Sensory Approach to Manual Therapy
Sensory Approach to Manual Therapy
What Happens When We Treat The Nervous System First
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What if the biggest gains in manual therapy come from changing how we dose touch, not how hard we press? That question sits at the heart of this conversation with educator and former elite high jumper Jenny Mapes, who brings a coach’s eye to sports massage and recovery. We dig into her Quadrant of Intentional Treatment—a simple, visual framework that maps care across superficial to deep and global to specific—so you can choose inputs the nervous system is ready to accept and turn short sessions into lasting change.
Together we unpack why “deep” is about more than force; it’s also about time, attention, and sensory load. Jenny explains how superficial, global inputs can downshift tone and open access, and when to pivot toward specific work without tipping a client into threat. We explore keeping clients clothed and moving on the table, coupling touch with motion, and using tools like cups and tape to amplify proprioception rather than overwhelm it. You’ll hear practical examples—from cautious anterior neck work to rib-cage breath lifts with gliding cups—that show intention beats any tool.
We also talk shop on confidence with athletes, why weekend warriors deserve the same game-day respect as pros, and how to build a network across PTs, ATs, acupuncturists, and osteos without getting stuck in turf wars. The throughline is clear: outcomes improve when touch is information, movement is integrated, and clients feel safe enough to adapt in real time. If you’re ready to move beyond scripts and treat the nervous system first, this one will sharpen your eyes and your hands.
Subscribe for more sensory-forward conversations, share this with a colleague who loves blending movement and manual therapy, and leave a review with your biggest takeaway—what quadrant will you start in next session?
Meet Jenny Mapes And Her Path
SPEAKER_00Hello, everybody, and welcome again to another episode of the sensory approach to manual therapy. My guest today is Jenny Mapes. She is on the Pacific Coast in the US. She has a company called Cross-Functional Sports Massage. And she is an educator who I met at the 2025 Dallas National Convention for AMTA. And I was very interested because when I spoke with her, she was kind of speaking my language about decoding the body and figuring out what's going on. And she even talked about the sensory system, which for me was just lit my ears up and made me laugh. So welcome, Jenny.
SPEAKER_01Thank you. It's an honor to be on your show. Appreciate it.
SPEAKER_00Um I only met you for the first time ever this past summer. And I'd heard about you from other people who told me, Oh, you got to meet this lady, you got to meet this lady, uh, because she's like, you guys will get along like two pieces in a pod. And I remember the first time we actually sat down together one-on-one. The first thing you said to me was, I don't know how much I want to talk to you.
SPEAKER_01I was trembling in my boots. I was like, oh man, Troy just sat down.
SPEAKER_00And I think that's really funny because I don't think I know where that comes from because there was another colleague teaching at the class, and he said some stuff that is a little on the outdated side with research, and him and I had a talk about it. But I just thought it was funny that that was how we introduced ourselves together. Because then five minutes later in the conversation, I was like completely enraptured by the stuff you're talking about. So tell me a little bit about what brought you, you know, I so historically you were a high jumper and you comp you tried out for the 2012 London Games. You were, you know, high jumping even at a professional level, let's say it's not the most lucrative of sports. So the idea of seeking out, yeah, the idea of seeking out, you know, daily treatment for injury prevention is not necessarily something that they can afford. So tell me a little bit about what made you interested in the human body from being an athlete to now being the practitioner.
From Athlete To Practitioner
SPEAKER_01Yes, I did not intend to get into this field. Um, I got my degree in a completely other field, and I was an IT um mapping software company uh right after I got out of the University of Oregon. Um but when I met my coach, um, my Olympic coach for training, and he said, I think you can make the Olympic team, let's start training. Um, I said, okay, let's do it. And the unique thing is um I realized that I loved the human body and working with the human body. And working with my coach, we would be with different athletes on the professional level, teaching them about their first step quickness, uh, their big toe flexibility, uh, working with the nervous system, downregulating, up regulating it. And I was like, you know what? This is helpful and beneficial, and not just for athletes, but for I mean, we all live in our bodies and we all want to move well and optimally, right? And so I got to the point where I said, you know, I really love my job and working in IT, but I really love helping people physically as well. And so um I decided after working in the personal training and working with those uh groups of athletes after my endeavor was over, I'm like, well, I want to get a degree. I looked at all the different options and I already have a degree, so I was like, well, I think I think I'm gonna go into massage because I want to touch people because I know that I can teach somebody how to exercise or how to stretch, but if I can see physical restrictions and help them get out of that or help help um their their system get past whatever they're going through, that will make their life better and then everybody's better. So how do we do that effectively? Um, training as an elite athlete is very fascinating, especially if you're not on like a regular sports team, because you have to find your own ways to uh heal. And so, what does that look like? Well, back in 2012, we didn't have all the technologies that we have today, uh, the Norma Tech compression boots, and uh even um at that time, Michael Phelps cupping was a big deal that like hit the main stage. And I think that's about the same time as Kinesio tape as well. I had some really good experiences and positive experiences and some really negative experiences. So I definitely came into the profession with a uh cautious mindset because I didn't want to hurt others because I had been uh hurt in some before some events and I didn't want others to go through the same. But I also knew that it's not the tool, it's how you use it that makes the difference. And it's the level of mastery from that practitioner that determines the result. It can help determine the result. Because if you trust that person, then you're you let your guard down and you're able to accept that treatment better. Um, and so I was like, you know what? I'm gonna come with those that understanding and try to put it into massage. And so started cross-function sports massage. Um, I met my husband, uh, moved up to the Seattle area and uh started my massage career in the spa and then moved up into back into sports where I really wanted to thrive. And here we are, cross-function sports massage, turned into cross-function sports recovery. Now have a clinic up here in Seattle. We have currently 13 employees that are recovery specialists and massage specialists. But the academy was really born on that whole teaching other people how to work with athletes because they can be scary and they can be uncertain. Like if you aren't familiar with that world, um, and you have an athlete come in and say, Hey, I've got an event this weekend, um, that can instill a lot of panic in a in a person. So I wanted to be able to help dispel that fear.
