Inherent in the perspective granted by a particular vantage point is the absence of all other possible views. In other words, I see what I see based on where I’m standing and the lens I’m looking through.
As we learn anything, we generally start with a simplified, two-dimensional lens. You probably initially learned that the solar system is a series of balls going around the sun. Simple. Then, as you went along in school, the theory evolved to include elliptical orbits, varying orbital speeds, the planets spinning as they orbit, moons spinning and orbiting, and all of it hurtling through space making interesting helical patterns as the sun orbits the galactic center.
Or, consider the evolution of your understanding of an atom. It was probably a similar journey from a picture of solid, round particles in ordered patterns to mostly space and clouds of charged particles blinking in and out of existence—suddenly you discover nothing is actually as solid as it appears.
It’s the same with the evolution of our understanding of the body in massage education and practice. Not only do we get better at our techniques, adding more to our toolbox over time, we must also allow our way of seeing and understanding the body and our role to continually evolve.
As massage therapists, we first learn simplified, two-dimensional models of the body and massage techniques. We learn the rules and routines. We learn posture according to a plumb-line analysis, and function according to uniplanar concentric contraction on a table. It’s a fine place to start, but the body has undoubtedly one of the most extraordinary and complex designs—awe-inspiring even. The more we learn about it, the more we discover there is to learn. We are dynamic; in motion always. Even while reading this article, you’ve taken at least a few breaths, had a number of thoughts and opinions pop up, maybe wondered what you’ll eat for your next meal, shifted your weight or position in your seat, perhaps scratched an itch or adjusted your glasses.
It is a complete dynamic person (like yourself) who is on your table—not a lump of flesh and tissue. And people don’t typically need to be optimized for lying on a table. It would be more beneficial to optimize them for their full expression in the lives they are living. We therefore propose a natural evolution in how we as therapists perceive, and subsequently address, the body that is based on a more dynamic, integrative lens. We call it Integrative Anatomy—a view of the body that functionally incorporates not only multiple treatment approaches but also multiple understandings of the design and function of the body in order to expand our results. Here’s a look at how to begin expanding your assessment and treatment lens to integrate these perspectives.

The Body’s Expressions

Most fundamentally, the body could be considered to consist of three different aspects or expressions—the structural, the functional, and the energetic or informational. The structural aspect consists of the parts and pieces, the anatomy: bones, fascia, muscles, cells, tissues, etc. The functional aspect is the body (and its parts) in motion, the purpose of the parts and the whole. This includes the physiology of cells and systems as well as muscle and joint movement, both internal and translational through space. The functional perspective also considers dynamics in relation to environmental factors, such as gravity or specific stressors. The informational level, also called the energetic level, consists of the flow that is underneath and woven through the rest. It is known through different systems as prana, wei, qi, chi, torsion fields, quarks, etc. This aspect also includes consciousness, thoughts, beliefs, and emotions.
These three aspects of the body are inextricably linked. In fact, they could be considered reflections of each other, one and the same, expressed in a different medium. Think of the different map views in Google Maps—default, satellite, terrain. It’s the same location, but you see different information based on the lens you choose. Standard massage education and practice deals primarily with the structural/physical level. Although this isn’t consistent with touch therapy’s roots in ancient healing systems, such as ayurveda and traditional Chinese medicine, it does align with the current Western medical model, which is primarily reductive and deals mostly with pieces and parts of the whole. Although this has been necessary for acceptance and credibility of our profession by the current model, it has also limited the understanding of what can truly be accomplished with manual therapies. We believe a more integrative approach is to consider all the body’s expressions—structural, functional, and energetic.

