Are Elbows Ever Relaxed?


Consider how much we use the elbow joints; constantly in flexion, use, and motion. Our arms are not limp by our sides even when we’re relaxed or asleep. Discomfort in the elbows can often be alleviated simply by opening the well-used muscles above and below the joint. Focusing on the upper arms in this example, so much hypertonicity can sit here, muscles can harden until all tissue pliability seems gone. With all the tension in people’s necks into shoulders, it’s common for that tension to just march down the chain into the upper arms. affecting function and movement of the elbows. 

Applying broad, sweeping strokes along those upper arm muscles down towards the elbows feels great to receive. A surface level opening usually begins right away. As the movement pushing open the tissues flows down into the elbows, you can feel the joint seemingly lighten and expand, both in doing and receiving this work. The mechanics beginning to free up, the joints can feel almost renewed, like years have been shaved off. The massage strokes can start from lighter and move to deeper and slower as the client’s tolerance permits. It’s nice to do this work when the client is face up and down, accessing different angles and planes of the arm without having to put too much demand on moving the shoulder joint into awkward positions. It allows the therapist to gently, thoroughly explore this region, all the way around. Since the upper arms are a smaller area, nerves and blood vessels can be more easily accessed, so being aware of working to your client’s tolerance and remembering sensitive and more exposed spots is important (example: the medial side of the upper arm into the elbow region where so many nerves structurally sit). Opening this area up can create a sense of warmth, as blood moves more freely from the tissue expanding and the muscles regaining a wider movement range. In doing the work, it’s interesting to balance pressure and movement from our own bodies into these small, compact zones. Asking the area to open as we flow forward in our mechanics, applying that movement onto and into the tissue.

Looking at the body as the whole unit that it is, a complete system where all aspects of it affect the economy of the entire environment, we end up with a better understanding of how to support it. Pain or imbalance in any given area of the musculoskeletal system can be both a local issue and a part of a chain of dominos. Thinking about all the muscles that lead into any given joint in the body, if any of these muscles controlling the joint’s movement are too tight, it will create difficulty for the joint.  An example of applying basic and logical concepts of self-care to our bodies with happy, effective results. Wonderful to enjoy the feelings of expansion, warmth, and freedom that come from muscle tissue being restored!


Copyright © by Lara Stillo 2017



Holding a Space for the Nervous System

Sometimes the kind of bodywork any of us may need is actually a simple light touch, more like holding a space for the client’s own nervous system versus working the soft tissue open to effect changes. This sort of approach can seem dubious in our more allopathic western system of medicine, the focus being on pharmaceuticals, surgeries, and pathologies. Yet there’s room and need for all the aforementioned, human health being that complex to address. So in this range from surgery to doing the most basic touch within bodywork, I’d like to briefly look at cradling a client’s head, fingers at the occipital ridge of the skull, the client’s head resting easily in the palms of the therapist’s hands.

This technique generally sounds pleasant and relaxing, yet it might seem inconsequential in describing. However, this simple hold can prompt relaxation within the central nervous system through activating our parasympathetic NS, the system that supports healthy functioning of unconscious body actions while the body is at rest (digestion, for example). The technique comes from a modality known as craniosacral therapy, which dates as far back as the 1830s. While I’m not a practitioner of the aforementioned, I do like many of its principles and practice this one hold on clients occasionally. The effect is generally increased relaxation and often deeper release in the upper shoulder and neck muscles. While it may not work for all people, it’s worth trying! A nice way to end a session after already having done manual therapy on the neck muscles.

Some things to keep in mind…explain to your client the basics of the technique and that you’ll try just for two minutes. Do right before the session ends, making sure your client is fully awake before you send them out the door to drive! Get your chair height with the table correct to sustain this hold easily while you clock it over the two minutes; longer time can be applied another time if you and the client agree to do so. Keep your hands, arms, and shoulders relaxed and allow your client’s head to merely fill your palms, like water someone poured into them. This is truly “holding a space” for your clients. It allows their muscles time to ease out of holding patterns while they breathe and expand into the table. 