SPEAKER_00I think it's interesting. I have I have an athlete actually who's running on Sunday at the Philly Marathon, and he's spending on, he's hoping to podium in the master's category. And I I fingers crossed, I hope he does. Um, but it's just one of those interesting things because for a lot of therapists, you know, we work, I, you know, sports is probably one of the biggest things that keep professionals like yourself and physical therapists and myself alive because people get hurt during sports. Yes, people get hurt during daily life, they're sitting at their desk, they're lifting an object, but sports is really a big component, especially when it comes to research. That's where most of the money goes. And so it's really interesting because most therapists will treat athletes and they're not worried about it. Oh, yeah, I treat it. No, they're running a marathon. But the moment they treat a professional athlete, who it's their livelihood, suddenly they go, Am I qualified? You know, like I'm happy to work on the average human who's performing athletically, but as soon as it comes to somebody who has this extra level of stress or responsibility, they therapists seem to take it almost like, oh no, I'm not trained enough for this. And maybe they're not. But I always found it interesting because for the everyday human running the marathon, that is their professional moment. That is their biggest moment. And so it's always interesting to me that, you know, somebody will work with an athlete trained or untrained in sports type massage and store in sports type sciences and things like that, let alone the exercise. And for me, I want to talk to you about that because I know your clinic does both. And that to me is one of the biggest missing points we have in the manual therapy profession. But it's always interesting to me that when it's, you know, just an average human, we go, oh, no problem. I have the confidence to work with you. But when it comes to a high-end athlete, people get scared. But it's the same level of importance to the individual performing.
SPEAKER_01Right. I have had people individually contact me via Facebook Messenger or others, like I'm concerned that they there are a lot of misconceptions in the sports world that I'm trying to dispel as well, in terms of pressure and speed and time and all of that. And um, because you're really it's about outcomes. Uh athletes are a different breed, regardless if you're going into a um into a marathon or into a um powerlifting competition, just like a master's meet, whatever the case may be, and whatever level, um, athletes are very goal-oriented. So they come in, and so it's it's a little different. Um, they have a little different headset or a little different, they want a game plan and they want a headset, they want intentionality and they want to know why you're doing things. They got a lot more questions. It's not just I want to relax, I'm stressed, oh, you know, I just got a shoulder operated on. Well, that's orthopedic, but movement is missing in our field. We are very passive. We are very passive at a we we are taught passive movements, um, static movements. Um and athletes, everything we do is move. And I'm going to reel this back. An athlete isn't just I consider an athlete someone who wants to move and use their body in a positive direction forward.
SPEAKER_00So I love it. Yes, exactly. If you're getting paid for it, you might be a professional athlete. If you're paying to participate in it, you're still an athlete. Because the other thing, too, is like if you're doing a 5k and your goal is not, you know, a 315-minute kilometer, sorry, Canadian 315-minute kilometer. I don't know what that breaks down at the mile. I think it's like a five-minute mile or whatever it is, six-minute mile.
SPEAKER_01If you're not looking to I'm actually better with kilometers than miles.
SPEAKER_00If you're just looking to finish, but you've never run five kilometers in your life, the level of mental dedication, and you've got a family and you've got a full-time job, and you've got school, and you've got parent-teacher meetings, and this, like suddenly it's almost just as stressful because you don't get to only focus on your discipline. You have to focus on everything and add your discipline to it. So I love that. And actually, the movement thing, I just I'm just gonna look up the name of it really quickly because I just created a brand new class, which I haven't finished designing, and I'll be teaching it in May in Ontario. And it's exactly about that concept, and it's called uh neurosensory massage, but it's about the playfulness of science and percept and perception of the body. And it's a class that's designed around creating not only hands-on techniques, but how to make movement and integrate movement into our massage techniques to make it playful. Because too many people get on the table, if they're hurt, too many people just get on the table, undress under the sheets, which means now they can't move. Yeah, you're you have no restricted. Yeah, you're restricted what you can do with the drapes that doesn't expose them. But if they're clothed, they can get up, they can move, they can be active while you're doing treatment, and they don't have to be athletes to participate in movement, they have to be humans, and I think that's so valuable.
SPEAKER_01I would say in my clinic, when I where I practice, for me, um I would say I would say I have half and half, 50% athletes, and the other half are uh standard people with orthopedic issues. Uh and um I would say in my sessions 80 to 90 percent are on top of the table in a tank top and shorts.
SPEAKER_00Yeah, I'm I'm the same way. And it's interesting because I find, and this is one of the, I mean, you've said you've listened to some of my podcasts, and for most of the listeners who are familiar with this, they they've expressed this to me when I go to conventions and they talk to me about this stuff. They've said the same thing that as we progress through our profession and we're in it longer and longer and longer, and we gain more nuance, it seems to be the direction of most therapists. As they're in the profession longer, they start integrating things like movement. Oh, don't get under the table on drapes because I won't be able to test if that hurt, we won't be able to reassess your condition, we won't be able to see how it feels, we won't be able to add movement. And it's not always the case because if all you like is spa type therapy, that's one thing. Right. But if you're focusing on anything therapeutic or pain related, it seems to be that they move away from the lay on the table, passively have something happen to you, and it becomes more actively, let's engage together. And I love that about the progression.
Movement Belongs On The Table
SPEAKER_01I I I I agree with that. I also think people get used to their default. And it's and if they're stressed or tired personally, it's really easy to go to your use. And our our defaults tend to go towards what we learned in school or or what we are comfortable with doing. And so you I believe you have a couple of mindsets. You have the ones that want to progress and move forward, and you have the others that are really comfortable just um doing really well at their standard processes. So I think it's the the mindset of learning that uh that that elevates that.
SPEAKER_00The one my wife and I, we always talk about this. Um, is I I don't call it the mindset of learning, I call it the mindset of effort. And essentially what it is is like if I'm tired, it consumes less energy to do something I'm used to doing because neurologically, it literally consumes less calories to just do something I know how to do. To do something brand new is consuming a lot of energy. So I always go, oh, it doesn't have anything to do with what you know, it has to do with how much effort do you want to put into it. And I'm a human, and my wife, it's it's one of the pros and cons that my wife likes about me is the pro is I'm someone who always has excess energy, having pretty high intense ADHD. But the downside it is like when it comes to recovery, I'm not really bad at that. But when it comes to like, oh yeah, it just takes energy. We've got energy, right? And every she's like, no, no, no, today's a no-energy kind of day. And so I think what you're saying, like when we go our defaults, yeah, it's just I don't I don't like using the word lazy because I feel like that's a misnomer because lazy implies that they don't have the willpower, but I think it has more to do with they just don't have the energy that given day to put the effort in.
