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F A Q  about Bindegewebsmassage


Where did it originate?

Connective Tissue Therapy (CTT), Connective Tissue Massage (CTM), Bindegewebsmassage, developed by Elizabeth Dicke in Germany in 1929 is well known throughout the world but less known in the United States. It is slowly acquiring a reputation in the United States. The development of CTT and CTM systems of bodywork began in 1938 when Elizabeth Dicke met with Professor Kohlrausch and Dr. Tierich H. Leube to initiate research and training in CTT. They incorporated the work of J. MacKenzie who researched changes in muscle tones in relationships to organs. In 1942 Dicke, Kohlrausch, Leube and Mac Kenzie published "Massage of Reflex Zones in the Connective Tissue in the Presence of Rheumatic and Internal Diseases". Many General Hospitals and Orthopedic Hospitals, Physical Therapist and Health Spas in Switzerland, Italy (Florence), and Germany continued to research and practice CTT.

In 1954 the Elizabeth Dicke Society was established to continue the research. Currently the treatments/sessions are used for visceral diseases also diseases dealing with circulation.

Note: Dr. Henry Head, MD an English neurologist who in 1898, initially drew attention to the fact that the internal organs when diseased, manifested their disorders on the skin surface of the body, rendering it excessively painful and hypersensitive to touch, pressure and temperature changes. He also is credited to charting area of the skin naming them "maximal points".

What is Connective Tissue?

Connective tissue is present in the human body in two main varieties - Formed and Loose Connective Tissue. For the purpose of this work we will consider only Loose Connective Tissue.

Loose Connective Tissue is distributed widely throughout the human body. It forms superficial and deep fascia, the inter-muscular septa; it surrounds blood vessels, nerves and aids in forming the framework of most organs. This spider's like web provides connection between structures throughout the body.
The Epimysium Sheath is the outermost sheath of connective tissue that surrounds a skeletal muscle. It consists of irregularly distributed collagenous, reticular, and elastic fibers, connective tissue cells, and fat cells.
The Perivascular Sheath is located around blood vessels and the perineural sheath is located around nerves the fibrous capsule for glands and organs.

To Summarize: Superficial fascia supports nerves, blood vessels, and lymph vessels and sometimes muscles. Superficially it bends with the true cutis (skin). Deep fascia surrounds muscle groups, attaches to bone and blends with the periosteum. In its areolar variety it forms tissue spaces. Fascia is strong and flexible. It allows and restricts movement while giving quality and strength to tissue.

How does the treatment effect the body?

Connective Tissue treatment effects the tension of the fascia releasing it where it is tightened, increasing range of motion, flexibility, reduces numbness, tingling or pain resulting from tightened tissue. CTM predominantly effects the central nervous system, balancing the parasympathetic and sympathetic divisions of the autonomic nervous system. It seems to increase parasympathetic activity, blood vessel dilation, possibly because patients/clients have treatments/sessions when experiencing a pathological problem, stress and anxiety. It aids in blood circulation, increases oxygenation to the tissues, encourages lymph drainage, elimination of waste and toxins, and relieves arthritis and visceral disease. It is helpful with musculoskeletal injuries and in the prevention of scarring following surgery or injury. Because CTM has a profound effect upon the autonomic nervous system it may produce awareness and /or emotional changes.

How often and long are treatments/sessions?

Treatment plans may be long or short-term, depending on the needs of the individuals and their desire to relearn patterns in their body. A series of treatments can be 10 to 20 sessions, as the effects are cumulative. The treatment is given with the patient/client sitting or lying position. The treatment/session may take anywhere from 30 to 75 minutes and no oils or lotions are used.

How will it feel? The strokes are carefully applied and follow a prescribed order, starting in the pelvic region. The strokes may feel like the flesh is being cut by a knife, or may feel quite dull with little sensation by the patient/client. Different sensations are experienced with each pull on the tissue. The results of a treatment/session can vary from producing weariness, a desire to sleep, excessive perspiration, deeper breathing and even a drop in body temperature. The area where the stroke is applied may become reddened as the blood vessels dilate. Beneficial effects may continue for months after a series of treatments.

Can I use it with other modalities?

Yes, Bindegewebsmassage (CTM) is used as a therapy independently but can complement other modalities once the CTM is administered.

