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You should always Massage Distal to Proximal. Is this yet another Massage Myth?

Recently there has been significant discussion about the massage myths that are frequently perpetuated by therapists (and sometimes even taught in massage schools). For example, pregnancy massage being contraindicated during the first trimester and massage releasing toxins are myths that are in the process of being eliminated.

distal to proximal massage
Massage therapists are always taught that they must massage distal to proximal, from the extremities towards heart. The argument is that the bodywork can increase the back pressure in the veins and potentially damage the vein’s valves through undue pressure.

Although it may appear to be logical rationale, is there any evidence that massaging proximal to distal does cause damage?

If you can imagine a fluid filled balloon inside a second fluid balloon and apply a local pressure to the external balloon, then (without claiming to be a scientist), it is hard to imagine that there will be a significant increase in the local pressure of the internal balloon. Isn’t this the situation in say the hamstrings, the calves or the quads? Would applying a distal force in one of these muscle groups really cause an increase in pressure significant enough to cause damage to a valve in a vein, even if the therapist was performing a strong deep tissue massage?

Please note, I am not advocating that therapists throw out the mantra that you must always work towards the heart. It is always understandable that there should be caution with working distally with anyone who has varicose veins, risk factors for deep vein thrombosis, potentially weaker veins (ie the elderly), during pregnancy, etc. However, let’s say for reasonable fit and healthy clients, is it true that we can really damage their veins?

I’m struggling to find any evidence that it can and has happened.

There are those who argue that working in a distal direction can be effective in achieving your massage goals, particularly if you are performing structural bodywork or the like. If you are massaging with correct intentions and are in tune with the requirements of the client’s, then you should work in the directions that will get the best results for the client.

According to Art Riggs(1) there are significant advantages of working distally:

• Since most muscles attach proximally in order to exert force proximally, working distally lengthens short muscle fibers and fascia for lasting relief from contraction which limits joint function and causes discomfort.
• It frees and lengthens nerves that have shortened along with the muscles.
• It decompresses joints and releases tight ligaments for better osseous function.
• Possibly the most important benefit is that working distally helps train our clients to override protective holding and reprograms movement patterns as they release in the direction of lengthening and relaxation.

  
If you have never tried releasing soft tissues by working proximal to distal then maybe it’s time to consider introducing it to your range of massage strokes and techniques. Just be mindful of normal massage contraindications, what you are doing, why you are doing it and who you are doing it on.

(1) “Distal vs Proximal Work”. Art Riggs. http://www.abmp.com/textonlymags/article.php?article=91

By Richard Lane


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