SPEAKER_01You know, it's really funny that you mentioned that whole uh consuming calories thing. People don't realize how much our brain consumes with the cal caloric intake. Um, and my students say at the end of our weeklong training all the time, like, man, I am eating so much. I mean, I'm like, your brain is working on double time. So it you, yes, you are hungry. Maybe you're not physically moving as much as you're used to, or whatever the case may be. But yeah, your brain is consuming all that energy. That's why you're so hungry.
SPEAKER_00I think I think people forget too. Like, there's so many people who go, Oh, I'm tired. I had I have clients come in, like, I'm tired, I don't have the energy lately. My wife has been saying that lately. She's going through praying menopause, and she's like, Oh, I'm tired lately. And she's going through the, and there's all these hormonal reasons, but one of the other ones I said, well, if you're tired and you're not feeling motivated, why don't you do an extra protein shake today and see if your fatigue is nutritionally based. If it's hormonally based, the protein shake, you're gonna take in a couple extra calories, you work out every day, it's not gonna be a big problem. But if it's not hormonally based and it is nutritionally based, you'll totally perk up. And so we've done a couple days of those, and energy levels are totally different. And it's amazing to me too, how much when it comes to caloric efficiency, people forget that the brain primarily functions off of a lot of fat, on a lot of really healthy fat. And people are like, no, no, no fat in my diet. I'm like, well, some fats are really good for your nerves, they make your brain work really efficiently. And I it's just amazing to me. And again, it's that thing of the longer you've been in any profession, the more information you pick up and knowledge you learn. So, with that in mind, I wanted to pick your brain specifically about what I really enjoyed talking with you in Dallas, which you texted, you told me I didn't remember this. You sent me the it in the email. The quadrant of intentional treatment. Um, which for I think this is something that a lot of people uh who are like, you know, the better clinician project, yourself, you're teaching. I know Justin talks about this kind of stuff. I know I talk, I know a lot of people in kinesotaping. This is a big thing that Dr. Koss said, but he calls it the hydrokinetic theory. Different names for it and things like that, but it sounds to me like a very similar language, maybe seen through a different lens. And so I really wanted to hear what that means for you, because I know my listeners will hear it and they'll go, oh, that's that's what we've been listening to with all the other podcasts and what we're hearing about right now, especially with the group. I teach a lot with a group at the Canadian Massage Conference, and we all talk about very similar things to what you're talking about with this, just you know, with our own words and languages.
SPEAKER_01Sure. And and this was derived coming from that athletic and movement background. Um, so um I've been focusing on what I would call micro movements for a very long time. So is a person when they are sprinting, um, what's the degree of angle of their dorsiflexion? Um, what do they do they have any excess energy moving left to right when they should be moving forward? Um, how hard in training they have a thing called period, uh an athlete has a thing called periodization table, uh periodizations. So you have macro and micro periodizations within a training cycle, meaning you like have mesocycles. Anyway, basically what it is is you you push real hard in training and then you back off. And then you push real hard again and you back off. So, and when you back off, you get what we call these bumps or these spikes in performance because your nervous system has had a chance to rest and heal and recuperate so that it can go full power.
SPEAKER_00I uh do some people might know it as taper before your event. You know, you have your big load phase, your volume phase, your taper phase, and all those things. Yeah.
Energy, Effort, And The Brain’s Load
SPEAKER_01Correct. Um, and people who play video games, it's like when you go and you're running and that little bar gets lower and lower and lower because the energy is being depleted and your little guy needs to stop and let it recharge. I love it. Your mana is a concept. So we have to realize that when we are touching people, we are also um it's easy, it's it we we call it intuition, I believe, in our profession. We tend to say, oh, well, I intuitively knew to do this. Or uh I know, I know, you're giving me the cringe face.
SPEAKER_00Uh I don't know if I've ever told you, I don't know if you listen to the podcast where I talk about how much I don't like that word in maiden therapy, but that's okay. It's a different subject.
SPEAKER_01Well, I understand where you're coming from because everybody has an intention behind it. They just don't understand why they have that intention.
SPEAKER_00Yeah, I call it time and experience. Oh, intuitively you didn't know time and experience has made you understand that that's the right thing to do. You have, you may not be able to explain what moment in time and what experience made you look at the human body and go, that's the muscle to treat, or that's the disorder, or that's the pathology. But it's not intuition. It's time and experience. And in healthcare, for me, intuition is one of those things like you would never want to go to a doctor and they perform a surgery around you, and they're like, Why'd you do that? Oh, intuitively, it was the right thing to do to take out that colon. You're like, no, I would really, really know the scientific reason behind it, please. Like, you don't want intuition being something. I for me, it's outside of therapeutic care, no problem with intuition. But in therapeutic, physiological, that that for me is one of those words in in medicine that that that gets my goat.
SPEAKER_01Well, I understand you completely, and that's why I developed the quadrant. Because I'm like, you know, we all have the time, and and and some of us choose to take that time. But but what happens if we had the ability to skip ahead in that time a little bit and understand the why behind it? Um, athletes always want to know why. And so I'm annoyingly one of those people. Well, why does that work? Why is it? I don't mean to question you. I'm just I genuinely want to understand. And I'm a very visual person too. So not only am I asking people why all the time and trying to understand, I'm in my head, and as I'm talking to you right now, I am visually putting it together in maps and and and movements and stuff. Like it just it turns into pictures for me. Um, and pictures say a thousand words. Um, how can I make this easier for people so they could jump ahead of the ship here?
SPEAKER_00And uh I can't remember the name of the brain type, but there's there's I I just found this out the other day. I and I'll have to try to find the info, and I it's so new that I can't remember the name of it. But in neuroscience, they've they've broken the brain down into five types of learning, and not everybody has the internal dialogue. Like I have an internal dialogue, I have a little human. Inside my head that speaks to me as though I'm talking to another person. But there are other people who they don't use words, they use images, and the image contextually is a thousand words. Whereas other people, it's a thousand words. For some people, it's only emotions. They don't have pictures in their brain. They don't have words in their brain. They only have emotions in their brain. And that that is their way of thinking. And there's five different in total. I'm I it's so brand new. It's my next thing I want to delve into. But it sounds like you do the picture thing. I do the word thing, but it's just sounds like you visualize it, and that is your version of what we would call thinking, as opposed to somebody just literally plotting out words in their brain.
