Bevin Keely, LMP

What is fascia?

One of the common questions I get about my work is “What is the difference between massage and Structural Integration?” The primary difference is intention and the systems we are working with: massage therapy is great for stress reduction and getting the blood and lymphatic systems moving, Structural Integration is aiming more for engaging long-term patterns in the connective tissue of the body. This connective tissue system is something we call fascia.

For a long time fascia was just the stuff the anatomists cut through to get to what they were studying, but over the past decade or two there has been more interest in the material itself. Several years ago I attended the very first Fascia Research Congress at Harvard University, where researchers and clinicians gathered for the first time to share their findings with one another. The fourth Fascia Research Congress was held just last month. I’m not a research wonk, but I did find the scientific process fascinating– ask a question, create a test, isolate the variables, collect the data, present your conclusions.

Last time I checked in with the wonks, there was no consensus on the exact mechanism of change for fascia– i.e., why does it respond to Structural Integration, what is the physiology, what is the best way to get a response? The answer I got was that they only knew it was not strictly applied pressure. To create connective tissue change with pressure you have to load one spot with a tremendous amount of it, a force so great even the most heavy-handed Rolfers are not capable of doing it.

The search continues, of course, and my curiosity lies with what they might find out about the nerve fibers and contractile tissue in the fascial matrix. There seems to be a place in connective tissue where the person (or the nervous system) is engaged, sometimes over-engaged, and if they can be met there and convinced that the grasp on that tissue can be loosened without dire consequences… well, it’s probably another post entirely to go into that, but let’s just say I’m interested to hear what the researchers find out.

Here is a lovely, graphically detailed and illustrated description of fascia with Robert Schleip, a Rolfer® and researcher in Germany (subtitled in English):

The Allowing Will

Some time ago the magazine of the Rolf Institute of Structural Integration® published an excerpt from Dr. Jeffrey Maitland’s book Spacious Body: Explorations in Somatic Ontology. It was a dense and chewy read by a philosopher and Rolfer, and though it took me a while to read the whole article, his ideas have resonated in the years since.

Scanning through the article again, I feel like he needed a better editor, but the idea of finding within oneself an “Allowing Will” has been very juicy for me over the years. Can I choose, for instance, to allow support from another being, or allow something deep to happen in my body or experience without trying to control it? What if I just let gravity have that leg for a moment? Will all hell break loose? How about allowing myself to feel that tangle of emotions in the hip? Will the universe implode? Letting go of control can feel very dangerous to someone who has used it to navigate this crazy world. Not that I would know (ahem).

“Fundamentally, allowing is a surrendering of the body-self and its conflicts into a spaciousness greater than itself from which empowered willing and action can manifest.”

From this place the universe seems kinder and gentler and has a little more flow. Terrible things happen, but bracing against terrible things tends to make more terrible things happen, and allowing them to be something that instead once happened and then allowing the future to hold the possibility of quite different experiences… well, it works better for me.

Click the quote above to access the book, the Allowing Will is chapter 4.

I’m sensitive

I am late to the game on this, but after talking with one of my clients recently about being extra-sensitive to the feelings of others, among other things, I finally did a little search online about it.

I have never identified as a “Highly Sensitive” person because (according to my therapist) I have excellent coping skills, and (it’s my feeling that) I’m not THAT sensitive. I’m lucky enough to be able to dial it in and dial it out most of the time, but there are times when I have to do a little self defense in the empathic realm, and my education about how to do that has been piecemeal.

There are a lot of us out there who get stronger signals from the world, which many of us read as ANXIETY, dreadful inexplicable anxiety. Somatic Experiencing has helped me tremendously with that, making it possible for me to experience anxiety as a felt-sense phenomenon that may or may not have a real issue it is trying to help me with. My discernment skills around that have gotten pretty good, and I may be able to teach you some of those skills if you like.