Structural Level Concepts

Since we work with our hands, impacting tissue and structure directly, let’s begin by fleshing out the structural aspect of our integrative lens.
In massage school, we initially develop a basic ability to observe posture and feel muscle tension. Are bony landmarks even and balanced? Where does it hurt? But this understanding must evolve. We get more advanced and start noticing rotations, tilts, and shifts, looking for how the parts relate to one another. We begin to better understand fascia, the nervous system, and the interconnectedness of it all.
There are many great modalities for addressing the fascial system that have helped us help our clients reach their health goals, including the structural integration work of Thomas Myers. The structural integration approach has helped therapeutics evolve from looking at the body against a plumb line to assessing the body’s relationships. The former tends to promote a static view of posture, tempting us to force the body to be perfectly straight and rigid. But we aren’t walls; we are designed to move. If we take the approach of looking at the relationships of body parts with each other, we get a much better understanding of not only the structure, but also the dynamics of movement and energetic flow and balance throughout the system. We can look at the relationships of body parts next to each other (such as the femur to the pelvis) or far apart (such as the lower legs to the neck) and that helps us understand the relatedness within the body. For instance, a therapist can assess the relationships of the lower leg to the pelvis and how that is related to the client’s forward-head posture.
Since each body part and body area has an effect on all the other parts, we start to see the bigger picture of what our clients are really experiencing and how we may be able to help the body reorganize itself into a collection of healthier relationships. There are so many structural compensations in the human body that each session and each client must be approached with a fresh set of eyes for our work to be truly effective.
Tensegrity is another invaluable concept from the structural realm. Ida Rolf noticed that “weight does not go down in the body, it goes up.” As we understand how fascia and other connective tissue gives lift and support to our structures, we start to understand how our physical bodies can endure decades of stresses. We also see why chronic pain persists, as well as why specific joints may need to be replaced as the victims of misplaced force caused by compensatory patterns.
An advanced structural lens enables us to help the body balance the relationships of its individual parts within itself and to gravity, but it does not give us a complete picture of our clients. Notice that with this lens alone, we don’t yet understand how our clients are expressing themselves in life or why a certain area of muscle and fascia is chronically restricted and spasmed. We may see the “what” but not the “why” or “how.” The treatment is also limited primarily to “releasing.” This does give the body the opportunity to reorganize itself, but, as the nervous system is ultimately in control of the muscular system, reeducation on the functional level is required for rapid, lasting change. Otherwise, the old neuromuscular patterns persist.

Functional Level Concepts

As mentioned previously, we are not walls, nor do we spend our lives lying on tables. We move constantly; we function in the world. Hence, the recent movement toward “functional” everything. Functional medicine, functional fitness, functional foods. As with any buzzword, it is often misused (kettlebell swings are not functional training for anything you actually do in life unless you swing large objects around), but it’s an important concept to explore. Function simply refers to the action for which a person or thing is specially fitted or used, or for which a thing exists.
In human function, the body is designed for incredibly efficient motion—walking, standing, sitting, jumping, running, breathing. It is always going through cycles of acceleration and deceleration, pronation and supination, loading and unloading, eccentric and concentric contraction. As body function is studied more in depth, there’s an emerging understanding that the body does not move as individual parts, nor are there antagonistic muscle relationships. When properly balanced, every body part is loading and unloading synergistically, working together efficiently for movement and stability.
To see function of the body more clearly, consider the three planes of motion a healthy body uses: sagittal plane motion (forward and back as in flexion and extension), frontal plane motion (side to side as in abduction and adduction), and transverse plane motion (rotation). Every body part and joint must be able to move through all three planes of motion at the same time to have efficient movement and expression. When we learn how the body actually moves through all three planes of motion and fully understand the eccentric and concentric loading patterns of each muscle and joint in the body, our potential for great change in our sessions is amplified significantly. We can more clearly see where restrictions and pain may be starting (often far from the point of pain).
Most natural human movement is a combination of several or all planes of motion at once. The brain tracks movement and position via proprioception, which allows us to know where our body is in space and in relation to itself. As the body moves through all three planes of motion, it is in a constant dynamic of loading and unloading in every area to transfer, absorb, and generate force. If the nervous system senses that it will not be able to slow down and decelerate a motion, to prevent injury or strain, it will tighten up the fascia and muscle tissue to keep the body part it is protecting safe but also restricted and limited. This can keep us from getting injured in the short term but sets us up for catastrophic injuries in the future.
As the body moves, the nervous system controls the amount of movement based on the body’s coordination, flexibility, and strength, the goal being to simultaneously maximize motion and stability. My favorite word for this is mostability (coined by Gary Gray, PT, FAFS, of the Gray Institute), which combines the concepts of motion and stability.
Through the functional lens, we see restricted fascia and muscle tissue as a means of keeping the body safe when it does not perceive having functional stability. This compensation is very noticeable, especially with our elderly population. The lack of controlled motion leads to muscle stiffness, limited physical ability, and eventually to injury, as the body will no doubt be placed in a situation it can’t handle. This is underneath a torn ACL, hamstring, Achilles tendon, etc. Working with the body to help it restore function and dynamic movement is essential to health and expression on all levels.
Incorporating movement with fascial release techniques is a cutting-edge way to reeducate the nervous system regarding safe range of motion. Now that we understand more about the proprioceptive nervous system and its role in function and structure, we are seeing our old standard method of stretching and corrective exercise change quickly. You may have noticed that active or passive stretching with your clients on the massage table mostly creates short-term flexibility, but rarely provides the education that the neuromuscular system can use to reorganize its structural and functional patterns.  
However, having our clients engage their muscles and fascia in normal functional patterns and multiple functional planes of motion has drastic effects immediately. The clients can then use these “stretches” as homework to create new functional habits that will last, keep them pain-free, and optimize performance. The goal then is not merely lengthened tissue or passive range of motion, but more coordinated, balanced, liberated function and expression through space. This is cutting edge, especially for athletic performance. When the fascia and muscle are stimulated through the three planes of motion, the central nervous system allows the muscles to relax since it has been reminded proprioceptively of its true function. It now has the ability to decelerate eccentric motion and can let go of the structural patterns it put in place for protection.

