Ep 215 – Fascial Compartments and the Irony of Empathy: “The Rebel MT” with Allison Denney

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0:00:48.6 Allison Denney: Hi, my name is Alison Denney, and this is the Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow. But the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peak at what's under the surface.

0:01:36.2 AD: We are an empathetic group, we have to be to do what we do. And it serves us extraordinarily well, but it can also hinder us. It is not necessarily that we feel too much, it is rather that we are unable to counter what we feel with a separation from the outcome. Being empathetic means that we have the ability to share what another human is feeling, which is great when it comes to understanding pain, listening to a client story and grasping their experience brings us closer to resolution. You can know on very deep levels what a client feels, and you can then curate your work to cater to that particular set of circumstances and that specific collection of anatomical parts standing in front of you in your office. But it is the same ability that can also create road blocks. Feeling all the feels is a good thing, it is not something we should attempt to curb. They are enormous though, so much so that they can overwhelm, they can literally send us spinning down the rabbit holes of, did I do the right thing? Did I say something wrong? And should I have done anything different? These questions can be dizzying, so we do what only seems natural, we attempt to rein them in, we spend many hours meditating on how to calm them or tame them or navigate the shame that saddles up next to us when those feelings seep out.

0:03:04.3 AD: If we let them in, they can eat up our every waking moments. What if we flip the switch though? Instead of trying to figure out how to squish what feels like an intangible and enormous cloud into a poorly constructed box, what if we allowed the cloud to be as big as it wanted to be, and invented a cover that would just sit on the surface of the cloud, moving as it moved, growing as it grew, constricting as it got small and allowing things to pass, but only with permission. And this cover was smart, it knew when the cloud needed to expand and when it needed to contract, it became more protective when it sensed danger, and it softened when circumstances felt safe. This cover or the boundaries that separate us from the other parts and beings in the world are something most of us lack, not because we don't want them, but because we are never really taught how to maintain them, much less create them. They are sticky in our personal lives at best, and they can wreak havoc in our professional lives.

0:04:11.5 AD: As body workers, boundaries are our moats, our security guards, out armor, but when the moat has dried up or our guards are taking a nap, or our armor has worn down, our professionalism itself is at stake. Being empathetic, although it offers us incredible insights can then become our biggest downfall. Creating strong boundaries is clearly the goal, and while this is something you may have learned about in massage school, there are a few important lessons that I think we can glean from our dear own personalized anatomy. Underneath our skin, these boundaries are called fascia. And fascia, if you really look at it, is exactly the kind of boundary we can dream about, at least in theory.

0:05:00.1 AD: In theory, if all the elements are aligned, fascia is multi-faceted and smart, it is thick where it needs to be thick, thin where it needs to be thin, strong where it needs to protect and vulnerable where it needs to soften. It is plugged into the wiring that controls us, the nervous system and the endocrine system. It responds to fear, trauma, sleep, meditation and stimulation. It is the perfect example of the boundaries we all need to hone in other aspects of our lives, but because humans are well, human, fascia doesn't always operate ideally. It can stick, it can grip, it can pull, and it can weaken, it can become inflamed and overwhelm the tissues around it, it can become stressed and guard to the point of suffocation. There are a lot of demonstrations of these in our pathology books, plantar fasciitis, carpal tunnel syndrome, facial fibrosis, but there is one that epitomizes how important boundaries are and what it looks like when they go awry.

0:06:03.1 AD: Fascia is this wonderfully mysterious tissue in the body that surrounds everything and helps to define one thing from another. We have superficial layers and deep layers. We have fascia surrounding our muscles, muscle groups, organs and organ groups, it is our own body's way of creating boundaries and categorizing what's inside or putting everything into compartments. Compartment syndrome is defined as a critical pressure increase within a combined compartmental space. Any fascial compartment can be affected, and there are fascial compartments in many parts of the body, the leg, the thigh, the forearm, the foot, the hand, and the gluteal region. Most commonly though, this shows up in the lower leg or forearm. In theory, critical pressure increase typically occurs from traumatic physical events like a car crash or a damaging blow like a kick or a punch. There are other less common causes, but the result is the same, a vascular disruption that increases the pressure of the area. The area like the name suggests, lives within the confines of a compartment whose boundaries are sheathes of fascia, so this build up of fluids into an already limited space turns into its own little pressure cooker.