But–in big energy situations where my senses tend to get weirdly overwhelmed (a great example for me is festivals, where lots of crazy energy is running rampant) I have found it necessary to to a little self-care up front with little practices I’ve made up on my own. If the message about how to take care of oneself in this way has had a hard time reaching me, a person who has been surrounded by resources for over 20 years of working in the healing arts, then maybe it’s having a hard time reaching you, too.

Here’s a local class for you sensitive peeps out there that might prove helpful: http://www.annaholden.com/sensitive-self-program-series/sensitive-self-defense-training-course/

I’ve been clicking around on this website, too: http://hsperson.com
Something about the language of this site speaks to me less (I don’t identify with it), but I appreciate her focus on research, and have her book reserved at the library.

Here’s to continued learning!

Straighten Up and Fly Right!

Vintage Stranger Ad, unfinished
Vintage Stranger Ad, unfinished
It’s Summer in Seattle! The best time of year, and you should be feeling your very best. To help keep you flying through these long and lovely days, I’m offering a mini-series of Structural Integration for a reduced rate: Three sessions for $300. (That’s a savings of $75 for the set!)

If you have never received Dr. Rolf’s Structural Integration work, three sessions is a perfect intro, and should leave you feeling light on your feet, longer in your spine, and either completely satisfied or aware that you need more.
If you have done a series in the past, three is a great tune-up set.

To take advantage of this offer, book three appointments here and use promotion code SUMMER!. Offer ends August 31, 2016.

Liberation is Possible!

Twig Wheeler has done some lovely descriptive work with the ideas of Somatic Experiencing over the years. He did a one-man theater piece that demonstrates viscerally what many words of explanation would still struggle to convey. Here is an excerpt wherein slowing down and feeling/listening to his body yields a feeling of completion and illumination.

There is something about a supported yielding to the programs and preferences of the subconscious mind (or autonomic nervous system) that potentiates deep reorganization for us in a way that striving for understanding through language does not.

Settling in

The big move is behind me. I have been working in the new space for a week, every day adding a little more of this and adjusting that. I have a couple more things to take care of, but it’s almost home.

I like it more than I thought I would. I’ve traded seagulls for train whistles, and crazy afterthought bathrooms for easy listening in the elevators.

Entry
Entry
Afternoon light.
Afternoon light.
Small but cozy.
Small but cozy.
Night view.
Night view.

My hope is that as I settle into the space, it will become more and more restful and welcoming for you.

Moving

August 15, 2014 marked 21 years in the Maud building for me. I was 22 when I signed that lease, fresh out of massage school and super tired of being a bike messenger. My brother had asked me if I wanted to fill up some space on the back of the Stranger (where he was one of two ad reps) with a free ad, and I needed a place to practice when people started calling. I remember the first client I had in my new space– a friend of a friend.

It was never my intention to end up in Pioneer Square, but the spaces I was looking at in the Capitol Hill and Belltown areas felt cramped and ugly, and this little room had a tall ceiling, an exposed brick wall, and a lovely big window. I paid $110/month for the tiny room I have been using as my office, enough room for a massage table, a cabinet for my sheets, and that was about it. When I got my Structural Integration certification in 1997, I expanded into the spacious suite I’ve been using ever since.

Pioneer Square has historically been a sketchy neighborhood–like, right from the start– and yet I have never felt unsafe here. I have watched the Square struggle to balance high rent retail with a high percentage of homeless services, suffer the blows of the Nisqually earthquake and the big Recession, endure a reputation of violence and stink, and see it now emerging into the new “Foodie Heaven” advertised on the buses, a place with more people living in it and working in it and more development on the way.

When my landlords told me last month that it was time for them to occupy the whole building, I immediately began looking for my new space. As I walked around Pioneer Square, my gut sat low and sluggish, sad and heavy. The rents were predictably much higher than what I have been paying (a fact I have always appreciated), and the spaces were uninspiring, despite being in beautiful old buildings. I went to check out a new building in SODO and my gut sat up a bit, got lighter, more curious, despite the awkwardness of the location and the smaller size of the room. How strange.

