Until now JMS hasn’t addressed the Eastern views on healing and somatic rehabilitation. We were not arrogant, but we simply didn’t get submissions worth publishing and sharing with our readers.

            This article written by Charles Soupios, LMT who has extensive knowledge of that subject fills this void and we think the author did an excellent job expressing and explaining his points.

            Of course, some of our readers may disagree with Charles’ ideas and opinions, but we believe in productive discussions which make us all grow professionally.

Dr. Ross Turchaninov, Editor in Chief

 

ENERGY WORK IN MASSAGE THERAPY: EXPLORING THE EASTERN PERSPECTIVE 

by Charles Soupios, LMT 

            Self-healing is not something most people associate with massage therapy, but long before modern medicine came into focus, massage in the form of pain therapy was practiced for centuries throughout Asia to heal and rejuvenate the human body. Unlike the massage work we see today, this ancient pain therapy used methods to develop a client’s own self-healing abilities.       In other words, therapists taught their clients how to heal themselves. The practices often included energy work, but what has rarely been told is that such energy work relies upon the body’s myofascia to harness the energy of gravity, which helps to differentiate and loosen various tissues. 

            Even today gravity is considered a powerful force when utilized in body enhancement routines, such as Tai Chi Chuan or Qigong. And therapists who still practice these ancient methods can use gravity to ‘re-align’ their clients’ central nervous systems and thereby motivate their myofascia as needed. Obviously, nerves conduct signals and deliver the mind’s responses to each situation, but the crux of pain therapy is to reprogram a client’s mind and to strengthen its connections to the organs and soft tissues. This is best achieved through proper utilization of the myofascial, which was previously believed to be inert an incapable of responding to the mind. Now, after much research, the therapists are learning how to use this tissue to nurture their own health as well as that of their clients. 

            So, this begs the question, how can massage therapists fulfill these grand ideas using the methods taught in massage schools? Well, some aspects of this therapy are actually taught in massage schools, but it takes experience for students to realize how touch can help clients regain control of their bodies. Part of the problem is western schools teach students how to engage a client’s body first, whereas eastern traditions teach students to align their own bodies and minds before engaging their clients. So, the answer has two parts:  

1. Therapists must learn the process of connecting to their own bodies by gaining control over their own internal organs and tissues through their own nervous systems.   

2. They must also gradually develop skills to access their clients’ minds to help them accept refocusing from an outside source. Another way to look at it is the therapist is responsible for applying therapy methods and then teaching similar methods in a self-care format to clients as needed.   

            Most western-trained massage therapists have never been taught to utilize their own nerves and tissues for self-healing. Some even believe Asian therapists who use such methods are just working with a client’s skin, which isn’t the case. Seriously, how much control does anyone have over their skin? And who can move their skin without using any muscles? For this article, Dr. Ross Turchaninov gave me a very useful description of how the skin serves the mind/body connection:  

“Skin has mostly afferent (i.e., sensory flow to the brain) innervation since it delivers important data to the brain from peripheral receptors. It has far less efferent (i.e., motor flow from the brain) innervation which it uses to govern the smooth muscles that cause, for example, goose bumps, and perspiration in the skin which are under the control of sympathetic nervous system. So, the efferent innervation of the skin is not directly linked to the skeletal muscle functions, whereas the afferent is. A great example of this is in the reflex tightening of the muscles when the skin is exposed to cold temperatures.”   

            This tells us the skin uses afferent nerves to initiate involuntary responses which can alter muscle tension, but with limited efferent control, MTs may find it difficult to use a client’s skin only to fully release tension in tissues. By contrast, the energy work described herein depends on fascia, which can be used to initiate voluntary responses for releasing fascia and muscles. Research has corroborated the massive innervation of the fascia, and some sources (whom I’ve cited) report the nervous system’s connection to the fascia surpasses that of the skin.  The main advantages of so large innervation are that clients can be taught internal cultivation to control their fascia, and therapists can use that connection to initiate lasting changes in their clients’ bodies. 

 

UNDERSTANDING THE MIND / BODY CONNECTION: HOW DID WE MISS THIS?