SPEAKER_01And you know, it's interesting in two fronts. A, that makes sense why you have a podcast so you can audibly talk everything out. But also in education, we have to be able to uh train students in multiple ways. And so you have to you're like, okay, well, I'm gonna visually show this, I'm going to kinesthetically show this, I am going to audibly explain why. And so you're able to uh hit those different sensors for people uh to be effective. Yeah, that's great. Uh when I was in choir on a side tangent, when um I'm in choir, I'm in a community choir, and um I was doing a solo, and these words and the notes were were they were they were dissonant, which they just they they weren't they weren't matching up with the other people's and they weren't supposed to. And the words were very tricky because it was more like the old English style versus of talking versus how we currently talk. So I literally had placed the words and the notes on the back wall of the facility that we were singing in, and I was just reading the notes and the words as I was singing to make sure that I got it right.
SPEAKER_00That's awesome.
SPEAKER_01Human brain is so fascinating.
SPEAKER_00So you were you were envisioning the quadrant in your head. Sorry, we went on I took you off on a tangent.
SPEAKER_01The singing quadrant.
SPEAKER_00Exactly.
Introducing The Quadrant Of Intentional Treatment
SPEAKER_01But it's the same, it's the same. Um, but I mean, circling back, what we're what we're discussing is a very similar thing. It's like, okay, you do you you work with the auditory, okay. We've we've um we can express why and how this this this all works, but can we visually also explain it? So it's just another tool in the toolbox to be able to um program out or show people um what you're talking about and try to help them understand it a little bit better.
SPEAKER_00And I think I think the thing that about it that I like the most was that you broke it down from superficial to deep, but also to global to specific. And for me, the the fact that you started saying superficial is probably for me the thing that I that I want to talk about the most because uh people know I'm a kinesotaping instructor and I've been for a very long time. But also anybody who's taken my classes knows that you know I try to focus my first touch of the human body is about three grams of pressure. And then we slowly will build up to 10 to 25 to 200 to 150 to 150 to 200, and we have scales in class and we play with those pressures so that people get good at it. Um, but we all it's all the way we talk about it is, or the way I talk about it is it's easier to start light and go deep than to go deep and return to light.
SPEAKER_01Yeah. Well, let let let's let's uh let's go back a little bit so that some people who are listening understand what what we're referring to here. So I created this quadrant of intentional treatment, and as is um what Troy's mentioning is it's it has two lines. So it has uh imagine a vertical line, and at the very top of that vertical line, it says um superficial. At the very bottom of that vertical line, it says deep. And then to the left, it says uh global and on the a horizontal line. Left says global, right says specific. So basically you have four quadrants. You have the top left hand quadrant, which is global and superficial, then you have the top right hand quadrant, which is global and or sorry, which is specific and global, specific and superficial and superficial, thank you. And then at the bottom, you've got deep and specific, and then on the other side you have deep and global. So you have these four different quadrants that you're always playing in when you're touching or putting sensory input or onto a person stimulating them. So you're either going light onto a skin layer, a muscle layer, whatever tissue you are referring to, because remember, deep does not always equal deep pressure. It could be deep on the specific muscle. I mean, your trap isn't that thick, and if you push too far, you're going out of the trap and into the city.
SPEAKER_00But what I say often is, you know, just remember like between the uh lateral malleolus and your skin, there's not exactly a lot of depth. Yeah. But you can touch deep really quickly.
SPEAKER_01Yep. So intentionality and your intention on what quadrant you're playing in and how much and deep also means time. If you're spending a lot of time on one specific area, you're you're affecting that tissue more than if you are going deep on an area, but not pinpointing that spot for a extended amount of time.
SPEAKER_00You see, that that single sentence is like the crux of why my podcast is called the sensory approach to manual therapy, because I can use a fine touch, like fingertips on the forearm, and it's not very stimulating. But if I leave that for a very long time, it it goes deeper. It goes it not only.
SPEAKER_01I'm gonna say I'm gonna say deeper. I apologize, that's the wrong word. Yes, it goes deeper in the fact that it's stimulating the brain more. The brain's like, whoa, something's there, something's there, something's there.
SPEAKER_00And that for me is the key behind essentially allostasis, which is this idea that the totality of all the events in your given moment in time, meaning your past, your history, your future, the temperature in the air, gravitational forces. Do you have to go pee? Your interoception, how much are you breathing, what's your heart rate doing, how much energy are you consuming listening, let alone do you have injuries? Are you stressed about going to work? Did you eat too much salt last night? Have you had sex today? Everything going on in your experience as a human. And that single touch, if held for too long, might flip you over the top. And then the brain says, fuck off, I'm out. And then suddenly we have we have discomfort. And that for me is why I like I like that when you're saying deep. It's not just deep in tissue terms, it's sensory system. And that's the title, like that's why the podcast, it's the use the sensory system to dictate manual therapy. If the sensory system is overwhelmed, you should probably change your approach. And that's why I like this quadrant, because if you are, let's say, on deep global, maybe the body's like, I'm overwhelmed, and I want deep specific or light global, you know, depending on if they want upregulation or down regulation of the nervous system. Right.
SPEAKER_01I tell my students, you have to have a very good reason why you are going deep and global. Why are you taking your elbow and running it all the way up from the ESGs to your scalings in extreme pressure on someone? What's the purpose of that? Or why are you fast and quick and hard scraping across a system?
SPEAKER_00Like the breakup. Like you have to have a reason that's not gonna enjoy it too much.
Deep, Superficial, Global, Specific Explained
SPEAKER_01You have to have a reason. So if you're reason, if if there's a legit, like one time I had a guy, I you know, I say if you put a cup on and you're vacuum cupping and you're keeping that vacuum cup in one spot, you are overloading this tissue in that one spot. So something's got to move, and there has to be a reason why now you're dragging that cup in extreme load all over the person. Now, are there cases that that is needed? I had a person who had scoliosis and she had to have like rods in her spine, and they completely fused every single one of her vertebrae. And the only time she could get a deep breath in was when I pulled on those cups while she deep breathed in, and then I drug the cups up a little higher and let her breathe. And that's the only time she got back breathing ever. So there was a reason for that, and I didn't do it for a long time. But so you sometimes can go into that, but you have to have uh intention. It's all about intention.