So, I am leaving Pioneer Square. My gut told me to, and we are tight like that. I don’t know what is in store for me, and I doubt that my new space in SODO will be mine for more than a couple of years, but I have a feeling that this move is the beginning of something good, the “next thing”, potentially amazing.

I have one more week here as I write, and I am enjoying the creaking floors, the terrible noise bleed, the comfort and familiarity of it all. I have grown up here, and I will always be grateful for the opportunities that the Maud Building has provided.

Onward!

Health Savings Account/Flexible Spending Account

One of the trends I have noticed over the past couple of years is the rise in Health Savings Accounts (HSA’s). More companies seem to be choosing high-deductible insurance plans and contributing some money to attached HSA’s for their employees as health care costs rise and insurance premiums become unwieldy.

Massage therapy and bodywork is not specifically listed as an “eligible expense” on IRS Publication 502 describing tax deductible Medical and Dental expenses, but neither is it listed as “ineligible”. From what I can gather, a “letter of medical necessity” or a prescription from your physician would push my services into the “eligible” category.

Flexible Spending Accounts (FSA’s) work in the same way.

If you use your HSA/FSA without the safeguard of a prescription or a letter of medical necessity and are audited by the IRS, they could decide that your treatment was not properly documented as a qualified medical expense and that the money you spent is subject to income taxes and a 20% penalty.

The good news is that the threshold for determining medical necessity seems to be relatively low– your physician simply needs to explain it, and that should be sufficient. Here is a sample letter of medical necessity from my own HSA. Check the website from your HSA manager to find the form they prefer.

Medical Necessity

To get your massage covered by your insurance, you will need a prescription from your doctor, even if your insurance plan says you don’t. This ensures that your massage is “Medically Necessary”, which keeps me out of trouble. It is outside of my scope of practice to diagnose your injury, and yet I must have a diagnosis code to bill with– thus, a prescription.

Additionally, you should be aware that insurance companies are pretty rigid in their definition of “Medical Necessity”:

“Benefits for inpatient and outpatient rehabilitation therapy services (such as massage therapy) are provided when such services are medically necessary to either restore and improve a bodily or cognitive function that was previously normal but was lost as a result of injury, illness or surgery.

Loss of function generally means a joint that doesn’t have full range of motion or full strength, or pain that prevents you from your activities of daily living.

Insurance companies are less interested in treating chronic pain syndromes; in my experience, they want to see results. If the treatment isn’t working within 6 -10 sessions, then it must be the wrong treatment. (See previous post.)

 

Pre-Authorization

Regence Blue Shield has recently begun to require pre-authorization for physical medicine services, including massage therapy. If your plan is administered by Regence, but independent of them (ex. King Care, UMP) this does not affect you.

I am still learning how this works, but it is supposed to go like this:

  • You come in for an initial assessment and treatment.
  • I submit for a pre-authorization online.
  • If you have not yet received any physical medicine treatments for the year, you get four sessions automatically, to be used within three months. This includes the initial treatment and assessment.
  • After four sessions, if you still feel that you need treatment, I then submit an updated treatment request showing changes you have made since the start of care, and outlining how we are going to quickly and efficiently get you healed within, say, another four sessions.
  • If you have already received some physical medicine treatments, including Physical Therapy, other Massage Therapy, and possibly Chiropractic care, I’m not even sure what we have to do. I haven’t jumped that hurdle yet, and as you may know, getting answers from insurance companies can be tricky.

Here is a chart showing their progress expectations:

I will update this post as I learn more about how this works in practice.

In the meantime, if you are a Regence client (not a King Care or UMP subscriber) and have had some physical medicine treatment already this calendar year, I will need you to contact me before you make your appointment so we can try to set the gears in motion.

Thanks.