Features Research
Suikodo Neuromeridian Stimulation Techniques

From a physical standpoint, incorporating SuikodoTM into your massage practice is quite easy, and can be done to a lesser or greater degree depending upon your level of knowledge and interest.

I treat some clients exclusively with Suikodo^TM, in the traditional fashion for Shiatsu therapy, that is, with the client lying clothed on a futon.

With these clients, I apply all the SuikodoTM assessment techniques, exercises, and NMS techniques, as well as traditional Shiatsu-style pressure techniques, in a kneeling position. However, I treat the majority of my clients on a regular massage table and, in fact, applying NMS techniques is easier when the client is on a table.

When treating clients on a table, the SuikodoTM techniques I use are the assessment techniques (which are generally palpatory or observational in nature, and can be utilized with the client either prone, supine, or side-lying), and, in particular, the Suikodo^TM  NMS techniques. I use the latter to help correct problems that cannot be treated easily with Swedish massage techniques, such as vertebral rotations, rib misalignment, sacral or pelvic torsions, functional leg-length discrepancies, and compaction of cranial sutures.

Any techniques that I use after applying NMS techniques in the session are slow, soothing, and relatively superficial to induce a relaxation response. It is important not to apply any strong stimulus that could interfere with the effect of the NMS.

Sometimes I use other modalities, such as hydrotherapy, cranial osteopathic techniques, strain-counterstrain, or muscle energy techniques (MET) in the first part of the treatment, and then apply NMS techniques to help consolidate the beneficial effect by releasing the neurological component of the lesion, or in the event that my other techniques do not provide the desired level of change.

Kikkawa  has designed SuikodoTM so that it can be used as both a complete integrated system (the more SuikodoTM techniques and assessment tools you know, the more effectively they work together), and as a series of stand-alone techniques. The techniques have been designed to be easy to learn for massage therapists without a background in Eastern theory.

When Are SuikodoTM NMS Techniques Indicated?
SuikodoTM NMS techniques make an extremely safe and effective adjunct or alternative to massage therapy, and are particularly indicated when:

1. the client has visceral problems;
2. the client suffers chronic pain;
3. massage aggravates or fails to relieve the client’s pain;
4. the client has local contra-indications to massage;
5. the massage therapist is unable to reach a satisfactory clinical impression using conventional assessment techniques, but still wishes to provide a safe treatment;
6. the client suffers from “phantom pain” (i.e. pain felt in an area that has been amputated or removed).

When are SuikodoTM NMS Techniques Contraindicated?
As with all manual techniques, there are some contraindications for SuikodoTM NMS techniques. These include:

1. local application over an acutely inflamed or hyperalgesic areas (however, there are NMS techniques that can be applied at a distance from the lesion to treat the area);
2. the presence of infectious disease that could be transmitted through contact with the client;
3. the client is unable to assume a position that would allow the therapist access to the points to be stimulated (although there are usually alternative NMS techniques that can be used);
4. within 72 hours before a sporting event or before very strenuous physical exercise. This is because the NMS techniques are believed to change the client’s habitual neurological postural patterns, requiring several days for the proprioceptors to re-adapt to the change. This could potentially render the proprioceptors more “clumsy” and susceptible to re-injury during this period;
5. pregnant clients in their first trimester, unless treatment is authorized by their physician. This is a general precaution for all manual techniques that may affect the pelvic or low back region.

Note that as with all massage techniques, the therapist must recognize his/her limitations and be willing to refer the client for appropriate medical care in the event that they suspect a more severe underlying pathology.

However, SuikodoTM NMS techniques make excellent adjuncts to the medical treatment of chronic disease states in that they appear to be effective for relieving pain and improving function to some degree. (Unfortunately it is not currently possible to verify these effects with controlled studies. Nevertheless, Kikkawa and his students, including the author, have observed the clinical effectiveness of these techniques on hundreds of clients).

What Are The Side Effects?

Because SuikodoTM NMS techniques are believed to change patterns in the CNS, as well as create slight positional changes of various bones and organs and change in muscle tonus and fascial tension, many clients may feel some stiffness or achiness in different parts of their body a day or two after treatment.

Usually, these effects result from changes in postural equilibrium, with previously under-used muscles now being forced to bear more weight. Sometimes, the stiffness or achiness is the result of other lesions that were previously masked from awareness by the main area of complaint that was treated.

Occasionally the client’s perceived pain level will increase. If it does, it is important to note that it is usually because the client is now moving the injured part into a greater range than was previously accessible to them.