SPEAKER_00So in taping, one of the things we do is we'll tape sometimes the anterior neck. Yeah. And we have a big, we have a it's not a contradiction site, it's a precautionary site. People say, why? Why would I worry about treating the SCM? Why would I treat about it worry about treating anterior scalions? Or right now the big one is the polyvagal theory. Why would I worry about you know treating the vagus nerve and stuff like that? And I go, well, it's very simple. We have the carotid artery, and in the carotid artery, there's a very specific cell that dictates pressure to the brain, the borough cells. And if I take a cup and I put it on the brachioplexus, or I take a piece of tape, which is a suctioning technique, if you go under 50% and I reduce pressure and they get dizzy, I'm affecting their carotid artery and not the targeted tissue of the muscle. So it doesn't mean don't do, it means have a really good reason. Right. And then pay attention. And I think it's also one of the benefits of manual therapy is, you know, I talked about this in my last my one with Ben Cormac in the podcast with him, which was it's low risk, high reward. You know, if you mess up with massage therapy, yes, you can hurt someone. Chances are the hurt is temporary, and chances are you have to be really doing something ridiculous to cause serious damage. It doesn't mean it doesn't, it doesn't mean it can't hurt. It means most manual therapy techniques people can recover from relatively easily. And yet our reward is quite high. If you do something and they get better, all the better. And if it doesn't work, it doesn't work. It's not like you doesn't mean you can't break the spinous processes. I'm big enough, I can. It means I'd have to be doing something really silly to do that. So most of our techniques are higher on the reward category and lower on the risk than opposed to let's say I'm cutting you open with a scalpel. Our risk category just goes higher and things like that. But with the quadrant, one of the other things I like about it, sorry, uh one of the other things I like about it is the superficial, specific and global, because I think in massage schools and in massage continuing education, we still hear people talking primarily about things like muscles as gears and levers. We still hear people talking about primary ligaments, we still hear people talking about joints. And what we don't hear people talking about is epidermis, dermis, superficial fascia. And we hear people talking about fascia all the time, but we don't hear them talking about, you know, epidermis, dermis, superficial, which is like literally 30 grams or less and conditions like CRPS, multiple sclerosis, you know, like that lady you met in Dallas that we were talking about before the podcast, like these are the tissue depths that we like to concentrate on. And so I really like that you focus on that superficial stuff with the quadrant because it's it's not taught or thought of as a tissue of intervention very often.
SPEAKER_01Oh, it absolutely is. And you and like you were mentioning a little bit uh earlier, you have to warm that tissue up before you can, before their nervous system stops guarding and allows you to get into the deeper, uh, deeper areas or or um, especially like if you're talking about a hamstring, if the guy's got a huge, huge hammy and he's got a problem in the middle of it, you can't just like go in there and go for it. Um you have to you have to use that that superficial. Um also in regards to techniques, because um I am talking to the Kinesio tape guru, um, and that is in the land of that. He's like, no, yes, yeah.
SPEAKER_00And uh no no no gourds like guru, please. It's not I'm not a fan of those things at all.
SPEAKER_01Um you have the the tape can even play into all of these fields because you can go, you can go global with the tape, right? You can go multi-joint, you can you can change the way a structure wants to move along the whole pathway. Um, but then you can go into specific if you're just looking at one area that you're wanting to uplift or to make changes to in one small area, but not um, which will of course affect the surrounding tissue, but not in the same way as having a huge global strand. So you can even play with this with the tape, like how much you put on, how hard you pull, how many joints it goes across, what area it's in.
Intention, Risk, And When To Go Deep
SPEAKER_00Yeah, it's one of it's you just said something to me that I that I really want to highlight as well, that I think is an important thing. Um let's say you you do an intervention, it doesn't have to be tape, it can be any any version of intervention. Sure. ISTM, cupping, hands-on treatment, heat, cold, needles, whatever it is, right? You do some version of intervention on, let's say, the TFCG, TFCC, and the elbow changes. I like I've always found it interesting how people think, oh, well, this joint affects that joint. Yes, it does. It doesn't. You know, like it does in regards to when they move more naturally, their body will move more naturally. But it's not, I'm gonna go ahead and hold this one thing down and lock it in place, and then everything else will be fixed. It's not like by lifting the arch of your foot out, I'm gonna fix your TMJ. Yes, we've all heard that story because it has obviously happened, but it has happened far less than it has happened. It is absolutely for somebody with TMJ joints, don't instantly look at the arch. It's probably not the right way to approach that type of injury. Right. But the story is oh, it's connected to the and then it moves this, and then you screw home mechanism, the knee goes valgus, and then you go in, the hip certainly rotates, it brings your pelvis under, your diaphragm tips down, your thoracic ribs change, your shoulder blades change, it brings your cervical spine back, and your jaw stops hurting. Yeah, but that's probably all accidental compared to they just feel like they're in less pain and they move naturally. And for me, that gets me into the next part of what I want to talk to you about, which is the movement component. Because not only with manual therapy is there a lot we can do with our hands, but this but the manual therapy, and the manual therapy for me is probably the next thing I'm focused on when it or the sorry, the movement therapy when it comes to the sensory stuff. Because I feel like people aren't paying enough attention. They just think lift heavy, always do HIT training. I always have to be at my max threshold or just sub-max threshold. And it's like, no, if you want to focus on VO2 max, there's specific times to train in zone four or five. But if you want to be focusing on weight loss, you want to stay in zone two, low zone three. If you want to focus on introductory cardio, like I really feel like people aren't paying attention to the fact that their sensory system is also dictating how they feel like when they move. And for me, my favorite example is people tell them you need to squat with your knees above your toes, lined up perfectly behind them, in between first and second toe. When in reality, it's if you can't squat that way, it's because you're not strong enough to squat that way. So squat how you can. And when you get stronger, you might start leaning backwards when you squat, but that's because you'll be strong enough to do it. And it's because you'll feel it's natural, not because you're being forced to perform that way.
SPEAKER_01Well, and everybody's shaped a little bit different. Like I have really long femurs. I'm six foot one with a 37-inch inseam. My squat's gonna look different than somebody who's five foot one.
SPEAKER_00You may fall, you may fail at the wall test where you stick your knees against the wall, toes or hated that test. That's the word your knees your knees drop you backwards, whereas I got short femurs, no problem, right? To make it look easy.
