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Power Under Soft Hands
PUSH Muscle Therapy for Chronic Pain

By Shirley Vanderbilt

Originally published in Massage Bodywork magazine, October/November 2006. Copyright 2006. Associated Bodywork and Massage Professionals. All rights reserved.

Twenty-five years ago, Michael Takatsuno was a tennis pro suffering the aches and pains customary to athletic endeavors. A debilitating injury and a chance encounter with a Zentherapy bodyworker set him on a path that led, after many years of experimentation and study, to the development of a muscle therapy system to reduce pain and chronic muscle tension. He calls it PUSH, for power under soft hands, and it's definitely a push in the right direction. According to Takatsuno, the PUSH approach not only brings relief to the client, it's also gentle on the therapist.

At the core of the PUSH system is the concept of Chronic Passive Tension. Takatsuno says this is a condition common to chronic pain in which muscles remain tight and contracted even in a passive or resting state. PUSH therapy utilizes a Soft Pressure Stimulation technique to release tension and increase range of motion, and subsequently reduce pain. To sustain that change, clients are instructed in self-treatment techniques and posture exercises that can be quickly and easily incorporated into the daily routine.

The PUSH therapy system, which also focuses in large part on client education and self-awareness, can produce both immediate and long-term relief for a variety of common ailments, such as low-back pain, carpal tunnel syndrome (CTS), headache, and tendinitis. But it does more than that. Takatsuno says his approach has a special payoff for the therapist--no pain, strain, or fatigue, even after hours of tablework. PUSH bodywork is applied with the therapist in a loose, relaxed state, with pressure maintained primarily through use of elbows and finger tools. The evolution of Takatsuno's approach took many years and many side roads, and included a few inspiring masters along the way.


From Zen to Anatomy
Takatsuno played competitive tennis as early as age ten and went on to instruct at the college level while participating in professional tournaments. Discipline was part of the process and was even more firmly ingrained when he added martial arts to his athletic endeavors. An early association with a Zen temple and tai chi master Benjamin Pang-jeng Lo, who Takatsuno describes as otherworldly, was just one of several fortuitous factors impacting the development of PUSH.

As a tennis player, Takatsuno says he stretched seven days a week. One day something popped, his back started hurting, and the pain lingered for four years despite his pursuit of a variety of alternative treatments. At a friend's suggestion, Takatsuno attended a seminar with William S. "Dub" Leigh, the founder of Zentherapy. "He worked on me and afterward told me it might burn and to rest for two weeks. It burned right away, but the pain started to go away."

Intrigued by the results of Zentherapy, Takatsuno embarked on a career change by attending Leigh's seminar at Esalen in Big Sur, California. Leigh was one of Ida Rolf's first students, and the bodywork he developed included his structural background, further training with Moshe Feldenkrais, and energy work with Zen master Tanouye Tenshin Rotaishi.

Continuing coursework with Leigh, Takatsuno found he had a knack for healing and established himself as a full-time practitioner. But the work was demanding and took a toll on his body. "In this form of structural work, I used my hands to move tissue deeply. It was physically hard. My knuckles were swelling, I couldn't close my hands, and clients also found it difficult. The purpose of that work was not really to address chronic pain. It would come back." After taking more seminars, Takatsuno was dissatisfied with the intensity of the application and lack of long-term results. "Most of what was out there was a kind of technique. I saw them as palliative, or if they worked they were hard to do. It seemed like there wasn't anything easier to do or that did it better."

To deepen his understanding of the body, Takatsuno applied to a physical therapy program at San Francisco State University with the intent of delving further into anatomy and physiology. "The anatomy lab had one of the best cadaver programs in country," he says, and his lab instructor "forced us to learn and enjoy." Hired as the instructor's assistant, Takatsuno spent eighteen months working in the lab every day. "I literally got to take the body apart from the most superficial to the deepest layers. I got to see how it all interrelated--the connection." Using what he learned, he continued to experiment with his bodywork clients and after much practice, he says, "I realized there were ways to get the tissue to release. I started to get really good results." His chronic pain clientele increased by word of mouth, but his own pain issues began showing up again from the strenuous work.

It was Takatsuno's tai chi practice that inspired a solution to the wear and tear on his body. Through the years he had continued working with Lo who taught an older form of tai chi. While Takatsuno had progressed in mastering the physically challenging tai chi postures, learning to relax his body in the practice, there was the mismatch of awkwardness and pain he experienced in performing bodywork. With his light frame and small hands and wrists, he knew his hands-on career would be limited. One day in a practice session Lo told him, "You should be doing your work like this," referring to the relaxed tai chi posture. "I realized he was right and I started to think, how could I get my body relaxed and rooted and still get results?" It was an epiphany, he says, and as his tai chi practice improved, he started to understand more fully how to adapt that relaxed stance to his bodywork.