Reading further about the purported effects and benefits of craniosacral work is recommended for anyone who has the interest, since I’ve touched very briefly here on one hold and the most basic application of it. The point of looking at this one hold in this most simple approach is to remind that sometimes the best we can do is to present a peaceful space, the room and time (even if two minutes 😉 for any given individual to breathe and expand out of constriction, and the acknowledgement that our systems naturally want to be in balance, but time with appropriate ongoing tending is needed for any garden to sprout and grow the right direction. 



Copyright © by Lara Stillo 2017


Stress Response and Animal Posturing



We are animals – human animals – yet we disregard this in very subtle ways, remaining almost condescending about the physical in favor of our intellects and our wills. Taking care of our bodies by noticing and feeling what they tell us, listening to its demands and responding is what we need to do, but this ball is usually dropped, if it is even picked up at all. How stress plays out in the body is a great example for this disconnect. One muscle that reacts quickly to stress with a  primal postural result is the levator scapulae. When hypertonic and overly engaged or “on,” it gives us a posture mimicking an animal protecting the vulnerable neck vessels from attack; a visual reminder of how we are a part of the animal world, despite our desire to control or reject it.

Spanning from the sides of our upper cervical/neck vertebrae to the superior border of the scapula/shoulder blade, the levator scapulae helps us to elevate the shoulder blade towards the neck, shortening the distance between the two attachment areas. When we think of stress affecting muscles in the body, the neck and shoulders are one of the primary areas people feel it; shoulders hunching high towards our necks. Levator scapulae helps create this posture, making it a good muscle to address in many bodywork sessions. A great place to start is to find the lip of the upper trapezius muscle at top of the shoulder, then work to get your fingers moderately under it, seeking to hit the edge of the levator scap. Depending on the person’s musculature, you may only hit the very edge of the levator, but that’s enough. A steady, gentle pressure with friction against and along the tightness felt there can begin the process of coaxing the tissue out of its rigidity, moving some of the adhesions that come along with hypertonicity. Remembering its path from the lateral/side neck to the upper part of the shoulder blade, it feels good to do the friction strokes slow, with a purposeful yet easy pull away from the neck towards the scapula blade; asking the muscle to come out of the hunching posture it’s frozen in.

Even after all these years of working on clients and myself, I’m taken aback at the rock-like feel the levator scapulae can hold. It has a distinct. sharp hardness to it once it’s become too tight, almost as if the tissue itself is gone and hardware has taken its place. Part of this is because levator is a small, thin muscle generally overloaded by taking over the work load of larger muscles that have become weak. But in musing on this stress response and the animal-like protective posture that levator can move into, it seems possible to me that the very quality of the tissue becomes defined by this primal, wordless protection of self and of life:  hunching up our shoulders to protect the jugular veins of our neck. An interesting reminder that’s both visual and palpable. Our bodies know what to do and give us messages all the time. Listening to them with respect and responding with care can bring balance back into our physical selves that then blossoms over into all other aspects of who we are as individuals.

Copyright © by Lara Stillo 2017



The Back of the Heart

It’s stunning to me how the power of simple touch can say volumes that no words in any language can express. Massage techniques, anatomy and physiology aside, the most basic touch can sometimes have an impact like no amount of deep friction, prolonged stretching, trigger point work, myofascial techniques, etc, can effect. And this not to say the aforementioned and so many other soft tissue applications and modalities are lacking in effectiveness or results. I’m always impressed with the changes wrought using good techniques at the right time, in the best way; it can be seemingly miraculous. But I want to speak to something simple right now and try to remain simple with it. What are we able to communicate wordlessly of ourselves to someone via touch?

In time spent with close friends, sharing back and forth about life pains that have arisen the last few weeks, listening as we walk, my palm goes automatically to their mid back; right between the shoulder blades, feeling the solidity of the back, maybe the prominence of the spine, the sloping forward of our often tired posture. I am not thinking anything in these moments. The natural gesture comes directly from empathy, free from condescension, lacking in attempts to control, acknowledging and accepting both our independence from one another along with our connection. What astonishes me is the palpability of the feelings as they run through the touch, like the rush of a flood without harsh impact.