SPEAKER_01So, what I teach in my classes is all about it's all about movement. Something moves. It's all about movement. Something moves. If the cup is static, the human body is moving. Um, ideally, you move, you you test, you see how they go, how they're moving, you elicit change through some type of sensory of I'm going to keep using the cup as an example since we're it could be any modality, it doesn't matter what it is. Cup, like the the implement moves or the the the client, uh the body moves, and to be able to integrate the two, because that's what we do in coaching. Like, so when you're coaching an athlete, you don't just say, and I'm a high jumper, right? You don't just say, hey Jenny, go jump over the high jump bar. It doesn't work that way. You go, hi, this is called a penultimate step. It's your second to your last step. You want to sink down just a wee bit so that you have enough spring to jump up. So let's like practice that first hop. Okay, now that you have that first hop, now let's scoop back and do three steps. Those are supposed to be your fastest steps. Now we're going to step back a little bit more and add the so you you do progressions, right? You don't just go with the whole thing.
SPEAKER_00I love how you say those steps as though everybody here listening knows what they are. You realize the likelihood of anybody else on the podcast being a high-end high jumper. It's not impossible, but it's not likely.
SPEAKER_01So the the but the concepts are the same. You don't do the whole full movement before you get the very, the very first, the basics down. Like, can't can my ankle even dorsiflex? Like, am I using my toes to do it? Like you have to start, you have to break it down. And so you do that with with with your techniques too. It's all about movement. So you are when you touch the skin or you touch the body, you are changing their where they're at, your their proprioception. And so now they have to relearn how to move in that new proprioceptive space that you created. And so you're moving, or the implement is moving, or they're both moving. And then you have to let them retest into that new space and get used to neurologically getting into that space now that it's different.
SPEAKER_00And so I almost feel like you can make another, I almost feel like you can make another quadrant, one where it's like the body's on top, the implement is on the bottom, and you have active and passive. So either they're actively moving with the instrument or they're actively moving with their body, or they're passively moving with the instrument or passively moving with the body. Because I feel like that's almost the same thing. Like I love the idea that it's like if it's the implement moves or they move. I think that's so valuable because, like, in one example, we are the implement. That would be manual therapy. Yes. But we can also have them passive an active move under our touch.
SPEAKER_01And have them move with load or without load.
Tools, Tape, And Movement Integration
SPEAKER_00Gravitational, non-gravitational. I love those things. Right. I think this is, I mean, this is this is wonderful. This is and so let me ask, can I ask you a more philosophical question that moves away from this stuff? I mean, you've been practicing now how long?
SPEAKER_01Uh 2012.
SPEAKER_00So a while, so 13 years.
SPEAKER_01Yes. Wow.
SPEAKER_00Yeah, I've been practicing 20 years now. And uh I see this more and more with people who have been practicing for a long time, especially educators. I see this more and more. And we're moving away from the conversation of the sensory approach, and we're moving into some of the other stuff I've talked about in my podcast about where's massage going? Where's not massage, where's manual therapy going? Because at what point, not to say that you are a physical therapist, not to say that I'm a physical therapist, but I have, and I'm sure it's the same for you, I'm sure you have clients who come in and ask you how are what how is what you are doing different from what a very diverse physical therapist is doing, a very diverse acupuncturist, a very good occupational therapist, a very good athletic trainer, a very good personal trainer might not be able to do the hands-on thing, but it doesn't mean they don't know what should be done. So, at what point when the knowledge is present, like with social media, with the internet, with research so readily available, with AI nowadays being able to break this stuff down for us so much more, at what point does manual therapy go away from the idea that you are your title and become a gray zone where it would be very hard to distinguish what you're doing versus what another master is doing?
SPEAKER_01Yeah, it's a good question. I call myself a movement specialist. Because I'm my training, I'm a little backwards from most massage theories. Just to just to kind of give you some context of where my answer is coming from. I've been a coach for how old am I? I shouldn't bring that up. Oh 25 years. I've been a coach. So I come from the movement background. Thank you. I come from the movement background, the coaching background, right? So I'm coming from the mechanical movement coaching background. And then I moved into the massage background. So I'm trying to meld these two, the movement and the massage together. So this is so a lot of massage therapists, they want to get deeper into it, then they learn about movement. And this is like my programs like to help combine those two worlds because they really they're very synergistic with each other. And um, it's something that I believe manual therapists should really have a good concept of and a grasp of because they marry very well together. I love my other healthcare practitioners. I think we we join together so well. I have a great group here in Seattle who I send my clients off to all the time. Oh, go see this person for uh your shoulder stuff and go see this person for for um uh go go ahead and check this out. We have a really good relationship, and it's also breaking the boundaries and and and making sure that you have trust with your your colleagues is a thing. So yeah, we're we're starting to gray and blur boundaries around things, but um I don't want to spend an hour teaching someone proper forms, proper um, I don't want to make sure that their knee bend is past 180, 120 degrees, and um getting them right after surgeries. And like physical therapists are they love that they just they live for that, they love seeing all of that. Um, I like to do just the hands-on and the docs, they tell me what the challenge is. I don't know what it is, I don't have an MRI or a CAT scan or anything. So you tell me what the problem is, and that'll help uh devise a solution with the rest of the team to fix that in our respective fields. I think it's great that we're all kind of blurring. Um, I think there are a lot of wars internally and within our sports, within our medicine world now because of it, because we're trying to keep claiming our territory instead of scope of practice becomes valuable and for insurance billing and for compensation.
SPEAKER_00But at that at one point, you got to think, okay, my scope of like I I was offered the opportunity to take a university program, which I just can't afford, unfortunately, even though they're giving to me at an incredible discount, I still can't afford it. But it would be get a master's in physical medicine, um, which would which would be wonderful because all the shades of gray would go away for me. My scope of practice would disappear.
SPEAKER_02Yeah, yeah.
SPEAKER_00But at the same time, I you just can't afford it, can't afford it, right? But it's one of those things where I think at one point it almost feels like anybody who's moving far enough into the profession, that one field, who's integrating movement and manual therapy together, when they get far enough into it, those, yeah, those shades of gray become really hard to distinguish.