Energetic Level Concepts

Energy medicine has long been practiced in many cultures, perhaps longer than most other modalities, though it has been shunned by Western medicine and only now is gaining acceptance as a complementary option. Advocates for the field, like James Oschman, have gone to great lengths to compile information and research that shows the validity and effectiveness of energetic work.
I was introduced to energy medicine by my father, who used microcurrent and acupuncture point stimulation in his chiropractic clinic 40 years ago. I delved deeper and integrated it professionally into my practice when I became a BodyTalk instructor 13 years ago. I came upon this powerful modality after all other approaches had failed to help my 4-year-old son with his allergies and eczema and in only two sessions he was completely cured.
Over the years, I’ve studied and integrated a number of other techniques that rely on energetic concepts and energy as an invaluable aspect of my practice. I like to look at energetic medicine more as “informational medicine.” The body’s innate intelligence governs the body and all its functions—on all levels of our existence. The meridians, wei, chi, chakras, photons, and quarks that make up our energy systems are fast communication pathways that not only work within the body, but also outside the body with our environment (exteroception).  
Consciousness, belief systems, and the emotional aspects of the body are often included with energy medicine, since energetic modalities are some of the most effective ways to make changes in body awareness and the learned belief systems/perceptions in the body that may be causing stress or dysfunction.

