Bindegewebsmassage Article

Technique
Bindegewebsmassage:
An Elegant and Useful Technique
Brian Utting, LMP
Bindegewebsmassage (Bin-deh-geh-vebs-massag-eh), now A Theory is Born

often called Connective Tissue Massage or CTM, was
a technique I learned back in the early 1980s and used Dicke and her associates proposed that this specific pattern
frequently as a massage practitioner. Around 1990 I of stroking the skin not only mobilized the subcutaneous
incorporated it into the curriculum at the Brian Utting School fascia, but also created a reflexive change in visceral
of Massage and taught it there for the next 17 years. We (smooth) muscle tension, arterial constriction, and other
found that a 7-hour Bindewebsmassage training elegantly autonomic functions. Which specific organ or artery
demonstrated the relationship between skillful touch and seemed to depend on the skin region worked, so Dicke
autonomic health and balance and gave students a powerful theorized that stroking a specific skin referral zone could
tool for relieving symptoms of menstrual cramps, asthma create an autonomic (usually parasympathetic) change in
and migraine headaches. the corresponding organ.
The appeal to me was direct experience. I found that CTM Organ and nerve referred pain patterns were, by then, well
reduced or eliminated symptoms of dysmenorrhea in over documented. Liver pain, for example, is often felt overlaying
90% of my clients and also had a general calming influence. the right trapezius, around the inferior right scapula, and in
Most importantly, it only took 20 minutes to complete a basic the upper right quadrant of the abdomen. But the idea that
CTM sequence, which meant a significant benefit relative to these viscerotomes were a two-way street (that is, stroking a
the time invested. dermatome could in turn influence the organ) was a surprise
to many.
Bindewebsmassages Beginnings Dicke taught a style of fingertip stroking that was done along
specific skin regions in a specific sequence. The proposed
In late 1929, a German physical therapist named Elizabeth effect was vasodilation in the target structure and relaxation
Dicke found herself wheelchair-bound suffering from a severe of smooth (visceral) muscle. Thus menstrual or intestinal
and painful condition in her right leg called endarteritis cramping could be relieved essentially by tricking the
obliterans. Amputation of the leg was considered and no target organ into thinking it was being massaged.
method of relief was obvious. She began to experiment on
her own skin, stroking with fingertips where it seemed most That the viscero-cutaneous reflex
sensitive. After some initial pain, the underlying muscles interconnection is reversible, that is to say,
seemed to relax and the skin felt warm. After doing this
that it not only leads from the internal organs
for successive days and refining her technique as she went
along, she experienced not only relief from pain but gradual
to the skin, but vice versa, is a long-established
restoration of sensation in her leg. She enlisted colleagues fact. One of the most elegant and fundamental
to apply similar techniques and after three months, got the systems, which conforms almost flawlessly
most severe symptoms to subside. Within a year, she was to the workings of the segmental reflexes, is
back to work as a physical therapist. connective tissue massage as prescribed
by Dicke.
What Dicke had accomplished seemed miraculous. She
immediately sought to refine her technique and with the help Hans Schliack, M.D., Professor and
of some neurologist colleagues, proposed a physiological Neurosurgeon, Berlin
rational for its effects. Her technique, Bindegewebsmassage,
has since become a mainstream technique in Europe,
taught to a variety of practitioners to treat fascial pain and
autonomic imbalance. (Reference: Beards Massage)
24 www.amta-wa.org
photo credit: Laura Nelson
What Does the Current Research Tell Us?

As with any treatment modality, both the methods and the
theories of CTM have evolved since 1920s Germany.
Whereas Dickes team developed the technique as an
adjunct therapy for cardiac, respiratory, digestive, and
reproductive dysfunction, modern practitioners use CTM just
as often for myofascial complaints. And whereas the original
CTM techniques were taught with specific sequences, many How CTM is Applied
modern practitioners are adopting a more fluid approach, CTM is typically done seated, so that dermatomes are
treating cutaneous dysfunction where its found. (Prendergast exposed and so that there is sufficient tension on the
& Rommer, 2013) subcutaneous connective tissues.
A handful of clinical trials have shown CTM-style The technique is usually applied with two fingers in a steady
manipulation has beneficial effects in pain reduction, dragging motion with sufficient depth and tension to contact
reduced depression, improved quality-of-life, and moderate and mobilize the subcutaneous layer but not the deepest
short-term increases of beta-endorphins. These trials add muscle layers.
to anecdotal observations from clinicians: that CTM often
causes virtually immediate relief in visceral or myofascial Generally the technique begins around the sacrum, moves
pain as well as general relaxation. Also noted at times to the gluteal area, and then travels up the spine and
were undesirable autonomic effects, such as dizziness, posterior ribs. The intent is to initiate a parasympathetic
nausea, and sweating. (Prendergast & Rommer, 2013) effect at the sacral/pelvic nerve roots, and then moving
into dermatomes that effect more organ-specific reflexes.
The physiologic mechanisms of CTM have become more During application, there is constant assessment of both
clear but much remains uncertain. Good evidence now the local tissue (particularly the mobility and density of the
exists that chronic organ dysfunction can induce changes in skin and underlying layers), local erythemia, and systemic
sensitivity, inflammation, fluid content, and tissue density in autonomic effects.
corresponding zones on the bodys surface. But what about
effects in the other direction? Can skillful skin manipulation At the end of the session, balancing strokes are applied at
create predictable changes in organ function? Preliminary the collarbones and pectoral area with intent of stimulating
evidence and plausible mechanisms exist to support this the vagus nerve and thus calming and balancing the system.
idea but the jurys still out. A handful of animal studies
show organ responses after skin stimulation. Broad clinical For Those Curious
research suggests that organs, fascia, and skin that share Brian teaches 8-hour Bindegewebsmassage classes two or three times a
a common nerve segment are also connected by reflexive year through the Pacific Northwest School of Massage and the Therapeutic
pathways. (Holey, 1995) Training Center. For more information, see www.pnwschool.com, or
contact Brian at brianutting@speakeasy.net
But what of Bindegewebsmassage specific sequences?
Does stroking each zone have the effect we suppose? Are
there known or unknown contraindications? Although the
technique has been successfully applied to thousands of
patients (Beards), the evidence is still coming in on these
questions, so stay tuned.
Washington Massage Journal Fall 2013 25

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Technique

Bindegewebsmassage (Bin-deh-geh-vebs-massag-eh), now A Theory is Born

What Does the Current Research Tell Us?

Washington Massage Journal Fall 2013 25

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