A client arrives at your clinic, complaining of chronic sacroiliac joint pain. He tells you that repeated treatments using a variety of therapeutic modalities have failed to provide more than temporary relief of the pain. Upon examining his posture, you notice that his posterior superior iliac spines are uneven and he has a torsion in his sacrum, contributing to a lumbar scoliosis.
September 17, 2009 By Simon Kerslake MT ST
A client arrives at your clinic, complaining of chronic sacroiliac joint pain. He tells you that repeated treatments using a variety of therapeutic modalities have failed to provide more than temporary relief of the pain. Upon examining his posture, you notice that his posterior superior iliac spines are uneven and he has a torsion in his sacrum, contributing to a lumbar scoliosis. He has orthotics, but neither they nor his previous treatments have been able to correct his pelvic imbalance.
When your assessment is concluded, you ask him to lie face down on your table in a comfortable position. Placing your fingertips over certain points on his pelvis, you lightly rotate your hands in opposite directions. After a few minutes, you ask your client to stand up, and you reassess him. His pain is gone, and his pelvis is level.
|Mitsuki Kikkawa with
Sound impossible? Several years ago, I would have agreed. Since then, I have been privileged to see this scenario, and others equally impressive, played out many times. I have come to trust the effectiveness and reliability of the method by which such results have been achieved.
The technique described above is called the Posterior Superior Iliac Spine’s Neuromeridian Stimulation Technique and is part of a system of manual medicine called Suikodo.
What Is Suikodo?
Suikodo is a new and innovative form of manual medicine developed by Shiatsu Master Mitsuki Kikkawa. It includes precise palpatory and observation-based assessment techniques, as well as treatment
techniques such as meridian stretches, direct-pressure Shiatsu-style techniques, Neuromeridian Stimulation (NMS) techniques, and some energy-based techniques. Suikodo posits that the body’s innate wisdom can be interpreted through direct feedback from the body.
Using that information, the therapist can determine the appropriate type and amount of stimulus to be applied to obtain healing.
Who Is Mitsuki Kikkawa?
Suikodo was developed out of Mitsuki Kikkawa’s experience as therapist, educator, and treatment innovator. Educated at the Japan Shiatsu College in Tokyo under the mentorship of Master Tokujiro Namikoshi, Kikkawa came to Canada in 1972 to practice in Toronto. In 1981, he co-founded Kikkawa College, the first two-year professional training program for shiatsu therapy outside of Japan.
Since then, the school has evolved into ICT® Schools, owning and administering two massage therapy schools, ICT Kikkawa College in Toronto, and ICT® Northumberland College in Halifax.
Over the last thirty years of private practice and research at the company’s original location in Toronto, Kikkawa has developed a unique approach to healing that is both visionary and rooted.
In the words of A.J. Webb, Academic Co-ordinator at ICT® Kikkawa College, “Mitsuki is on a quest to understand the body when the body cannot be understood.” Kikkawa began to articulate Suikodo as a way of sharing his therapeutic skills with massage therapists to allow them to expand the range of conditions they are able to treat.
Kikkawa realized that in order to effect any lasting beneficial alteration in the body, it is necessary to bring about a change to the central nervous system.
The CNS ultimately controls the tone of every muscle; the position of every bone; the tension of every ligament and fasciai; the activity of every organ; the degree of vasoconstriction or vasodilation of all veins, arteries, and lymph vessels; as well as the activity of the endocrine system via the hypothalamus and pituitary gland. All of these activities are part of the motor division of the nervous system and all motor activity arises in response to sensory stimuli.
Kikkawa reasoned that theoretically an appropriate sensory input should be able to alter an abnormal motor response that is maintained in the CNS.
However, as Eyel Ledermann points out, the body generally screens and filters sensory information arising from the periphery in order to maintain central control.ii Thus random peripheral information, such as your clothes rubbing on your skin, is filtered by the CNS and generally discarded as “trivial” without allowing it to seriously affect important internal systems such as heart or lung function.
This filtering serves as a protective mechanism to avoid serious internal dysfunction as a result of minor somatic injuries. Kikkawa realized that it also makes it more difficult for the therapist to initiate major positive change in the CNS by treating the periphery.
Toward a solution …
Some therapists alleviate some of the abnormal sensory impulses from the periphery by mechanically removing the stimulus on the affected sensory receptor. For example, by mechanically improving venous and lymphatic drainage from an area, local receptors that respond to ischemia and irritating metabolic by-products no longer send their impulses to the spinal cord. Without these irritating signals, the CNS at the spinal cord level implements a new pattern that allows reduced tone in the locally affected muscle.
High-velocity adjustments of a spinal vertebra are sometimes used to mechanically change the abnormal pattern of impulses from proprioceptors in that joint. As a result, a new pattern is restored at the spinal cord level that permits a normalization of tone in the muscles of that level, as well as a change in the tension of the joints and ligaments. Some clinicians argue that such reduction in abnormal somatic proprioception at the spinal cord level will also beneficially reflexively alter visceral motor output.
There is mixed evidence to support this. Ledermann argues that somatic neurological reflexes that affect visceral function would be insignificant compared to central control.iii Irvin Korr states that visceral function can be affected peripherally at the spinal cord level, but attributes most of the effects as being due to either sensory-motor “cross-talk” at the level of a peripheral or spinal nerve root that has its microcirculation impaired by local mechanical tensions, or by abnormal impulses in the visceral motor fibre itself due to local ischemia.iv Korr, in effect, suggests that although high-velocity adjustments would be beneficial for the viscera at a mechanical and circulatory level, they do not demonstrate an actual somato-visceral reflex.
Muscle-spindle reflexes, used in techniques such as muscle energy (MET) or strain-counterstrain, are examples of techniques that effectively use a peripheral sensory input to achieve a reflex change in motor output. But again the effect is primarily local, and doesn’t directly affect the visceral output.