How can this kind of touch be appropriately brought into a bodywork session where the focus is on using manual therapies to resolve soft tissue dysfunction and pain? Working with a client has very different boundaries than talking with a close friend. But as alluded to above, we can recognize the humanity in all of us, respect the freedom of each individual as they stand before us, and proffer our best wishes as a gift given with no return expected. Coming from a loving place, dropping assumptions that your touch has any power at all, a two or three second touch can say much. Keeping with the mid thoracic back as example, this often strained, sore zone can feel burdened on us, as if carrying a weight, much of it coming from overtaxed posture. No matter the reason in this instance, let your palm land gently between the scapulae, noticing what it feels like to have your hand rest there a couple of seconds. Brief is best to start with since the gesture can seem intimate to some, or even bring up emotion for others. The touch is simply an offering free of ego, based in reassurance and understanding. 

This simple laying of the palm in between the scapulae is basic yet powerful; another reason for keeping it short in duration. It’s a lovely way to end a session if the client is face down, or before turning the client over. This fleeting touch can also be grounding, bringing people back into the solidity of their body and the present moment. Whatever good intention you offer in this touch, notice not only what you intend, but what you feel. As we give in kindness freely to another, we also receive gifts unexpectedly in return – an acknowledgement of our shared humanity. 


Copyright © by Lara Stillo 2017


Expand Those Ribs and Meet Your Intercostals


Really, what could possibly feel good about having the tissue in between the front ribs massaged? Why would any of us want massage work done on areas where it feels either uncomfortable or just straight up odd? The body’s feedback often gives reason in the moment; feeling the anterior torso breathe open, or noticing referrals to other sore muscles light-up. Or it can be in what we sense right after the work, moving around feeling lighter and more flexible. Since structure and function walk hand in hand within this beautiful system of the human body, working on areas that can be bony with less tissue mass, small or difficult to access, and which might feel unusual when addressed, can also be surprisingly revelatory. It’s as if you just met a truly nice, interesting neighbor who’s been there all along, though you’ve never spoken. You feel energized, engaged, and more aware from this expansion.

So what can working on the intercostal muscles, these tiny and tight little tissue areas in between the anterior ribs, technically do? Opening up the front torso directly affects its counterpart, the back – one of the top areas that nag people with chronic soreness and pain. As we get curled forward with gravity, stress, and struggling posture, that tight anterior torso over stretches our already taxed backs. More structure and function, since the intercostal muscles assist in respiration, relieving tightness there improves our breathing.

  1. Whether working on yourself or a client who’s given permission for this focus, place the fingertips of both hands lightly at the top of the sternum/breast bone. Keeping fingers closely knit together is supportive for the hands when working; it feels strong keeping the bones of the hand close together like a team. If you’re working on a female client, this compact grouping of hands/fingers also helps keep you further away from breast tissue.
  2. The focus here is on an often very tender zone right where the intercostals end against the sides of the sternum or breast bone (also fortunately keeping the work from intruding on female breast tissue). Working one side at a time, slowly push the forefinger and middle finger laterally off the sternum into the space between the uppermost ribs. You can feel the density of the rib bones above and below this small space. Anchor the fingertips in, moving them minutely in a horizontal direction for a few strokes, and then a vertical direction. The space is so small, so will the movement be.
  3. Working one whole side gently open before switching hands/fingertips and moving to the other allows the person receiving to notice differences between the sides, letting sensations stand out more clearly. Each little space between ribs, abutting right alongside the sternum will probably feel different to palpate and to receive. Each has different information to give. 
  4. The pectorals major muscle also runs along most of the sternum. Working on the medial part of the intercostals will simultaneously work into where pec major attaches along the sternum. A lot of hidden, surprising soreness lies in pec major, making the aforementioned intercostal work that much more beneficial.