Takatsuno raised the table height so he wouldn't have to lean over. He began experimenting with his elbow and hand tools, and he focused on working from the core muscles to the extremities. "If it was too hard, I threw it out," he says of his experimental techniques. Within eight years the system was refined and the techniques established. "At this point we apply pressure but no muscular force. The (therapist's) body is in a completely relaxed state." And the client notices, he says. "If we make ourselves feel relaxed, it doesn't feel invasive. The trick is getting the therapist to completely relax."


Chronic Passive Tension
Takatsuno says the repetitive movements we engage in daily, whether for athletics or accomplishing the simplest tasks, lead to Chronic Passive Tension. In his bodywork, he was seeing clients with chronic systemic tension and pain in which attempts at stretching in the active state did nothing to resolve the problem. In what he calls the chronic tension cycle, Takatsuno says, "Muscles that begin to fatigue--from overuse or repetitive use--need rest. If you could stop and rest once the muscles feel tired, they would rejuvenate and be fresh (picture stopping to rest during a marathon). If fatiguing muscles continue to work, they build up lactic acid and begin to tighten. This tension begins to limit blood flow to the tissue resulting in decreased oxygen intake. Restricting oxygen cuts off the nutrients tissue needs to maintain tonicity and have stamina." As the cycle continues, muscles become more rigid, further restricting blood flow. "Once you're in that negative loop of fatigue, tension, constricted blood flow, and rigidity, it becomes a chronic state, so the tissue is contracting all the time, even while at rest."

With the tissue chronically tight in the passive state, muscles are constantly contracting between attachment points, either at joints or soft-tissue attachments. "In a supine position, these contractions cause tight muscles and/or compressed joints to lift anteriorly, toward the ceiling," he says. With this continual contracting, the muscles will tighten even during sleep.
Takatsuno says that although stretching can help prevent injury and increase range of motion, in his experience it won't eliminate chronic pain and chronic tension. "When practicing a voluntary stretch, what you're primarily stretching is the joint. You are pulling the joint apart. Muscles and tendons are stretched, but not as much as the joint. Stretching is not going to change muscle tonicity. Muscle memory is very powerful. If you train a muscle to stretch to a certain range of motion, that muscle will remember that range of motion, but as soon as you release the stretch, the muscle returns to its natural resting length. If the resting length has not been changed (Chronic Passive Tension exists), the muscle will still be tight at rest. Tension will always return until you change the tone of that muscle while at rest.

"Active muscle tension is tissue that becomes tight after a workout. This tissue will relax with rest or active muscle treatments, but if this pattern is repeated, muscles begin to shorten and Chronic Passive Tension sets in. This kind of tension cannot be released from rest or active treatments. Working the muscle actively only helps in that active range. You have to get muscles to stop contracting involuntarily while at rest.

"The net positive result of the PUSH treatment is no tension in the muscle at rest," he says, "but another benefit from changing the resting length of a muscle is when using that muscle you are starting out in a more supple state. You get more efficient use of the body. This is the best thing you can do for an athlete. It will take a longer time to fatigue, and will prevent injury and increase muscle performance."

As he developed his approach, Takatsuno discovered he could eliminate common pain symptoms related to chronic tension and the chronic tension itself. "The root source of muscle tension is a lack of oxygen. We have to get oxygen back to the tissue in order to get it to stop pulling." Although there is certainly an effect on fascia with the application of PUSH therapy, Takatsuno says it is primarily the muscle stimulation techniques that promote positive change. "The key to chronic tension buildup is to get blood flow restored back to the tissue, and the best way I know is to stimulate tissue, not by trying to move tissue. I don't believe you can permanently change tissue unless you restore blood flow to the muscle."


The Hanging Spine
Takatsuno's research on working with muscles and chronic passive tension took another leap forward when he applied the concept of the hanging spine model. "All chronic tension in the body originates from the core of the body," he says. "If the back is hyperextended and the pelvis is tilted anteriorly, the lower back will always be tight. With the body in this alignment, the back muscles push the spine up causing a natural elevation of the shoulders. This leads to chronic shoulder and neck tension. Loosening the neck and shoulders will always be palliative unless the lower back and hips shift. The way to prevent this is to train the body to stand and sit with the lumbar spine sinking posteriorly and inferiorly and the pelvis sitting level with the floor."