            In ancient healing systems an important protocol was to help clients develop more control over their bodily tissues, but it was also understood that not all tissues could respond to that agenda. In recent years Dr. Robert Schleip did an interview with Prof., Dr. J. Staubesand of the Anatomical Institute of the Albert Ludwigs-University of Freiburg, Germany which illustrates how fascial interactions with the nervous system differ from those of other tissues in the body. Dr. Schleip is a well-known researcher who has stated himself that fascia is heavily innervated and far more interactive than the medical community previously believed. The interview explains several aspects of new research which are pertinent to massage therapy. You can find the entire interview and download it from this link:   

http://www.rolfyoga.com/PDF/Fascia_Innervation_7.0.pdf

            Excerpt: 

“Yet what we can say is that there are myelinated, as well as unmyelinated nerve fibers in fascia. The myelinated axons are generally regarded as sensory. The unmyelinated nerve fibers could have motor functions as the efferent nerves of the autonomic nervous system to the smooth muscle fibers…” – Dr. J. Staubesand   

            I was surprised to read from a western source that fascia not only sends sensory input to the brain, but it also responds to signals from the brain, most likely through efferent nerves. In Asian therapies this has been considered common knowledge for centuries. Eastern cultures have been utilizing myofascia since before acupuncture, but their “data” came from a different kind of research called “experience.” The value of such knowledge still confuses many in the west, but that is changing. 

            Today western therapists are finally starting to realize that even though nerves control skin and muscle, any effective pain relief must also include the myofascia. This does not mean therapists who choose to work with only skin and muscle are any less capable of pain therapy, but their methods will include fascia whether they realize it or not. To understand how westerners missed this point, we’d have to review very old medical perspectives which never explored fascia as a living tissue. In that mindset, the fascia just got in the way during surgery, so doctors simply ignored it.    

            Here I should explain I am a proponent of Asian healing arts. I also believe in Asian scientific perspectives because western technology has developed so fast and in so many ways that we have forgotten the origins of science were not based in technology. Asian cultures embrace technology too, but they have retained some scientific principles which have held true for thousands of years. I realize there are many definitions for science, but I also realize that too many “wannabee” scientists in the west believe there is only one science, and they think they own it. Their perspective is called ethnocentrism, and it essentially means they judge other cultures and views by their own social mores. 

            In terms of massage, many therapists have forgotten the roots of western massage hail from some of these other cultures, including China and Egypt, yet modern techniques reflect very little of their essence. Further, some therapies included massage, but they were distinct healing modalities which might not be considered massage work by some individuals. Unfortunately, such attitudes have caused a disconnect which detracts from our purpose and relevance as massage therapists in today’s world.     

            So, what is the point of energy work when it doesn’t appear to have any science behind it? Well, appearances can be deceiving. It’s important to remember the studies we use today were not a part of science in the beginning. One can say they were part of its evolution, which is fine, but you’d be missing an important point in that energy has been an inescapable scientific fact throughout history. It exists in the human body as metabolic energy, and externally in other forms, such as sunlight. Gravity is an external energy we can learn to internalize, provided we are willing to explore internal cultivation techniques. 

            Internal cultivation is where learning to use myofascia becomes very important since that is the only tissue in the body which is known to conduct gravity. To master that tissue, Tai Chi Chuan and Qigong (pronounced Chi Kung) are internal exercise routines practiced by millions of people in China. They are separate programs which are often practiced together to supplement each other, and both reference the myofascia in the study of body mechanics. Unfortunately, by ignoring their applications and health benefits, westerners have largely missed the scientific value of Tai Chi and Qigong which are the most direct approach to understanding internal cultivation.  

            Western research is clearly missing data from Asian self-cultivation methods which could help us understand how our bodies really work, but few western science enthusiasts will admit it. This has diminished our learning capacities because we are locked into a conditioning which tells us our science rules our existence, but it’s not true. In the east, to seriously study something is to practice it until it becomes second nature, whereas in the west we believe that to observe something is the same thing as to study it, thereby negating any experience of what we are observing. Further, eastern healing arts and sciences do not always have discernable boundaries, so there is often confusion in the west about whether something as complex as acupuncture should be classified as an art or a science. 

            When westerners review eastern scientific research, repeatable results may not be enough to validate any conclusions because in the west empirical data outweighs personal experience. This is why at the end of many western studies you may find a statement saying, “further research is needed.” Repeatable results would be a better option for research, but we choose to ignore such information while relying on third hand empirical data. Unfortunately, some research actually relies on studying prior research with little or no field work, which really amounts to nothing but conjecture; hence, the complex issue of changing beliefs to include new factors which never been acknowledged can be a problem.   