Deep pressure techniques are sometimes used in therapies that seek to achieve an improved biomechanical relationship of the body with gravity. Some techniques attempt to elongate and improve mobility in key muscles and fascias in an appropriate order to reduce as much as possible any abnormal impulses in proprioceptors and pain receptors due to whole body imbalances in mechanical tension. Although these techniques will affect the sensory input, they work primarily by using local mechanical and circulatory effects, rationally applied, to indirectly normalize whole body mechanical tensions and thus proprioceptors and nociceptors secondarily. They do not work by a direct neurological reflex.
In fact, most manual therapy techniques work either directly or indirectly through mechanical or circulatory effects, and not directly by neurological reflexes. The exception to this is the muscle spindle reflex, which still only works at the spinal cord level, and doesn’t directly affect the viscera. Although the therapies listed above are all capable of powerful beneficial effects on the body’s tissues, they do not address the central control system of the CNS.
“But wait a minute!” many massage therapists will cry, “What about the soothing effects of a general full body massage? Isn’t that an example of peripheral sensory stimulation having a reflex effect on the CNS and thus affecting motor output?” Actually, the effects of a general full-body massage do not represent an example of peripheral control over the CNS. Rather, it represents an example of the CNS collecting peripheral sensory data, comparing and interpreting it with respect to previous sensory experiences, and initiating a generalized response for either stress or relaxation. This explains why many clients of massage therapy gain an increased benefit from subsequent sessions; the progressively deeper levels of relaxation in response to massage represent a learned response. Similarly, a client who is undergoing a transference reaction in which their therapist reminds them subconsciously of a previously hostile figure will initiate a stress response. The rate and techniques applied may be the same in both cases, given by the same therapist, but the physiological effects will be profoundly different.
The relaxation response is a powerful healing force that can and should be harnessed by massage therapists, but it is a generalized response that doesn’t represent an example of peripheral control over the CNS in order to achieve a specific therapeutic objective.
Kikkawa’s Approach to the question
Since the CNS filters peripheral sensory data, what is needed is to hypothesize some way in which a peripheral stimulus would be given a high enough priority that it would change an existing neurological pattern, and specific enough that it could be used to achieve a precise therapeutic goal.
It would not be enough to just apply a more intense or painful stimuli in order to distract the CNS from the existing neurological pattern. That would create a temporary counter-irritant effect such as hitting your thumb with a hammer in order to make your headache go away. The neurological pattern creating the headache would remain, even if you didn’t currently feel it, and now you would have the neurological pattern associated with a sore thumb.
Ideally, what is needed is a very gentle stimulus that won’t generate any pain or stress response from the body, since that would interfere with the precise effect needed. The stimulus should also be specific enough that it could be used to achieve a reasonably specific aim. Since the technique should involve only very gentle pressure, there are a very limited number of sensory receptors with which to work. This means that specificity must be achieved by precise location of stimulus, rather than just by type of stimulus. So which locations should be used?
A likely possibility would be to use the points associated with Eastern medical theory, for example acupuncture or Shiatsu points. These points have been used empirically for thousands of years to provide treatment for a variety of internal and external pathologies. Thus, they would seem to present an ideal possibility for using a peripheral stimulus to achieve central control. In fact, a recent study at the University of California showed that stimulating acupuncture points on the foot traditionally associated with treatment of vision resulted in activation of areas of the brain involved with vision.v Although Kikkawa’s hypothesis regarding the mechanism by which his Suikodo Neuromeridian Stimulation (NMS) techniques work cannot currently be proven, studies such as the above, showing the physiological basis of acupuncture through “brain mapping” (analysis of activity of different areas of the brain in vivo using functional MRI) offer promising avenues for supporting evidence.
Unfortunately, using acupuncture points presents a number of difficulties for massage therapists, including the necessity of learning the complexities of Eastern theory and diagnostic methods. According to Kaptchukvi the effectiveness of acupuncture is significantly increased when applied according to classical Eastern diagnosis as compared to a symptomatic application to western pathologies.
The effectiveness of Suikodo for massage therapists rests on its method of determining the type, location and direction of stimulus through direct feedback from the client’s body, primarily interpreted through immediate and specific palpatory feedback. For example, in the case of Suikodo Neuromeridian Stimulation techniques, the determination of the depleted or excess energetic condition of the point need not be done according to traditional oriental diagnostic methods, but can immediately be determined from the direction in which a vertical rotating fingertip can move most easily over the point. According to Kikkawa, easier movement in a clockwise direction indicates a deficient condition, and easier movement in a counter-clockwise direction indicates a condition of energy excess. With this method it isn’t necessary to pay attention to a specific Eastern diagnosis— just ensure that your fingers are rotating in the easier direction and you will automatically be providing the appropriate type of stimulus.
Suikodo NMS techniques were developed from a combination of Eastern and Western concepts. Kikkawa uses acupuncture points that are combined in a different fashion from the point combinations indicated for a classical Eastern diagnostic condition. He has discovered certain combinations that he believes create a change in neurological patterns that can create certain types of changes in the alignment of bony structures, the tension in certain muscle groups, an improvement in certain ranges of motion, and a general decrease in pain and improvement of function in an area. Each technique has a given indication regarding its primary area of effect (for example the Posterior Superior Iliac Spine technique is primarily intended to release the pelvis and low back area). However, the fascial, biomechanical, endocrine and neurological interconnectedness of the body often lead to unexpected benefits outside its usual area of effect. For example, using the Posterior Superior Iliac Spine NMS technique, I have been able to alleviate neck pain, foot pain, sinus congestion, and headaches in a number of cases. The techniques are relatively easy to learn and to apply.
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