Takatsuno says tai chi can help achieve this posture, but he realized he could not teach tai chi to every client. To train the body to hold this position naturally, he developed a simple exercise called the PUSH Posture Exercise. An essential part of the PUSH system, the exercise is incorporated into both the training of students and the treatment plan for clients. The exercise begins with the student establishing the PUSH posture in a standing position. "When all the major joints are in line, the muscles can just hang on the body. Once we teach that, we have them squat to an end range where the body stops naturally. Then we have them set themselves with the weight over the ankles, and with pelvis and lower back set and the upper body completely relaxed, hanging over the spine."

The goal for the student is to hold the posture and try to relax every muscle in the body. "If you hold the stance and get the muscles to relax, you will get strong thigh muscles that are soft and supple. The thigh muscles support the body in an upright posture. You want them to be strong and supple." Takatsuno says with daily practice, the stance can be held for increasing periods of time. "If you do it once a day for two weeks, you can hold it for two minutes versus the fifteen seconds in the beginning. You can actually feel your thighs getting stronger and your tension releasing in two weeks or less.

"We are literally teaching people how to eliminate chronic tension in their body and how to prevent it from coming back," he says. "The concept comes from my tennis and martial arts background. You can teach posture to anyone, but the changes won't be permanent until you change the muscle memory. Muscle memory is ingrained through repeated practice. Just as Tiger Woods has to practice hitting a golf ball repeatedly, you have to train the body to stand correctly and without tension repeatedly. I believe that most chronic pain and general muscle dysfunction originates from chronic tension. If you eliminate the chronic tension, you will eliminate the pain."


PUSH Treatment
In PUSH treatment, the client remains fully clothed throughout. The session begins with a experiential body reading to identify pain or tension and any asymmetry in alignment. With the client standing, posture is analyzed from the posterior, lateral, and anterior view. The client then reclines in a supine position on the table, with the therapist again looking for tension and symmetry between the left and right sides of the body. A third reading is taken for elevation--any area where the posterior side is not touching the table. This goes back to Takatsuno's analysis of the hanging spine. With proper alignment and no tension, the muscles should lay flat on the body at full rest. Observations are shared and discussed with the client and this interchange continues throughout the treatment process.

To initiate treatment, the therapist begins with light and very brief palpations. These palpations serve three purposes, Takatsuno says. "One is to help the therapist identify the area and pattern they are going to use on the treatment area. So the therapist goes over the pattern using light fingertip pressure. This allows the therapist to feel the superficial layers of tissue, which they will treat first, and also helps the client become aware of the area about to be treated. Minimal time is spent on palpation because the palpation does not change muscle tone. Each moment with the client on the table is valuable and as much time as possible must be spent on bringing change to the tissue and educating the client."

The therapist proceeds from palpation to stationary pressure utilizing an elbow or hand tool. "Stationary pressure helps desensitize and begins stimulation of the treatment area," Takatsuno says. "Pressure is applied with the therapist in a very soft state using the weight of the arm or body. When you understand how to truly relax with the PUSH postures, you can engage and feel the tissue better with your elbow than you can with your hands."

Stationary pressure is followed by Soft Pressure Stimulation, in which the therapist maintains a completely relaxed state while stimulating tissue layer by layer. "You sink into the tissue until reaching a layer of tension, sensitivity, or rigidity. Once you feel any one of the three symptoms, you stop and don't sink in any more. Stay relaxed and engage the tissue working across the entire width. This is the key to getting blood flow to the tissue. Most tissue tightens layer by layer; if you loosen it layer by layer, it releases easier and more permanently.

"Soft Pressure Stimulation is a very subtle movement that originates from the ankles and allows the whole body to flow and move very effortlessly. With the tables elevated and while standing upright, we're maintaining the hanging spine posture during the entire treatment. The elbow is held at the place of pressure while the therapist's body is moving the elbow horizontally along the tissue." Using this approach, Takatsuno says he can treat clients all day and remain rejuvenated at day's end. (He once treated eighty-five clients in a ten-day span.) "The reason for this is that the postures used while working support proper body alignment and relaxation," he says. "You should feel better after treating someone with PUSH than before you began." When tension is present in the lower back, it will rise through the body as the therapist tries to apply pressure. When the therapist's body is relaxed, without chronic passive tension, the hands will go soft--power under soft hands.