Why use CTM?

When dysfunction occurs it is understandable that pathological as well as physiological balance is off. CTM attempts to influence these imbalances. Reactive adaptation is therefore possible in both directions through the connective tissue reflexes. The reflexes can pass from deeper lying structure to the body surface or it may pass in the opposite direction. CTM influences the circulation the body surface in selected areas and so opens up increased circulation pathways to other regions of the organism in its reflexive manor.

What are the effects of Connective Tissue Massage?

The mechanical tension stimulus is the immediate cause of the circulatory effect. At the present time it is only possible to suggest various explanations as to how this effect is achieved. The autonomic reflex pathways are involved and gives evidence that the endocrine system is involved when the mechanical tension stimulus is applied. Mast cells contain heprin and histamine in the cell granules and are released by appropriate stimulation. The types of reaction to the stimulus are similar, however the intensity and duration may vary, depending on the severity of the pathological condition and strength of the stimulus.

Three main reactions to CTM:

Sensation - When the tensile stroke is applied to healthy tissue, the patient/client will report a very slight scratching or cutting sensation. Applying the stroke to tissues with increased tension will produce a very sharp cutting sensation, which is obtained by applying very little pressure with a much decreased angle of the fingers on the skin. The sharp cutting or scratching sensations is typical of the correct application of the technique. It is also indicative of a satisfactory circulatory response. As tension decreases, so the intensity of the cutting sensation decreases. Under certain conditions the patient/client may report a sensation of deep dull pressure, which shows no relation to the pressure actually applied by the fingers. This feeling of dull pressure often becomes apparent when passing through areas of elevations or swelling. It is possible to decrease the cutting sensation by decreasing the speed of the stroke. It is difficult to give a definite explanation of the pathways responsible for the conduction of the described sensations.
Skin Reaction - When applying the tensile stroke to healthy skin a two-fold reaction can be observed.

Appearance of a red line confined to the area of the stroke, within 30 to 60 seconds after the stroke is applied. It may disappear in a few minutes or a few hours.
When the stimulus of the stroke is strong and / or repeated several times over the same line a second visible reaction can be observed. The reddening so no longer confined to the line of the stroke. There is a few second delay and beyond the original red line, from the stroke, a reddish flush develops which may spread in varied distances.
Along the line of the original stroke and often slightly beyond it, a slight swelling may appear. This swelling is termed a "Wheal" and may take up to three minutes to appear and may take several hours to disappear.
The appearance of these lines is not a contraindication to the massage treatment. It is advisable to explain this to your client before the treatment. The improvement in the peripheral circulation coincides with a less violent reaction in response to the massage stroke.

General Reaction - The overall effect of the massage seems to be improvement of circulation to all structures including supporting tissues, muscles and nerves. It thereby helps to restore the balance between the two parts of the autonomic system. CTM attempts to influence the pathological alterations on the body surface as far as these can be influenced by alterations in the circulation. Change in peripheral temperature ads in warming the hands and feet. Relief of Visceral Functional Symptoms- patients suffering from asthma, cans suddenly breath freely and deeply. Relief of Visceral Pain causing gastric discomfort can be lessened. Finally patients/clients reports a general feeling of well being and are very inductive to sleep.


Dicke, E.H., Schliak and Wolff, A., A Manual of Reflexive Therapy of the Connective Tissue (CTM) "Bindegewebsmassage". Simon, Sidney S. Publisher, Scarsdale, NY 1978.
Ebner, Marie, Connective Tissue Massage, Theory and Therapeutic Application, Robert E. Krieger Publishing Co. Malabar, Florida
Connective Tissue Massage, Therapeutic Application, New Zealand Journal of Physiotherapy, May 1968.
Friedman, Lawrence W., MD and Galtom, Lawrence, Freedom From Backaches, Simon and Schuster pocketbooks, NY 1973.
Luedeck, Ursula, "History, Basic and Technique of Connective Tissue Massage, The Australian Journal of Physiotherapy, XV,4< December 1969.
Tappan, Frances M., Healing Massage Techniques, Holistic Classic and Emerging Methods, Appleton & Lang, Norwalk, Ct. / San Mateo, Ca. 1988 2nd Edition.