In getting to know your own body better, or in guiding a client to experience more of theirs through massage therapy, there’s this warm sense of solidity and security that arises; understanding how different parts of our bodies work, how they feel in being worked on, and how addressing them interacts with how other areas of the body feel. This exploration truly puts us back in our body. It’s an ongoing journey of self-exploration, ownership, and self-care – never boring, often surprising, ever useful. A grounding sense of comfort is derived from feeling what your body is telling you and owning all parts of it with gratitude and kind, loving attentiveness.

Copyright © by Lara Stillo 2017

Gut Feeling, Gut Ache, Gut Instinct, Gut Sick, Follow Your Gut…


A topic that comes up more personally for me regarding health, touch, and the physical body is an understanding of digestive imbalances; how stress and emotions affect and can create digestive problems, how this affects our muscles and physical posturing, how diet obviously can create digestive imbalances which can in turn maintain difficulties with diet, and how complicated patterns arise from these situations, looping around over and over. With digestion and the abdominal region there’s much to potentially discuss,  so I’d focus as usual on one small area, this time in the upper abdomen. Located directly beneath the sternum, commonly called the solar plexus, or celiac plexus in anatomical terms, covered by the superior aspect of the rectus abdominus, this is the first soft spot in the anterior torso after coming down from the ribs. It seems fitting somehow that this less protected area can be vulnerable to emotional stress along with physical pain showing in our digestive organs and proximal muscles.

Congenital illnesses aside and a physician always recommended when symptoms are severe, imagine the basic upset stomach. Whether from food, stress, emotions, or all the above, and whether the pain is from the stomach versus the intestines, when there’s pain in the abdomen we generally flex forward towards it. Our rib cage tilts in, our abdominals get “cramped” space-wise, and our mid thoracic back gets over-stretched. Already in abdominal pain, now there’s an added strip of muscular pain going across the mid back, below the scapula blades and above the base of the ribs. Since the anterior torso muscles flex us forward and the posterior torso muscles bring us back to being upright or further into extension, the aforementioned posture literally tilts musculoskeletal structure, and thus function, off its balance and creates pain. A challenging posture to come out of depending on how ill digestion is, but when physically able, lying on a flat hard surface can be a nice start to regaining that balance, easing out of muscular pain front to back and giving the abdomen space to breathe, expand, and calm.  Carpeted floor and covering up with a blanket for warmth is a good idea. Warm muscles are easier to bring out of spasm or cramping versus cold tight ones, and the solidity of the ground makes for welcome support as we coax muscles open.

As for touch, again how the digestion is will determine what can be done, but laying a palm on the area right below the sternum is warm and stabilizing. It lends a sense of calm, caring, and even an embracing of the spot while focusing the breath into it and then through into the posterior ribs, expanding the rib cage gently out. This can be done during a massage with the client on the table, too. Once digestion has leveled some, bodywork feels amazing in helping sweep soreness out of the muscles. Taking pain out of the body can also help affect things systemically since less energy is spent by our bodies trying to address pain, and more attention can be directed towards healing system imbalances instead.

  1. After laying a palm on the area and practicing deeper breathing, gentle exploration of the tissue underneath the sternum and along the bottom ribs near the sternum’s base can be done. Gentle is the key as digestive organs once upset generally take a while to calm back down.
  2. Alternating hands, use supported flat fingers with moderate to light pressure and sweep down from the base of the sternum and out along the edges of the medial base of the ribs near the inferior sternum.
  3. Placing easy sustained pressure on any tender spots can help open up this area all the way into the posterior back, acknowledging the interplay between regions.  A common trigger point sometimes resides to the side of the sternal base, close to the edge of the ribs (a trigger point is a hyper irritable, small spot in the muscle fibers that remains contracted). With some gentle sustained pressure held for several seconds on this trigger point – try at least 10 – a pain referral and pattern often light up across that mid back region.
  4. Opening up the soft tissue along the bottom of the anterior ribs, focusing around that celiac plexus zone, mid back pain can start to ebb or even clear away, easier breathing can be restored, the digestive area literally has more room to heal, and a burden all of a sudden seems removed off our backs.