After treating one side of the body, the therapist stops for a halfway body reading. This gives the client an opportunity to observe the changes and gain increased awareness of how chronic tension has impacted the body. The treated side now touches the table while the other side is still elevated. Takatsuno says the reading at this halfway point is essential to the client's understanding of the impact of PUSH. "At the halfway point, they can see the change." Work then continues on the other side of the body and concludes with a posttreatment body reading where again, the client can see the immediate results.

While the severity and root cause of symptoms will factor into the outcome, some chronic conditions resolve quickly with PUSH. On average, knee pain, elbow tendinitis, and planter fasciitis require from two to four treatments and chronic headaches or back pain may be eliminated in six sessions or less. Even those with arthritis pain can benefit from PUSH's tissue stimulation, with increased joint mobility and improved body function as a result. Takatsuno says the standard contraindications for bodywork apply in PUSH practice, but additionally he doesn't treat if soreness exists from a previous treatment or self-treatment.


The Educated Client
The PUSH Treatment Plan is an entire system of treatment that invites full participation by the client. In order to sustain long-term change in tissue muscle memory, clients also learn self-treatment techniques and muscle relaxation training through practicing the PUSH Posture Exercise. "We can eliminate chronic tension in any client that follows this program," Takatsuno says.

"Fifty percent of our work is educating the client. In massage therapy they teach you to work in silence. We educate the client from the moment they walk in the door," he says. Throughout the session, the therapist communicates with the client about treatment goals and the relationship of muscle stimulation and return of blood flow. "With body readings we're not only explaining what we're doing and what the process is, we're showing them at the halfway point what the muscle resting length is and how that impacts tension."
Clients are encouraged to practice the PUSH Posture Exercise about one to two minutes each day. This is where the squat comes in again. "The key is the hanging spine law," Takatsuno says. "This is the posture that the PUSH treatment puts the body into naturally.

You bring the stomach in, drop the tailbone, and let the body sink downward." Again, the emphasis is on maintaining that posture whether standing or sitting. For those more athletically adept, the challenge can be increased by practicing in a one-legged position.
After the first few PUSH treatments, clients are taught self-treatment techniques. Using finger tools or rollers, the client is instructed to work areas of the body from head to toe several times a week. This also reinforces changes in muscle tension, affecting the tissue in much the same manner as the therapist's Soft Pressure Stimulation.


The Practitioners
PUSH certification requires completion of five training modules which Takatsuno says can be completed in approximately nine months. The modules are offered about six weeks apart, with students encouraged to consistently practice what they've learned before moving on to the next level. Modules one and two, covering the upper and lower body, address such issues as chronic shoulder and neck tension, CTS, knee and low-back pain, and plantar fasciitis. Module three, focusing on the body's core and structural alignment, includes advanced work with low-back and hip pain, chronic psoas tension, and conditions resulting from poor posture. Module four combines treatment of dysfunction in the extremities, such as hands and ankles, with further training in PUSH protocols and client education. At completion of the fourth module, Takatsuno says a student can work the entire body with some proficiency if practice has been consistent throughout the training schedule. The fifth module rounds out the training with a refinement of skills and a practicum exam for certification. In addition, both modules four and five cover marketing and practice-building aspects.

Takatsuno says there are now about one hundred certified PUSH therapists in active practice. Some of his former students are still by his side, serving as workshop assistants, taking advantage of an opportunity to hone their own skills while learning to train others. Maria Foster of Colorado, a massage therapist who now practices PUSH exclusively and frequently participates as a PUSH training assistant says, "We're also learning. It's an opportunity to get our feet wet with teaching so we can evolve as instructors."

Although relatively new on the block, PUSH is growing in popularity among therapists from a variety of bodywork backgrounds. Sam Shone, an acupuncturist also practicing in Colorado, has incorporated PUSH in his treatments for the past two years. "When you first see it," he says, "you think, well, that doesn't look like anything. Then you realize there are a lot of subtleties--ways to hold the arm you're not working with, how much motion you're having across the muscle. You get a feel for it." As a PUSH training assistant, he says he gets continued exposure, improving in those subtle aspects of the work.

Foster, Shone, and other PUSH therapists in Colorado have joined together to increase awareness of PUSH in their community by sponsoring group demonstrations at local sports events and health fairs. Even with an abbreviated body reading and treatment, Foster says clients are amazed at the immediate results. "They say, 'Ha! How did that happen?' But it's not all subjective. Some of it is actually seeing that the neck has dropped, or there is some other structural change, and some of the awareness is brought forward by release from pain."

For more information on PUSH therapy and trainings, call 866-416-7874 or visit www.pushtrainings.com.




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