Integration and Organization

There’s a “top down” approach to our body’s organization that says everything is energy manifesting into more solid form, therefore treatment should emphasize the energetic and the rest will sort itself out. The “bottom up” paradigm says the building blocks of structure come together and consciousness emerges at the top so treatment should be on the tangible, structural level. In an integrative approach, we give equal importance to each level, recognizing them as simultaneous expressions of the body. Treatment is therefore most effective and comprehensive when it integrates the structural, functional, and energetic aspects.
An educated touch can hold energetic and functional intention, in addition to causing structural results, but specific applications are more helpful. One of the easiest ways to be able to affect all the levels at once is using the myofascial reciprocals. These are joints and bones in the body that have pairs on the opposite side of the body or along the midline. The reciprocals act as a system of fuses along the circuits and energetic pathways of the body and also hold the consciousness of each body part. They also have major input into the proprioceptive nervous system, which in turn gives feedback to the frontal lobe, cerebellum, and pontomedullary reticular formation. This allows the brain to get a “neural update” on the location and position of the body parts and their relationships. The reciprocals are essentially integration points for the structural, functional, and energetic aspects of the body.
These reciprocal joints can be activated and balanced by massaging both areas at the same time, while a client breathes a connection between the two parts. An example is the anterior shoulder joint and the opposite anterior hip joint (front of the hip). You can balance these reciprocals on yourself by gently massaging both at the same time, while also breathing deeply with the intent to create a connection, balance, and harmony between these two points. After 30 seconds, you will notice a shift in posture and range of motion, and a sense of lightness. We recommend standing up and noticing the range of motion (before and after) in rotation and also how much length and extension you can create between these two areas. This is just one example of the 32 pairs of reciprocal joints in your body. This is a simple tool that integrates all three levels of the body and can be used before, during, or after a massage treatment to enhance shifts.

Integrative Anatomy Adoption

As bodyworkers, we have the luxury of being able to affect all three levels of the body-mind in our sessions. It’s already happening with basic training: we all have noticed that a good bodywork session can create more range of motion and create a sense of lightness or lift (functional improvements). These reorganized tissues can then have better energy and nerve flow, which helps the central nervous system relax and feel safe enough to go into a restorative mode, often shifting the client’s sense of being and expression in their life (energetic improvements). Defining the different levels of the body and fundamental concepts associated with each allows us to more intentionally develop and use our skills to create more comprehensive, lasting change.
We use integrative anatomy when we’re able to blend these lenses together seamlessly as we assess and treat our clients. In assessment, it is simultaneously observing structural relationships, tension areas, and postural imbalances while considering the functional dynamics, inefficiencies, or deficiencies at play in creating the pattern, and also considering informational dynamics that may be holding patterns in place, such as meridian imbalance or subconscious belief systems. In treatment, the integrative anatomy lens allows us to apply various tools with an intention of affecting the appropriate level(s) to address root causes and restore function. A critical aspect of treatment then goes beyond mere release to include reeducation of the nervous system and client.
So how can you adopt a more integrative lens to enhance your client assessment and treatment? Step one is to question your current point of view. Our point of view is like the air we breathe—it’s so close and pervasive that we rarely get enough distance to really see it for what it is. When you approach a body, what are you noticing? What are you looking for? What school of thought is that based on? Is it primarily a structural perspective? Notice how quickly you come to conclusions based on your particular point of view. Now you can determine where you may benefit from adding some aspects of the other layers we discussed. Look at relationships in the body. Consider function as you’re observing tension patterns. How does the body move through space? How do the muscles interact to help the body relate well to gravity and absorb and generate force efficiently? As you learn energetic modalities, you can consider underlying patterns that may be contributing to the stubborn pain conditions and chronic illness we see so frequently.
Common challenges for therapists in expanding their treatment perspectives are:
• They get comfortable in one way of seeing and knowing
• Learning new ways of seeing takes time and a beginner’s mind
• Their routine is habituated and it’s hard to create space for other ways of working
• They lack confidence in communicating with clients about how the body actually works and the benefit of an integrated approach
• They hold a belief that a client comes to them for a specific technique they do, as opposed to the client wanting to get results and trusting the therapist to apply whatever is needed to do so
How about you? What challenges you in evolving your perspective and approach? We always say that we teach therapists how to think, not just what to do. It’s easy to learn a new technique, but how you think about the body in assessment and treatment determines how you apply your tools. A session is an inquiry, a dialogue between the client’s body and the therapist. It isn’t something that is done to the client out of our own “great” skill. The client’s body has an innate ability to heal; as practitioners, we simply facilitate greater healing by helping to restore communication, integration, and function in the body on all levels to the best of our current ability. As your understanding of the body continues to evolve, consider expanding your education and thinking to include more functional and energetic levels, in addition to the structural. It’s like putting on a new pair of glasses and seeing things you didn’t even know you were missing—you may be amazed by what the body will reveal.