deeply is a great way to bring the client into their parasympathetic nervous system. Slide your fingers under the neck and work slowly from distal to proximal, pressing up into the posterior cervicals as you do so.

• Cervical mobilisation: Gently move the head in a figure 8 movement. Work slowly encouraging the client to let you take the weight of their head.

• Face massage: Finish with a good old fashioned soothing face massage. Still the ultimate in relaxation!

• Holding head and grounding: Finish the session by gently holding the head, grounding yourself and simply “being” with your client.

Acupressure pointsHere are several acupressure points that can be useful in treating the emotional component of chronic pain issues. These can be integrated into the sequence at any point. Governing Vessel 20 (GV 20) “Hundred convergences”• Location: Follow the line of the two ear tips

upwards. Where the two lines meet, at the top of the head there is a depression - this is

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MFR leg pull

MFR arm pull

Working the conception vessel

Working the diaphragm

Stripping the intercostals

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GV20. With the hands cupping the head hold the point for 3-5 breaths

GV 20 is a powerful point for promoting calmness and bringing clear energy to the head. Traditionally it is believed to help open up the crown chakra for connection to greater spiritual experiences. Great for the beginning or end of a treatment

Conception Vessel 17 (CV 17) “Chest centre”• Location: On the sternum, level with the

fourth intercostal space, between the nipples. A wonderful calming point

Use the third finger to hold the point for 3-5 breaths. It feels nice to have the other hand under the head as you do this

Heart 8 (Ht 8) “Lesser mansion”• Location: Get your client to make a loose

fist. Heart 8 is found where the tip of the little finger rests between the 4th and 5th

metacarpal bones. A good point for calming the emotions and you can also teach your client this one as a self help technique

• Hold with your thumb for 3-5 breaths

Stretches• Any stretches you know will feel great for

chronic pain issues. Here are a few good ones:

Gluteal Stretch• Take the corner of the drape and pull it under

the thigh so the client can hold the end of the drape for security. Get into kneeling tai chi stance on the table with your outside leg up at right angles and your foot flat on the table. Flex the client’s leg at the knees and hips and place it into the fold of your thigh with your outside hand on their knee. Use the inside hand to hold down the other leg and press the client’s flexed leg towards their belly by leaning forward with the pelvis into a lunge. As always work with client communication and breath.

Piriformis stretch• From the last position you can flow straight

into a piriformis stretch. This time take the leg across the centre line, again leaning forward into a lunge

Spinal Twist• Finish with a fabulous spinal twist. Place your

client’s bent left leg over their right. Standing side on to the table, anchor down the shoulder in the pectoral region with your right hand. Use the left hand on the thigh to take your client into a gentle spinal twist, working with their breath and communication. Feels amazing!

Rachel Fairweather is co-founder and director of Jing Advanced Massage. An acclaimed teacher and guest lecturer, she has been a massage therapist for 25 years and is co-author with Meghan Mari of “Massage Fusion: the Jing method for the treatment of chronic pain” published by Handspring Publishing. Based In Brighton, London and Edinburgh, Jing run a variety of courses in advanced techniques to help you build the career you desire including a BTEC level 6 (degree level) in advanced clinical and sports massage – the highest level of massage training in the UK.

Our short CPD courses include excellent hands on learning in a variety of techniques including advanced stretching, trigger point therapy, myofascial release, pregnancy and hot stone fusion. For the first time you are now able to learn these techniques at your own time and pace with our revolutionary new online courses and webinars.

Want to find out more? Please contact The JING Institute! T: 01273 628942 E: info@jingmassage.com W: www.jingmassage.comTwitter: twitter.com/JingInstitute Facebook: www.facebook.com/pages/JING-Institute-of-Advanced-Massage Training/133660816698821

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Acupressure point CV 17

Spinal twist

Acupressure point GV 20

Piriformis stretch

Gluteal stretch

Massage Fusion’ can be purchased from several outlets including Handspring publishing (www.handspringpublishing.com) and Amazon UK. Signed copies are also available from Jing Advanced Massage (www.jingmassage.com)