Sensory Load, Placebo, And Outcomes
SPEAKER_01Yeah, but I say find your niche and rock it. Like find what you love to do. Of course, you say rock it. And then rock it. Yes. You just you love it. Just just nail zero in, focus, do really good job at that, and then find your your network to pass off when it's a little bit out of your thing so that you can be because we can't be the best at everything. Like, I think one of the hardest professions is a primary care physician because they have to, they get like everything under the sun from uh internal medicine, external, you know, they gotta cut, they've got to sew up, like they have so many things they need to learn. But then they go into extra specialties where they spend more time and and money and um uh investing into a niche or a specialty. Um and and they still have that general broad overview, but they really love their niche that they're in. And I think it's the same thing with us as practitioners. Like you could dry needle, but don't be afraid of the acupuncturists who can do they they're doing something, but they're like, that's their niche. And an acupuncturist, not be afraid of the dry needlers because it introduces more people to needles, which some people might be scared of before that, you know, before it's now introduced. So I think we all play together really well as long as we can um um, I'm not even gonna say where our boundaries or where our limits are. Even if I had a license to do everything, I like my network and my people. And I think it's very valuable to see a same situation in different, in different lenses. We all view the body a little differently. I work in a clinic with client outcome.
SPEAKER_00Yeah, I I agree. I work in a clinic with osteos and acupuncturists and massage therapists, and we get to talk and we share clients, and we all get a talk about and and it it's so amazing because we yeah, it they get better, and that's the most important thing. And for me, I think the quadrant that you talk about is one of those things where that's actually a good example of how it applies is that somebody doing osteo work, somebody doing PT, somebody doing chiropractic, acupuncture, you know, manual therapy, massage therapy doesn't really matter. The superficial specific, superficial, global, specific, deep, you know, like none of like it's all the same. It's just are they focusing on the ligament, are they focusing on the joint, are they focusing on superficial, downregulating nervous system, cranial, like it doesn't really matter. And to me, that's why I like that quadrant, because the modality is not the important thing, it's what the modality is doing to the experience of the person on the table, for the person in the room, and that's the most important component. Um, so so with that being said, where do you see it going then? Like if this is where you are right now, you see that you have this quadrant that you work on, you're teaching. Where do you see the sensory stuff progressing forward? Because that's my next biggest passion is to see where this is going to be in another 20 years from now. Because 20 years ago, the sensory system, it wasn't even a conversation. You know, 20 years ago, PE was just becoming, and cognitive behavior therapy was just becoming a common terminology. And 20 years later, people are finally buying into this stuff, even though, and even now, stuff is coming out saying, Oh, it's bad for you, right? So right now the sensory stuff is really brand new. Where do you see it progressing into the future? Because that to me is where I think that's that's the hardest thing to envision in manual therapy.
SPEAKER_01Are you saying in a broad scope, where is it going with the more specific, it's more philosophical in nature, like okay.
SPEAKER_00To me, I think it I think it's gonna play into everything in our life, and I'm just trying to figure out where it goes.
Blurred Lines Across Professions
SPEAKER_01I think it already plays into our life. We're just again, I'm not why person. I I think it or in an intention, and I I think we're just realizing what those intentions are. So in my world, in the sports world, um so going specific here for a minute before I I answer your more broad question. Um, I have a myodynamics integration model where I play with the type with the nervous system, the type two muscle fibers, and all of that. And I discuss that in some of my classes because there's ways that you you treat different people, different bot somotyping and that kind of stuff, and you put layer it all together. So I've kind of figured out how that works, which I help people understand a little bit more. Again, back to the why am I touching somebody and how fast, how long, how deep, how like what would they respond to uh quicker, um, that kind of thing. So, and again, it's based all on movement patterns. Um and then to so that's where I feel that everything is going to start going because sports is movement-based. I believe everything is getting more movement-based. It's just what does that look like? And I'm trying to hope that it people realize it doesn't look like beating the tar out of an athlete is the way to go. Like, what are you doing and why are you creating that stimulus and that sensory to make an effort? Uh, they always have that little saying, less is more. And I think uh um athletes are like, go, go, go. You know, we tend to be type A. And so um realizing that, well, if we have an intention and you understand why it they'll be okay with having it a little bit lighter, a little bit um less directed, or whatever the case may be, why are you doing what you're doing? And that's where that um intention comes through. Um for the broader spoke, for the broader question of where it's going, I think science is always moving and changing. And what we learned 30 years ago, we kind of teach the opposite. We just have to be okay with being plastic and saying, is that what it's called plastic? Like being able to change neuroplasticity. Yeah. And just being okay to change with the times. Be like, you know what, we did the best we could at that. And this is why we remake things every five years. This is why we come out with new additions in our books, is because we've learned new research and the way patterns work. And I'm curious, in your studies, have you noticed that um that that studies are becoming more accepted? It's been very hard to prove about massage with studies because you can't just like dissect a a mouse or something and figure out what the tensile strength is of something. Like it's it's harder because you you're you're layering people's perceptions and and are you finding now, I'm curious from your perspective, are they finding now that that uh uh less quantitative, more yeah, that more quantitative studies are being more accepted or readily accepted in the medical community?