Much of the time when things are complicated, keeping it simple, taking small steps, and moving forward accordingly is not only the best we can do, it might be what we have to do. The very human reality of how we all tend to “get in our own way” comes to mind. Pain pushes us to our limits, so forgiving our own impatience and chaotic thoughts and feelings of that moment, consider the aforementioned simple example as useable support, the kind we often need in these off-balance moments. Breathe, take a simple step, be present, and be kind. Whether via bodywork or self-attendance, the solidity of a warm palm laid to rest on this curled in zone of pain says volumes without ever saying a word.


Copyright © by Lara Stillo 2017

Desk Knees, Theater Knees, Plane Knees, and Etc.


As human animals, we’re instinctive. If something on the physical body is sore, we reach to touch the area, lightly rub it to see if pain dissipates, or palpate it to see if we can discover anything. Yet while we’ll instinctively use touch to ease, resolve, and learn, human anatomy is still beautifully complex and addressing pain in our soft tissue (or working on a client’s) can be confusing; it varies per area, per context, and per individual.  Because certain areas tend to make us more nervous when they’re in pain, it’s worthwhile to have an ever-increasing understanding of how our bodies work, how soft tissue can be addressed, and how touch really can promote and be an important aspect of healing and feeling good ongoing.

Aching, painful knees are a great example of an area that once off-balance can take us from irritated to worried. “Have I worn my knees out already? Is there something truly wrong in the joint?  Will my activities be limited?” Think of sitting at a desk, in a theater, or on a plane, no comfortable way to extend the legs into a relieving stretch, and that 90-ish degree angle the legs are bent into begins to make for some “chat” in the joints. Automatically, we may reach to the area surrounding the patella/knee cap and rub the tissue. Actual joint pathologies aside, since generally more than half of knee pain is referred from dysfunction in the upper thigh muscles, rubbing the tissue controlling the movement of the knee-joint ultimately can help. Soft tissue dysfunction in the form of hypertonicity, trigger points, adhesions between muscle fibers, and scar tissue, along with imbalances in strength amongst the upper leg muscles can all refer pain to the knee, pull it off alignment, and create improper movement and wear patterns in the joint.

There are so many good ways to address thigh muscles leading into and controlling movement at the knees: using a foam roller on the muscles, general to focused massage work on the upper legs, strengthening exercises to rebalance how the upper leg muscles are working together, etc. Given that,  I’ll focus this time on the lateral aspect of the knee; an area that can be surprisingly sore, yet we don’t usually feel it until it’s palpated. Because of how the femur/upper leg bone angles from the hip socket to the knee-joint, it creates a stronger pull on the knee laterally/to the outside of the leg. Accumulated soreness from being overly tight can lie deeply in the tissues to the outer side of our knees. Trace your fingers from the outer patella/knee cap to where the upper leg and lower leg meet along the side of the knee, exploring this zone in a circumference of a few inches. It can feel bony with less tissue mass and even “gristly” because different muscle tissues here thin down as they transition into tendons; the quadriceps muscles (which make up the bulk of the anterior upper leg muscles: rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis) actually share a tendon that passes over the knee cap and attaches on the tibia bone below. All this makes for a bony, gristly, lumpy feeling landscape which can feel awkward and daunting to massage. Going back to exploring that outer knee zone, there is often a sore to bruised feeling in a few spaces here. Get lost in this region, seeking these hidden spots. Do small circular or back and forth friction movements with clustered fingertips, a supported thumb, and/or the heel of the hand; changing up how we use our hands is good so as not to overwork them. Spending time feeling where it’s tender, being interested by it, trying to gently move it, following where it may lead us to another spot in this small zone, or even applying several seconds of sustained pressure on a sore spot and then rubbing it away, can all help clear open the tissue.

I would never dissuade a client from checking in with an orthopedist if they had serious symptoms or concerns about their knees (or any other problem area in the musculoskeletal system), but it is important to remember that even if a pathology exists there, the surrounding musculature will respond to this imbalance via bracing or tightening to help offset the problem and maintain some kind of workable biomechanics. Meaning, no matter whether a joint pathology exists or not, if the knees are sore the surrounding tissue will have some dysfunction to address either way, leaving massage as a healthy addition in supporting the knees. And honestly, it feels great to get bodywork from both a therapist and via our own exploration. Giving care to oneself, accepting that the body needs and relishes nurturing, attentive touch, is fulfilling. It’s an emotional kindness back to oneself and a centering back into the physical form; a grounding back into the tangible, into something both simple and miraculously complex, reassuring us of our own solidity, presence, and intrinsic value over and over again.


