Clinical Massage

From the deck of the Lodge at Esalen Institute, in Big Sur, California

The article below was published in the January/February 2005 issue of Michigan's Healing Garden Journal; 125,000 copies were distributed around the state:

A Delicate Dance
Dialoguing with the Body through Massage

By Roger Byrd, BS in Ed, NCTMB

“I feel like I’ve had a dagger in my back for four years!” That was almost the first sentence this client (I’ll call her Anita), an accomplished professional, told me when she came into my treatment room in December 2003. Attempting to get a handle on her pervasive chronic pain, she had already spent years working with several very reputable physicians (surgery was seriously considered). Physical therapists had set up exercise and stretching programs for her which she carefully and faithfully did, but with minimal benefit at best; at times they actually seemed to aggravate her pain. These specialists seemed to agree that the pain was coming from her well-documented scoliosis, a lateral curvature of the spine. If that was the case, I told her, it was a real question whether my work could help.

"However, as a Clinical Massage Therapist, my approach to pain is fairly straightforward: find and release muscular tightness and imbalance, and myofascial trigger points (irritable spots in muscle or connective tissue that can trigger pain sensations in other locations). So I was willing to see if any of these conditions might play some role in her pain, and she agreed. We were both surprised when, after just 2 or 3 sessions, a very tight hip muscle, piriformis, began emerging as the source of nearly all her pain.

"Instead of launching an assault on this locked-up muscle, my approach was, as usual, to slowly and sensitively engage it, actually to dialogue with it through my hands, encouraging - rather than demanding - release. This involved taking the time to patiently listen. Just how resistant is this muscle? At what rate can it release? When the muscle was first contacted in this way, it would just sit there like a rock, inert and unmoving, or at times fibers would start twitching nervously. Then, possibly after several seconds, slowly and grudgingly, sometimes a millimeter at a time (sometimes a micron at a time), it would begin to yield, to melt the tiniest little bit... then another bit... then another... As I took the time to partner with it in this slow and sensitive way, it was able to start releasing at it’s own pace. I was co-creating with this long-suffering muscle, and with my client’s body as a whole, a clear feeling of respect and trust rather than invasion and domination. At the end of most sessions we did a specific type of stretch to help “set” the benefits gained.

"Deep pressure was certainly an important ingredient in this extended process, but it need not, and should not, cause pain in order to be effective (“Use the minimum amount of pressure necessary to gain a release.” — Earle Timberlake, my clinical massage instructor). By avoiding or at least minimizing pain and discomfort, a larger, more comprehensive release seems to be gained. This typically includes whole groups of muscles, more effectively utilizes the client’s own innate movement intelligence, and therefore yields a more complete and longer-lasting improvement. That might involve more than just physical aspects, too, easily the subject of another whole article. I am convinced that, in using any bodywork technique, the quality of intention and interaction with the client, and the conscious participation of the client as a partner in this process, add substantially to the work’s effectiveness. The basic elements of this whole-person focus, of sensing and dialoguing with the body in a personal way, were a significant part of my first massage certification at Esalen Institute in Big Sur, California, where this whole orientation to doing bodywork originated.1

"Blending this kind of sensitivity and awareness with the detailed, well-researched and specifically targeted techniques of clinical massage can be quite rewarding. For Anita, within 3 or 4 more weekly sessions, her level of pain (on a scale of 1–10, with 1 being barely noticeable and 10 being the worst pain imaginable) decreased from a 7 all day every day, to 2 to 3 all through the week, with periods when there was no pain at all. As we continued to work, this benefit extended into multiple weeks, and with only occasional exceptions, that improvement continues still. She now enjoys taking long walks, plays more easily with her young grandchildren, and spends much less time on pain management exercises.

"Anita does not conclude from all this that clinical massage is the whole answer. She still continues with exercises a particularly helpful physical therapist had recommended, but writes that those “strengthening regimens seem to require the critical complement of relaxing and lengthening muscles, the massage therapy ‘puzzle piece’ that completes this picture... [It is] this combined therapeutic approach... [that] has proven effective in helping me cope with nearly ten years of chronic, often debilitating, lower back pain.”

"It’s moving for me to play a part in helping unravel such deep and long-standing knots and blockages. At times it seems almost magical, a delicate dance with bound up tissues that yearn for release but have completely forgotten how. I can’t make them release, but by simply giving them a proper invitation, they gratefully do it themselves...


"Roger Byrd was certified in Clinical Massage in 1992, and has been with Borgess Medical Center’s Integrative Medicine department in Kalamazoo Michigan since it was created. He can be reached at

1 Coughlan, Brian: “Esalen: Where It All Began,” Massage Therapy Journal, Millennium 2000 Issue, vol. 38, no. 5."
(Note: the person in these pictures is not "Anita," but a model helping me demonstrate my work.)

This article was an attempt to convey the importance of patiently listening and sensing in doing this work - not only attending to the client's specific muscular tissues, but also to the person as a whole. It was a fundamental component of my initial massage training and certification at internationally-recognized Esalen Institute (fully 1/4 of my class was not from North America), located in Big Sur, California back in 1984.This is what distinguishes wholistic bodywork - whole person work - from the primarily mechanical approach of many therapies. 

Later I became certified in the detailed work of Clinical Massage, giving me many new, highly specific and very effective techniques and strategies. But my bodywork practice still continued to benefit from consciously focusing in on this sensitive listening dimension. My Clinical Massage certification was completed in 1992 (the same year I became Nationally Certified in Therapeutic Massage & Bodywork [NCTMB].

I then went on to practice for 17 years in Kalamazoo, Michigan, more than 11 of them in the Integrative Medicine department of 3,000-employee Borgess Medical Center. (For several years I also taught popular semester-long T'ai Chi classes through that department; see my T'ai Chi page in this website.) Another setting where I practiced Clinical Massage was Kalamazoo Anesthesiology Pain Clinic, PC, though only for a year and a half at that location. My personal 'golden age' as a Clinical Massage Therapist, however, was the 6 years - from '93 through '99 - that I spent with the Synthesis Center, LLC. This was started by Ruth Eichler in 1993, and joined by a group of professional practitioners in such diverse health & wellness fields as psychotherapy, acupuncture, yoga, sound healing, dietitian, hypnotherapy, etc. The Synthesis Center was an exceptionally collaborative group of professionals, and memories of my time with them remain the most positive of my professional career.

I qualified for membership in the Michigan Chapter of the American Massage Therapy Association (AMTA) back in 1986 (at that time, there were fewer than 4,000 members nationwide; now there are well over 50,000!). The next year I helped form Michigan Chapter's Southwest Michigan Unit, then later served as Unit officeholder, first as Secretary, and later as Chairperson. In 1997 I was given Michigan Chapter's Distinguished Service Award for those efforts. I remained an AMTA member until 2013, finally concluding at that time that ongoing problems with my feet (see my page in this website on RSDS/CRPS) would prevent me from ever returning to regular massage practice again. At that point, I decided to let all my certifications expire.    

Please note that, since none of my massage training was at a North Carolina-approved school (the state where I now live), I am not eligible for regular massage therapist licensing by the state of North Carolina. And significant physical and financial limitations have made this state's Licensure by Endorsement option more difficult for me than I can justify putting myself through. I am therefore not licensed to do massage in North Carolina. So, as a practical matter, my 2-decade career in Clinical Massage has, most regrettably, ended.

I of course wish to make it quite clear that I am not a doctor. Nothing on this page - or anywhere in this website - is intended in any way to diagnose, treat, prevent, mitigate or cure any disease or condition. Any specific health problems should be referred to a qualified health care provider.

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