The power of the elbow

I’ll never forget one of the worst massages I ever gave. I was working at a clinic in south LA, and a woman came in complaining about neck and shoulder pain. After doing some palm pressing along her spine to begin the session and orient myself to her body (and her body to my touch), I noticed some severely stuck areas in her shoulder. I began using point pressure with my elbow to invite this area to unlock. Unlocking can take time, especially at the beginning of a session, and I didn’t want to add too much weight too quickly.

After about 10 seconds, she said, “Are you just going to sit on my shoulder with your elbow all day?” Today I would probably say, “Yes, if that’s what it takes.” But at the time I was still fairly new to the clinic and didn’t want to turn customers off. So I said, “Would you prefer more motion?” She said yes, so I proceeded to do a more rhythmic patterning style of shiatsu massage, using thumbs and fingers rather than elbows. But the session kept going downhill. She directed me to use more pressure, then less pressure, then more pressure, then again less. Then she told me to go directly to her neck, but when I turned her head so I could access her scalene muscles, she asked me to please not hold her head that way.

It was like giving The Princess and the Pea a massage, except that this princess was kinda rude. I ended the session early and asked the receptionist to charge her for only the first 15 minutes.

This experience taught me a couple things:

  • some clients don’t feel comfortable with held points or stillness during a massage

  • ischemic compression using the elbow is sometimes misunderstood as a lazy or basic massage technique

But…for clients comfortable with stillness and ready to take a journey through discomfort to transformation…ischemic compression using the elbow is the golden ticket. It’s the strong paddle stroke that hoists the canoe out of the mud and propels it to the other shore.

Here’s why I like giving, and my clients like receiving, ischemic compression with the elbow as a primary tool:

  1. The elbow is versatile. From pointy sharp for laser-like precision, to round and broad like a lacrosse ball, the elbow can unlock the trickiest bundles of connective tissue and open up the smallest pressure points. Its 180-degree range of motion combined with its location close to the trunk of the body allow the therapist to use different angles and bodyweight to create just the right amount of pressure.

  2. The elbow is strong. While shiatsu is known for its thumb pressure, the reality is that strong pressure cannot be safely sustained by the therapist’s thumbs for more than a few seconds. The benefits of ischemic compression start to take place after about twenty seconds, and certain points need to be held for two minutes or even longer. The elbow is a safe way for the therapist to use bodyweight to achieve deep pressure over a prolonged period.

  3. The elbow is steady. If you add more than medium pressure to the thumbs, they start to shake, since weight is being channeled through the carpal bones of the wrists into the small saddle joint and hinge joint of the thumbs. Not only does this put too much pressure on these delicate joints, the experience for the receiver will be one of instability and maybe even stress. With concentration, the elbow can become as still as a Buddhist temple and as stealthful as a tightrope walker, giving the receiver’s nervous system the chance to relax deeply and accept the pressure.

  4. The elbow is round. Even the pointiest part of the elbow has a bit of softness to it, allowing it to penetrate the upper layers of connective tissue without causing any puncture, bruising or bleeding. The pointy part of the elbow can be used to induce a twitch effect in the muscle, similar to dry needling, without any need for needles, cotton swabs or hazardous waste. The broader surface of the elbow can penetrate slowly into deeper layers of tissue to dislodge stagnant chi, without any of the trademark bruising associated with cupping.

  5. The elbow is sensitive. Rather than employing a piece of bamboo or a plastic tool to really “dig in”, the therapist’s elbow senses subtle changes in the receiver’s tissue. This interchange and flow of information between the giver and receiver allows for the subtle reorientation of pressure being applied, and lets the giver’s body know once the energy has shifted and it’s time to move on.

The elbow sometimes gets a bad rap in massage circles as being crude or painful. Maybe that’s because it’s been used too many times in slip-and-slide, fast and hard deep tissue massages — the kind that give people bruises. Especially with oil, care needs to be taken to ensure that the elbow doesn’t glide too hard or too fast into deep tissues.

With compassion, patience and attention to angle, the true power of the elbow shines through. It provides precise, stable, sensitive pressure that heals.

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