Re-test them in the same range that they had before the treatment, and they will usually find that the pain has decreased or is absent. Always warn the client not to move in a jerky or sudden fashion and to restrict their movements to a pain-free range for at least 72 hours post-treatment. Also remember that although the neurological effect of NMS techniques may improve function and speed healing somewhat, anatomically disrupted tissues need adequate healing time.

A sample technique – Posterior Superior Iliac Spine Neuromeridian Stimulation Technique

• Client prone.
• Stand beside the table facing the client’s head.
• Assess your client for tissue tension in the muscles and ligaments of the pelvis and low back; get a pain scale of their tenderness upon palpation of various areas; and note any asymmetries of position with the posterior superior iliac spines, the sacrum, and lumbar vertebrae.
• Place your thumbs on the posterior superior iliac spines (checking an anatomy text if you are unsure about any of these landmarks or terms) with your palms toward the client.
• Flex your fingers at the proximal interphalangeal joints, and place them below the posterior portion of each iliac crest with about an inch between each of the first to fourth digits, in a horizontal arc from medial to lateral.
• Fifth finger is one inch directly inferior to your fourth finger.
• With your hands in this position, and without allowing your digits to slide over the skin, make small circular movements with your hands in either of the following two patterns (choose the direction of movement in which you feel the least resistance). (Note that it is your hands that rotate, and that the tips of your digits should not move from the points they are resting on. The tips of your digits are vertical to the points).

1. Cephalad (toward the head), laterally, slightly anteriorly (toward the table), caudally (toward the feet), slightly posteriorly (toward the ceiling), and medially back to the starting position; or
2. Caudally (toward the feet), laterally, slightly anteriorly (toward the table), cephalad (toward the head), slightly posteriorly (toward the ceiling), and medially back to the starting position.
3. Contact with your digits should be very light, and the rotations should be smooth and continuous; correct form is more important than speed.
4. In order to verify that you are applying the technique effectively,re-test the tissue consistency; the position of the posterior superior iliac spines, sacrum, and lumbar vertebrae; and the client’s tenderness upon local palpation at regular intervals.
5. If after applying the technique for some time you are no longer noting a beneficial change, re-check your hand contact, and re-confirm that you are rotating in the direction of ease. The most common error is applying too much pressure.
6. If you are no longer noting a beneficial change and your hand contact, pressure, and direction of rotation are correct, then you should discontinue the technique, since you have resolved as much of the client’s abnormal neurological holding pattern as possible with the technique at the present time.
7. Avoid disrupting the re-education of the client’s nervous system that is taking place with the new and beneficial stimulus you introduced through the technique. Do not apply any strong stretches; joint mobilization techniques; or deep, painful, or stimulating techniques following the technique, since these will introduce a strong sensory impulse that will interfere with our desired effect.
8. For the same reason, advise your client not to engage in strenuous physical activities, such as weight-lifting or aerobics, for (ideally) 72 hours post-treatment.

It is almost impossible to master any manual technique from a written description alone without hands-on supervision from someone who is already proficient in its use.

Results depend on correct application of the technique to the right points, at the right pressure, with the right contact, rate and rhythm.

Also note that although virtually all clients suffering from pain or mechanical imbalance in the pelvis, low back and sacro-iliac joints will receive some benefit from the technique when it is properly applied, the changes in some cases can be quite subtle and require careful observation and palpation on the part of the therapist.

Remember that this is an isolated technique, albeit an extremely effective one, and is being presented out of the context of Kikkawa’s complete SuikodoTM system that includes extensive palpation training, assessment techniques, and alternate SuikodoTM NMS techniques if one technique is not able to achieve the complete level of desired change.

As with any new type of technique, if you wish to incorporate it into your practice, you should seek proper training.

Mitsuki Kikkawa, MT (Ontario), ST (Shiatsu Therapist) Shiatsu Master Mitsuki Kikkawa is co-founder and director of ICT® Schools. He teaches at ICT Kikkawa College in Toronto and ICT Northumberland College in Halifax and researches and practices out of their Toronto location.

Simon Kerslake, MT (Ontario), CST (Certified Shiatsu Therapist) Simon teaches at ICT Schools, maintains a private practice, and is currently a student at the Canadian College of Osteopathy.
A student of Mitsuki Kikkawa’s since 1990, Simon has been integral to Mitsuki’s work of formalizing Suikodo, acting as interpreter, collaborator, and co-facilitator.