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Massage Today
February, 2012, Vol. 12, Issue 02

Freeing the Heart, Part 2: Equalizing the Pressure

By Dale G. Alexander, LMT, MA, PhD

Cardiovascular disease does not happen overnight. It is a progression that evolves over decades and genetic pre-disposition can accelerate this progression dramatically. That is why we read of so many people in the obituary column dying between the ages of 45 and 65 which is the prime demographic age range of so many of our clients.

What is rarely considered is how these progressions toward cardiovascular disease figure into chronic somatic profiles that clients present to us every day and can dramatically affect their quality of life.

Two core principles of the Inside-Out Paradigm assert that the body's two imperatives are to allocate resources (oxygen and nutrition) as equitably as possible to all body tissues and to distribute the strains of physical and emotional stresses across as broad an area as possible. The allocation function is carried out by the blood vessels while the body's intricate reflex arc system governs the distribution of strain thesis. It is my premise that all forms of therapeutic massage and bodywork can positively influence these dynamic relationships.

The names that are given to cardiovascular problems are many and varied. The basic categories concern the heart itself and blood vessels. These terms include: heart attack, stroke, angina pectoris, atherosclerosis, arteriosclerosis and high blood pressure; all pathological progressions are labeled as diseases. I will explore other heart progressions that relate to disruptions in its electric rhythmic activity, infections and congenital pre-dispositions in a separate article.1

man playing porker - Copyright – Stock Photo / Register Mark In order to de-mystify some of these terms, let's review the contrasting definitions of arteriosclerosis and atherosclerosis since even pronouncing them tangles my tongue. According to the Mayo Clinic, healthy arteries are flexible, strong and elastic. Over time, however, too much pressure in your arteries can make the walls thick and stiff and sometimes restricting blood flow to your organs and tissues. This process is called arteriosclerosis, or hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis. Atherosclerosis refers to the buildup of fats in and on your artery walls (plaques), which can restrict blood flow. These plaques can also burst, causing a blood clot which can either affect your heart causing a heart attack or, if it reaches the brain, may provoke a stroke.1

Functionally then, the term that I propose which makes the most sense to our orientation as massage therapists is "endothelial health."2 This relates to understanding what happens along the internal walls of arteries as a result of increased pressure and the accumulation of calcium and fatty deposits along their inner vascular tubes. Constant high blood pressure hardens and stiffens the arterial walls and makes them more likely to sluff off plaques. Again, it's a progression of deterioration. Pressure is like the Goldilocks fable... too hard, then, too soft, and finally, ah, just right! Instead of seeing pressure as the enemy, let's resolve to learn how we might assist the body to equalize its internal pressure(s) "between" the body's three great cavities and "within its 60,000 miles of blood vessels."3

In 1987, Dr. Jean Pierre Barral DO, inspired my understanding that the pressure within the thoracic cage needs to be "less" than the pressure of the cranial cavity and within the abdominal-pelvic cavity in order for circulation to maintain a normal homeostatic flow of fluids back to the heart.4 With this perspective, our goal as massage therapists is to increase the pliability of the chest wall, especially around the space of the heart, and to also ease the tensions throughout the thoracic cavity. Let's add two steps to the proposed screening protocol from my last article. First, lift the client's head, memorize its weight. Next, palpate the tension of the abdominal wall.

At the end of any bodywork session, not only do we want the chest to become more distensible, we would also like the head to weigh less and the tension of the abdominal wall to ease. All three markers are reliable indicators in my clinical experience that the pressure between the cavities has equalized to some degree.

Let's review one "inside-out" technique that can jump-start the easing of thoracic pressure. Its effectiveness relies on the loosely organized areolar connective tissue along the posterior margin of the diaphragm muscle. Standing on the right side of your supine client, posteriorly contact the opposite side of the spinous processes, beginning at C7, with your upper hand and placing the palm of your lower hand just below the anterior costal arch. Softly anchor C7 with finger tips in contact with the opposite side of the vertebra then stretch the abdominal tissue inferior and medial toward the belly button. Feel for the connectedness between your hands. Your intention is to stretch the internal tissues within the chest so that at the interface of the diaphragm, the downward and medial stretch gaps the loose connective tissues allowing the thoracic pressure to flow from an area of greater concentration to one with a lower concentration. A diffusion gradient is being manually produced. This same procedure can be repeated along each vertebra from C7 - T12. Yes, do both sides.

This approach is not the whole enchilada, but it consistently primes the pump between the thorax and the abdominal-pelvic cavities. And, this technique allows for a two for one potential effect. This same long lever stretching while anchoring each vertebra creates a potential rocker effect to the vertebral/rib complex which is theorized to hydrate and contribute to mobilizing the posterior thoracic spine. Therefore, is my premise that the progression toward all forms of cardiovascular disease is a backstory lurking behind many chronic somatic problems. It is also my assertion that as massage therapists we can make a real difference in the quality of life for our clients as we aspire to comprehend how the human body really works.


  1. Arteriosclerosis/atherosclerosis:
  2. Atherosclerosis - Cardiovascular Disease, Vascular Disease:,
  3. National Geographic Magazine, Healing the Heart, February, 2007,Vol. 211, No.2.
  4. Dr. Jean Pierre Barral DO, Developer of Visceral Manipulation, class notes 1987 -93:



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