0:07:24.1 AD: Have you ever cooked with an Instant Pot? An Instant Pot increases the temperature of what's inside to above a boil, which creates steam which can't escape because the whole confined space thing. You can then release the pressure by pressing on a valve and letting the steam out. The big difference is, is that we don't have pressure release valves placed strategically where fascial compartments exist in our bodies. I'm not gonna offer techniques for compartment syndrome in this episode, if I did, you all would have to be surgeons because the only management is surgical intervention. Fasciotomies are our manual pressure release valves, only with less steam and a lot more blood. Instead, I wanna reflect on how this all relates to our own boundaries or lack thereof. Think about the affected compartment as your office space and the clients that enter, when they sit with you and tell you what it is they wanna focus on, they are hoping for relief. Considering what we know about pain, that it's weird, that it comes in many forms, that it is commonly very difficult to describe, and most importantly for this topic, that experiencing pain can create distractions and a lack of focus in life. So pain equals pressure.

0:08:42.5 AD: The frustration that builds with any tissue or dysfunction can strain many aspects of a person's life, and you as the massage therapist, need to hold a boundary around that. Let me be clear, I'm not saying stop what you're doing and don't work on anyone. That is not my point. My point is, when you do work, you are relieving their pressure, you are helping them to de-stress, unwind, relax, heal, whatever words you wanna apply here, you are slicing open the fascia, figuratively, of course, and allowing a reprieve. You are hitting the pressure valve and giving them space to let off steam. If your own boundaries are not intact, their pressure will land on your shoulders. I get a lot of requests to make videos or write about self-care, there is no doubt in my mind that defining and maintaining boundaries is the most important form of self-care there is. As a group, we fall into the category of those whose boundaries tend to be soft or permeable, it goes hand-in-hand with empathy. There are those of us though, whose boundaries are too thick, too rigid and connecting to clients is not as easy.

0:09:57.1 AD: Neither scenario is ideal, and finding the balance that is right for you is your work. For most of us, we are hoping to help clients soften their boundaries, we are showing up and listening and being vulnerable in an effort to hold space for those who want to be heard, we are literally working to make those compartments more pliable. But the reality is, the opposite is true for our own compartments. We need to reinforce that which defines us from the outside world, if we don't, we begin to shoulder too much weight, stretch ourselves thin and wear ourselves out, and then we can't help anyone. When it comes to working with compartment syndrome, like I mentioned before, there is not much we can do unless we are surgeons, but as body workers, our best approach is to know our anatomy and look for signs that might indicate something is wrong.

0:10:51.9 AD: An excessive amount of pain in the area, numbness and tingling distal to the area and tension in the tissues without swelling compared to the unaffected side are common signs and symptoms. A loss of function such as the inability for the tibialis anterior to lift the foot into dorsiflexion, otherwise known as drop foot, is indicative that symptoms are more advanced and the client should be referred out. We can, however, practice preventative work. If your client seems to be on the path towards compartment syndrome, try these tips, move the foot passively while you slide up the calf or the chin, or move the hand passively, as you open up the flexors and extensors of the forearm. Engage your client as well, have them create movement around your work and bring their attention to their own anatomy, their own compartments and their own boundaries.

0:11:44.4 AD: Remember though, that if you don't know your own boundaries, they won't be able to know theirs. Your work as a massage therapist is not about whether or not you can heal soft tissue, it is about the boundaries you hold so that you can maintain your own integrity. It is about striving not to become complacent in your knowledge and techniques, remaining present with your clients and above all else, not crumbling or caving in to insecurities when something does not work. It is about your confidence, that you are standing in your integrity, and I have no doubt that you are.

0:12:22.7 AD: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears, and if you wanna get any of your words into my ears or more accurately into my brain via my eye balls from a computer screen, drop me a line at rebelmt@abmp.com, that's R-E-B-E-L-M-T @ A-B-M-P.com. I always wanna hear your questions, comments, suggestions or salutation. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage dabblings.

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