Features Research
Ashiatsu massage puts your foot down

Two parallel bars hang securely from the ceiling. A body lies prone on a massage table with the cervical spine neutrally aligned in a face cradle. Meticulously prepared, soft and hygienic feet glide slowly along a tension filled muscle, sinking into the lubricated tissues with precision.  

AOBT is currently practiced by thousands of therapists in the U.S. and is now starting to gain traction in Canada.

To the body on the table, the sensation is as if huge hands are engulfing its tissues with broad compressive strokes, followed by the inevitable wave-like reperfusion, which brings a rush of relaxation endorphins. As the foot moves, it perceives information about muscle quality, texture and tension, sending these messages back to the brain to form an appropriate response to be applied using that same foot, achieving a therapeutic goal.  

This is Ashiatsu Oriental Bar Therapy (AOBT), also known as Ashiatsu Deepfeet Bar Therapy. 

In Japanese, “Ashi” means foot, and “-astu” means pressure. Many forms of barefoot massage can be found in other countries throughout the world: Japan, China, the Philippines and India, among others. 

According to its founder Ruthie Piper Hardee, AOBT was created as a fusion of all the best features of barefoot massage modalities while ensuring a safe and therapeutic experience. Founded in 1995, AOBT is currently practiced by thousands of therapists in the United States who were taught by fewer than a dozen carefully selected and certified AOBT instructors.

Client experience
Many clients wonder what the feet feel like when used as a massage tool. The broader surface of the foot means less discomfort than with traditional deep tissue massage. Patients who prefer deeper massages will likely enjoy the Ashiatsu experience. For those who have been reluctant to try a deeper massage because of the pain associated with it, Ashiatsu just might be what changes their minds. Often, a patient on the table will completely forget the massage is being done with the feet and have no idea where on the table the therapist is.

It doesn’t have to be deep, however. Any stroke may be modified to have one foot working on the patient, while the other foot remains on the table supporting most of the weight of the therapist. This, along with the overhead bars, allows the pressure to be customized to the individual. 

Current theories in manual therapy are exploring the connection between pain and dysfunction and the brain and the nervous system. Muscle is not inert tissue to be bullied into change, but instead an innervated tissue to be coaxed towards a modified state. Given the richness of receptors found in the skin, massage, in its many forms, is an excellent tool for facilitating the conversation between the nervous system and other soft tissues.

Pain research has shown the intensity of pain diminishes when one feels safe and at ease, and goes up when one feels anxious. Massage and the power of touch can promote a positive frame of mind that can change the way one’s brain responds to discomfort. 

Given this revelation, a massage patient should expect to have a pleasant sensory experience during treatment. The complicating factor for the therapist is that this experience may mean something different for every person on your massage table. 

For patients who prefer a deeper sensory experience, the RMT traditionally uses small-diameter tools to achieve depth such as an elbow, thumb or a knuckle. The result can be uncomfortable or even painful for the patient, heightening the nervous system at the perception of threat. 

The broad, padded surface area of the foot used during an Ashiatsu treatment allows the deep tissue patient the opportunity to ease the nervous system without sacrificing the depth of the treatment.

Due to the broader surface area of the foot, greater consistency in the depth of pressure, length and flow of strokes feels comfortable for the patient. The rounded and softer surfaces of the heel and ball of the foot create less trauma for the tissue and breakage of muscle fibers than when pressure is applied using bonier tools such as the thumb, knuckle or olecranon process. A therapist is able to achieve the same releases using broad surface ischemic compression and stripping, while producing less inflammation and consequent delayed onset muscle soreness. The larger surface area of compression allows for enhanced reperfusion and helps to achieve a state of deeper relaxation for the client. 

Training 
Launched in the spring of 2013, Ashiatsu Deepfeet Bar Therapy Canada is now training Canadian therapists through NRG Medicine in Toronto. All provincial standards of practice have been met, making it easy for Canadian therapists to fit Ashiatsu into their massage therapy practices. 

Ashiatsu practitioners must follow strict hygiene practices according to regulatory standards.

To ensure the standard quality and safety of the modality, massage therapists who are interested in training must be licensed in their province of practice or students of massage therapy who have completed 75 per cent or more of their program.

When selecting a barefoot training program, it is important to consider the quality and depth of the curriculum as well as the level of expertise and training of the person from whom you will learn. This ensures that once trained, a therapist is able to begin his/her practice in a safe, effective and sustainable manner.  

The goal of each AOBT training class is for each therapist to leave with the tools to critically think and use sound judgment when working with their clients. AOBT instructors are hand-picked from qualified candidates who have completed an intensive application process and training program.

AOBT Canada conducts training in groups and in person, with a maximum of eight students per class. Following graduation, any needed support and resources will be provided, ensuring therapists and their clients receive a safe and precise practice for many years to come.

Certification courses include: Barefoot Basics, a 90-minute full posterior routine with one foot firmly planted on the table; Advanced Deepfeet 2, which includes two-footed and transitional strokes that can be integrated with the one-footed routine; and Ashi-Thai, a full-body 90-minute passive assisted stretching routine, both posterior and anterior done through clothing.

CMTO standards
As per College of Massage Therapists of Ontario Standard, all skin surfaces must be washed with soap and water or alcohol-based sanitizer for a minimum of ten seconds. 

Each Ashiatsu therapist will have their own unique routine to prepare their feet before going in the treatment room, but each should ensure that provincial standards are being met. 

Getting from the washbasin to the massage table is made possible through the use of single use socks – following the washing/drying protocol – and slippers or sanitized rubber sandals. These socks are then washed to the same standards as the table linens. 

Draping techniques taught in all classes meet the expectations of the majority of Canadian massage therapy clients.

Benefits to therapists
Ashiatsu offers therapists increased longevity, endurance and physical fitness. Using the feet in practice as an alternative to the hands and forearms helps to avoid repetitive strain injuries (RSIs) and overuse injuries of the small joints in hands, arms and lumbosacral issues from leaning over the table. 

With Ashiatsu, the therapist is able to deliver the same amount of work but spread over the entire body, this work becomes a low-grade full body workout for the therapist. As with any modality, proper ergonomics are paramount. To ensure safe and proper setup to minimize ergonomic stress on the therapist, bar installation and table height must be perfect. 

A look forward
Ashiatsu is expected to start appearing more frequently on spa menus, in massage colleges, clinics and massage supply stores across Canada. Its popularity will initially be based on its novelty and sheer intrigue. What will actually ensure Ashiatsu’s staying power within the massage therapy profession are the clients who will see and feel its benefits and continue to request it. 

Nicole Ramien, RMT, is the first fully certified AOBT therapist in the Greater Toronto Area. She has since then become the first and only certified AOBT instructor in Canada. She graduated with honours as registered nurse from McGill University, and has been trained in naturopathic medicine at several clinics around the world. For information on the AOBT and for available certification and training courses, visit www.nrgmedicine.ca.