Where Manual Therapy Is Heading
SPEAKER_00I am sharing with you a screen right now called The Dark Side of Muscoskeletal Care. Why do ineffective techniques seem to work? A comprehensive review of complementary and alternative therapies. That was open on my screen before we talked about this, because this is what I was reading before we started the podcast. Because this is the I just knew what your brain was going, Troy. This is the next research blog I'm I'm planning on uh dissecting and and reading about and and putting on my on my blog. Um, you know, it's interesting. Massage is definitely becoming more accepted across the board, and the results are becoming harder to refute. But, you know, uh Justin Solis, um, Gavi and Anna, they had this thing at Dallas that really liked, which is they have this little sticker they got, which just says massage works. And for me, I think it's probably the most accurate description of what the research shows us. Yes. Massage works. It doesn't tell you how, and it doesn't tell you why. Why, yeah. And that is a hard thing, you know. And I just did a podcast a couple weeks ago that was the last one I published, or two weeks, uh, two publishers ago with Sam Jarman, where we talked about evidence-based medicine and patient-centered care. And we talk a little bit about this in that, you know, it's that risk reward component of okay, uh, if if you offer manual therapy as a massage technique, and you have a rapport and you have a connection, and the client in front of you feels safe, the results will be greater. If they don't feel safe, the results will not be as great. We see that across the board with the research. Correct. So does that mean that it's the manual therapy that's working, or does it mean it's the fact that the client feels safe? Well, the two kind of go hand in hand. I teach a class on placebos, and you can't really take out that component. You know, uh, I was speaking with Laura Mosley last year in October, and I was talking to him about placebos, and he kept asking me the same question. And it was annoying because he's smart, he's a smart guy, and he can be annoying when he wants to be. And what he was saying to me, I kept saying, So, what do you think about placebos? And he says, Well, what's a placebo? And no matter how you answered it, his question was always, Well, what's a placebo? Because it's true, like it doesn't matter how you dissect a placebo, you still actually are just dealing with the world around you. There's nothing that you can't truly isolate anything from anything because the fact that they're in a room, the fact that they're in a paper, the fact that they're not aware of something happening or aware, be it an open label placebo or not. So with massage therapy, it's kind of that same component. It doesn't really matter. The why of it is something that a lot of us, like I like, try to answer, and a lot of people try to answer, but the why of it doesn't actually matter. The the does it work matters. Um, and statistically, we do see that quite. I mean, the last the last one I just did was on that. The last big Instagram post I did was on that as well, which was we know it statistically is relevant. The why of it is still the mechanism is really poor to understand. And and that's frustrating and okay all at the same time. Um, so yeah, that that to me is one of those things that I don't know if I'll ever actually have an answer to. Um for me, I I the thing I see the future being this thing where so you had talked about it, the mesomuscles and all those kinds of things. I I deal with it with phenotypes. So when I introduce myself to a client and we shake their hands, the first thing I do when they shake their hand is I touch the back of their skin, their palm, the dorsal section of their hand, the ventral certion of their hand, while I'm talking to them and I pinch the skin ever lightly to see do they have high tone, low tone, or average tone. And the reason is is we break it down into phenotypes, and if they have really high tone, and I teach this in my neuroscience class, if they have high tone, there's very specific types of touch that they like. If they have low tone, there's very specific touches that they like in general. It's not a blanket statement, but in general. So if someone's low tone, in the beginning, they want deep pressure because they want to be stimulated and feel safe. But once they feel safe and stimulated, they actually want to revert to really light touch. Almost like fingertip brushing touch. Uh sorry, reverse, sorry, low tone. They start with really light touch and then ultimately want the deep touch. But for people with high tone, in the beginning, they want, oh, I want to feel it. But then the moment they relax, they just want that light touch. Like for me, I'm incredibly high tone, and the best version of care you can give give me is a back scratch. Like if I'm in pain and you just give me a back scratch instead of a massage, I will tip you more than if you gave me a massage. Because the backstratch is far more relieving to any pain signal I have and far more calming to my nervous system. And like you, it's very hard to pitch my, I'm very, very high tone. And it seems to be this thing, like I think that's where the future of manual therapy needs to go. So this quadrant falls into that. This idea of looking at the person in front of you and not just seeing them as I have a technique that I'm gonna do to you, right? Instead, you have a sensory system and it's gonna tell me what you need.
SPEAKER_01Yes.
SPEAKER_00And I love that.
SPEAKER_01Exactly. And and it's like kneading dough. So you use this quadrant like you're kneading dough. You want to like do a little bit here, and then you want to go into this section, then you jump right back out of it, go into another section. Like you can't make good bread without playing with the the without playing with it, right? You can't use work. And so, so in and knowing different having, and that's why it's super helpful to have different techniques and uh philosophies in your toolbox because not everybody's gonna respond the same, yet you want to elicit a similar effect. So, how are you going to do that?
SPEAKER_00So, with that last portion in mind, um how can people get access to this quadrant from you?
SPEAKER_01Yeah, so I have a week-long sports massage certificate program. Um, it's seven D CE's, uh, NCB TMB approved and BOC approved. And um, it's basically a whole bunch of uh online courses and then a week-long intensive stepping through the process through uh through layering processes to get to the end with the critical thinking at the very end. And they become CSMS practitioners after they're done with it. Um, and it's just uh cross-function sports massage specialists, is what that means. And um, crossfunctionacademy.com has a little bit of the information on the different programs coming up. I do want to shout out that I'm gonna be doing a um uh inaugural sports massage competition and collaboration uh on June, in June here in Seattle to get a bunch of like-minded practitioners together. And if they don't like competition, that's fine. We're gonna have collaboration afterwards because I think it's really important to get like-minded people in a room talking together. That's awesome. Yeah, but it's at CrossFunction Academy for the Instagram handle and crossfunctionacademy.com for information.
SPEAKER_00And it's in June.
SPEAKER_01Well, the my classes are throughout the year. The the um the sports massage uh uh competition and collaboration is in June. I hold about eight, yeah, I held about eight eight-week long intensives a year currently, and I have a couple instructors who are also June and Seattle.
SPEAKER_00We'll have to I'll have to see about that.
SPEAKER_01Yes, it will be.
SPEAKER_00I was just in Seattle a couple weeks ago. I love Seattle. I'll be back there in March, actually.
SPEAKER_01And you missed me. Okay, you have my.
SPEAKER_00I'll be teaching my neuroscience class in March. Down in uh Olympia. I'll send you that privately. Yeah. Thank you. Awesome. Well, thanks so much, Jenny. It's great to meet you again. It's great to connect again. I knew it was fun to sit with you at in Dallas, and and this confirms it that like minds, and and I really appreciate that. And I love seeing the the different approach to it because it's the same, it's the same, we're we're seeking the same outcome in the language, but it's it's coming from something different, a different background with sports, but the quadrant, the visual component, and and if ever you have a chance to attend the Kenny Massage Conference, uh, the next one will be in Burlington, Ontario, the last weekend of May. Um, but I I highly recommend it only because we're a group of uh educators, and this is kind of the root of every one of our classes. And some are osteos, some specialize in cranios, some are one, I'm one of them, one's uh one does tweet. And yet this sensory component is the overriding theory behind every class. And to me, I really feel like it's something that you'd you'd you'd jive well with. But thank you so much for being on the on the episode today.
SPEAKER_01Hey, I appreciate having you having me on. Thank you. It's a pleasure talking with you and uh and and getting to top sh talk shop. This is always intriguing to me.
SPEAKER_00I thought you were gonna say talk shit with me, and I was like, yeah, that's we could do that also. Awesome, thanks.
SPEAKER_01Thank you, Troy.