Tattoos, or “body art” as my clients like to call them, are a common sight here in California. That’s why the large tattoo covering the upper back of the young man standing in my treatment room did not engender a response other than passing interest in the art itself while I completed his postural reassessment. He had come to me for help relieving his constant lower back and hip pain acquired while he attended college on a football scholarship, so my attention focused on the interesting collection of postural distortions and biomechanical dysfunction, not the wings spread across his shoulders.
My client’s history of injuries, at the age of 27, was too vast for him to recall in specifics other than the most dramatic and painful, the concussions, and of course, the one that ended his football career. His leg-length difference added an opposing hip and shoulder torsion to the complex soup of dynamics underlying his pain.
Initially, the work progressed well. His anterior pelvic tilt reduced, and even with his uncorrected leg-length difference, much of the pelvic rotation decreased, as did his lower back pain. Restrictions in his hips and knees eased, while changing his stride and cross-body pattern. He remarked that he no longer “walked like a duck,” and his strength and endurance were improving. Everything below the sacroiliac (SI) joint seemed to be moving along a predictable and gratifyingly rapid path. His upper body, however, was not so cooperative.
His skin, stretched taut over well-developed chest muscles, was pulled even tighter across his back. His shoulders and head pulled forward as though he were perennially considering going into a crunch. Taking my cue from his body, the work focused on the abdominals, pectoralis major and minor, serratus anterior, scalenes, sternocleidomastoid (SCM), and his deep anterior neck muscles. Back work was more to release the overstretched condition of the superficial and deep back muscles. What little success we achieved lasted only a day or two and by the time he returned the following week, his body had drifted back into a posture that was beginning to seem welded into place.
On this particular day, visceral massage revealed a tender spleen from a recent basketball injury. Upon release, his upper right quadrant relaxed, but it did nothing for his strangely shaped kyphosis. Stumped, I pulled up my rolling stool and sat down next to the table to better see what was, or was not, going on. This time, as he lay prone on the table, I really saw him. His “roach” back posture seemed impossible, given the anterior release work we just completed. Pressing into his back muscles, his ribs confirmed this was not an optical illusion.
This was the moment when his tattoo became more than a point of passing interest. A pair of wings cloaked his upper back. Sweeping outward from a crest floating over C7, they spanned his shoulders and scapula to embrace his posterior deltoid, trapezius, and infraspinatus. The ends of the feathers scooped upward to meet at T3–4. Staring at it, I began to see irregularities where older art lay beneath. The star and crescent hovering above C7 was an older image that contained ridgelines of scar tissue within the lower left point of the star. The upper line of the feathers traced the spine of his scapulae. A slight blur on the lateral side of his left scapula spoke to where an old tattoo lay beneath the feathers. It suggested potential scar tissue. The line along the bottom of the tattoo, tracing the feather tips and bottom feathers, looked smooth and even, but it still held my eye and begged to be touched.
His taut skin was difficult to tease into a skin roll, but a tiny ridge managed to make its way from his axilla to that mesmerizing line, where it stopped and he reported a sharp, precisely localized, needle-like pain just as the roll reached it. Testing what was quickly becoming a hypothesis, I rolled that tiny ridge along the path of the line and he reported the same pain. When the skin roll drifted inferior to the line, he reported it being somewhat unpleasant, but not painful. Reversing direction, I moved the resistant roll of skin up into a shaded area within a feather. Again, it was sharp, well localized, and painful, but not as painful as the line. Changing direction, the tiny roll moved laterally across the feathers and then outside the outline of the tattoo. The outline of each feather corresponded to a sharp needle-like pain, the center of the feather a lesser intensity, and outside the tattoo, he felt discomfort, but not pain.
Is It Scar Tissue?
Greg Williams, author of a soon-to-be-published book on scar tissue work, Pulling It All Together1 and instructor of scar tissue release work at the Massage Therapy Institute in Davis, California, says scar tissue creates sharp, well-localized sensations of pain, while adhesions are less localized and have a somewhat duller sensation of pain (see image, page 74). The age and degree of involvement generate different textures in the tissue, as well as levels and types of pain. As bodyworkers, we typically look for scar tissue and adhesions in muscles, joint capsules, along surgical scars, and within the abdomen after surgery. Sometimes we find them in skin when a person sits for long periods in one position and has chronically tight muscles.2
According to Tracy Wilson at Howstuffworks.com, tattoo artists typically use pneumatically driven plastic needles that inject ink at a consistent depth of about 1 millimeter (mm), which is supposed to be safely within the epidermis, well above the basement membrane, and unlikely to cause scarification.3 Nowhere in my literature search have I found anything about the current state-of-the-art tattoo equipment causing adhesions, but the less than 3-year-old tattoo in front of me was appearing to be one massive adhesion with scar tissue binding the outlines of the image to the underlying fascia on his back.
An Amazing Release
I did not know what releasing this mixture of scar tissue and adhesions would do; it just seemed the right course of action for something this large that was clearly “glued down” to underlying tissue. It took nearly an hour of skin rolling, J-strokes, and S-twists to free it completely from the fascia over the posterior deltoid, trapezius, infraspinatus, and teres minor.4 At the time, I thought the frequent shifts my client was making were more about his repositioning to become more comfortable on the table and perhaps escape some of the discomfort from so much release work. He commented at one point that he “felt longer,” but from my perspective, there was no significant change.
After his tattoo was released, a curious thing happened. The skin immediately below it lifted much more easily than it had when I comparison-tested it with the inked areas before starting the release work. The skin over L1–L5 had been glued down before the release work, but now, as I made a few quick passes down his back, the skin was much more pliable. I was completely unprepared for what came next. He shuddered slightly, then his body “collapsed” into the table and the roach-back effect disappeared. He broke the stunned silence by exclaiming, “My God, I can breathe!” When he stood up, his shoulders and head moved easily into alignment. He was obviously taller—by at least an inch if not more.
A New Protocol
The work has held over the weeks since the release was completed. During that time, I began investigating the tattoos of my other clients, and those of other students in a scar tissue release class. Several of the women in class had rather delicate and modest designs colored with the lighter pastel colors that are prevalent now. Many of these were located over the sacrum. Every one of them, regardless of whether they were over the sacrum or on the shoulder or forearm, was adhered to the underlying tissue. My protocol has changed to include tattoos in postural charting, and releasing them precedes bodywork.
Diane Hovey, PhD, CMT, has been a massage therapist in private practice since 2004. Certified in medical massage, as well as four other related disciplines, she specializes in clients with chronic pain that has proven unresponsive to more traditional approaches. Contact her at diane@focusedhealingtherapies.com.
Notes
1 Greg Williams, Pulling It All Together. For more information, email gregorywilliamscmt@yahoo.com.
2. Ibid.
3. Tracy Wilson, “How Tattoos Work,” Howstuffworks.com. Available at http://health.howstuffworks.com/tattoo.htm (accessed July 1, 2010).
4. The J-stroke is similar to the stationary circle used in lymphatic work. First, check the skin in north, south, east, west directions to determine which two directions provide the most resistance to movement. Starting in the direction of greatest resistance, move the skin as far as it will go, then scoop the move into the second-most restricted direction. The pressure is firm in order to stretch and separate the adhesions and areas of actual scar tissue connection. The S-twist uses two hands working in opposite directions, but using the same moves. Engage the skin and rotate the hand medially without changing position on the body for the basic move. This puts a torquing motion into the tissue. The full move involves placing the hands 90 degrees to each other with the fingers of the right hand pointing toward the tips of the fingers of the left hand. When the hands move medially, there is an S-shape in the tissue.