Copyright © by Lara Stillo 2017


Do I Want a Golf Ball Pressed into My Muscles?


Seemingly contradictory: I am in a health care field – I am not 100% perfect with my health. Don’t misunderstand; I definitely look after my health daily, ongoing, and with awareness. I’m just more of an 80/20 rule person. 80% of the time covers eating well, exercising, getting enough sleep, and being responsible in general about self-care, even to enjoying the discipline around it. That leaves 20% to cover my love of strong, rich coffee and dark, deep chocolate; chewy chocolate chip cookies with walnuts and the occasional dense, sweet donut; saying yes to more joyous social activities than I can actually do; and inadvertently waxing sometimes too dark and deep, needing to then pull myself back out and up. Yet, as I’ve told students in my massage classes many times before, I’m not a “guru” with all the answers, nor am I seeking to be. I seek to walk my talk and live by example. 

Being in the midst of winter rains storms and subsequent flooding here in the Bay Area, with sharper temperature drops and less daylight, self-care can fall away more quickly. I love having all the tools I use for support near at hand and pulled together. Right beside my tv sits a basket with bands and tubes for muscle resistance and strengthening; two different foam rollers and three different exercise balls for working the muscle tissue open; and a yoga mat and yoga block to support stretching the muscles back out. The visual reminder of this basket of tools, along with all being in one place, makes it hard to ignore, easy to use.

In using any of the aforementioned tools, much can be found on the net, in books, or often in any brief manuals that come with some of these supplies. Because I’m licensed as a massage therapist and focus on opening up and/or resolving soft tissue dysfunction and pain, I focus on the use of the foam roller and sports balls (lacrosse ball, golf ball, tennis ball) when talking to clients about self-care at home and defer to the physical therapists I work with for strength rehabilitation and training. I would say the same here that I tell clients: Know your own musculoskeletal health before going deeply with any of these tools; injuries old or new, the integrity of the skeletal system, any imbalances that may exist, etc.  It’s always good to start small and gentle no matter, so each individual can experience how these things feel and where modifications need to happen either direction (i.e., using a harder tool or a softer tool, which muscles to focus more time on, and so forth). The more you get used to using them, the more information you receive from your body, and the more you learn about your body. Small steps continually taken bring us to our goals well, versus dramatic leaps done in fits and starts. Meaning, try to consistently use one or more of these tools daily. I use the foam roller daily for a broad opening of the muscles, followed by one of the small sports balls for specific work. Stretching afterwards is ideal because the muscles are more open post-use of these tools.

Working the anterior, lateral, and posterior muscles is important as most of us feel discomfort in the posterior muscles from postural over-stretching and will be drawn to focus there. But since life is all about being flexed too far forward, the anterior muscles are often the offenders in tightest-of-the-tight without actually feeling sore; they need addressing. And it can feel great: Easing pressure into a sore, tight muscle – letting it sink in slowly with static pressure, or rolling in small 1/2 inch increments into the tissue, a couple different directions – following where these paths of tightness lead you, exploring your musculature in various areas – breathing with measured stretching after, opening different muscles, feeling how much more room there can be, how much more movement and flexibility. 

Humans are organic, not robotic. We’re all each our own, ongoing process; a garden constantly needing weeding, tilling, watering, and nutrients. It does not stop, it is ever-changing, but it’s rewarding and interesting if you can see it this way. Bodies are also shockingly resilient. That doesn’t mean waste what you have and burn it out, of course, but it does mean keep tending to it. There are ways to feel better. Life has intense, often grievous challenges, yet it also offers gifts, always. Here’s to taking care of ourselves in growing gratitude, which still can, I believe, include some type of “cookies” in there.


Copyright © by Lara Stillo 2017