 

THE CONCEPT OF ENERGY WORK IN MASSAGE THERAPY 

            So, considering this idea of internal control, have you ever thought of your body as a laboratory in which you could conduct your own experiments? This is how many early practitioners learned to become healers. In ancient times there was obviously no technology to study a body’s internal workings other than a healer’s mind and the experiences it could categorize as data. Healers therefore had to rely on their own internal resources along with their clients ‘conscious interactions and verbal clues. 

            Modern day massages have little in common with those times, but the question is: Could those ancient techniques be useful in making proper assessments and addressing pain issues in today’s world? Surprisingly, eastern cultures figured out long ago how subjective interpretations could be corroborated by repeated success, so repetition is always a part of training. In China, programs which include martial arts have often led to healing methods for the human body, and all Asian cultures seem to agree that some physical exercise is necessary to maintain health.   

            Most Asian people whom I’ve met believe energy exists in everything, living or dead, organic or inorganic. Unfortunately, westerners often find it hard to acknowledge energy work as anything more than fakery while forgetting completely that gravity, light, and food are all sources of energy which they can’t live without. The human nervous system also exudes an energy of its own which is a critical aspect of internal work.

            Many Asians have learned to utilize these resources to a high degree, and learning to work with their own efferent (motor) nerves determined how well they were able to use their bodies to internalize gravity as energy. Unfortunately, teaching these practices would be a difficult task for anyone. And again, how many western practitioners perceive of gravity as a form of energy? Without some training, the answer is very few. This has made it very difficult for western cultures to develop consistent views about the reality and the value of energy work.  

            I should mention here that I received training in an ancient massage therapy which was part of the Kaya Kalpa healing system as it was practiced throughout most of Asia for centuries until it was replaced by ayurvedic medicine and acupuncture. That’s a very long history. Originally the practice used two healers (as therapists). One was considered a master healer, and the other was usually an apprentice. Apprentices were used to rub specific herbal formulas into a client’s skin under the master’s guidance to facilitate healing. Unfortunately, the formulas that were used are no longer accessible since much of the original herbology was lost during historical events and the transition to modern medicine.  

            Some Asians still develop high levels of internal control to optimize this work, but it’s pointless to teach others how the herbs could expedite the process since they’re no longer available. Fortunately, some Chinese herbs have worked well as substitutes, and some formulas have been made into usable massage oils. Keep in mind also that this work does not intentionally “pass energy” to clients as we have often heard about in the west, but practitioners tune in to their clients’ nervous systems to help them initiate changes. This philosophy of facilitating the clients’ healing through their own efforts should be the goal of all bodywork.    

            Many Asians consider ALL massages to be various forms of energy work, whereas many westerners assume that Asian therapists who use energy work are practicing some sort of ‘magic’. Nothing could be further from the truth. I believe some common ground may help the west to understand energy work, but there’s no easy fix for these misconceptions. 

            Fortunately, in the western approach, massage therapy is used to relax the body, and that’s a good place to start since focused relaxation is also key to accessing the myofascia in the Asian systems. A common thread should therefore be learning to let go of muscle tension, which exposes the myofascia internally by differentiating the internal sensations. If clients can gradually be guided to relax enough so they feel like their skin and muscles are melting off their bones, they will eventually understand how myofascia can maintain a body’s structure with very little muscle tension.  

 

 HOW TO USE YOUR BODY AS A LABORATORY 

            As stated earlier, western cultures often do not recognize the validity of scientific principles as presented by eastern proponents. Some Asians will claim the reason is cultural arrogance, and while there is some evidence of that, it misses the point because westerners have little concept of any science outside of their technological paradigms. I believe they have also forgotten that scientific principles have been around much longer than those technologies they now use to measure them. 

            Gravity is one such factor we all take for granted, but there are others. The term “energy” evokes too many misleading ideas about what massage therapy can achieve in terms of healing, so we should take counsel from those teachers who say it is better to teach people to heal themselves than to actually heal them. For that purpose, MTs need to teach their clients how to utilize their own bodies for personal experimentation.  

            With that in mind, consider how Asian therapists occasionally use methods to loosen the soft tissues surrounding their clients’ internal organs. While they can’t access the organs directly, some modalities, such as Chi Nei Tsang, allow them to reach through the skin to loosen the fascia surrounding each organ. (Chi Nei Tsang is a form of visceral massage which goes deeper into the body than most other modalities.) Of course, the fear factor for many clients can be overwhelming, so other ways must be explored to loosen the organs without causing anxiety.        

            Fortunately, less direct methods have proven useful for this, and they are well-suited for pain relief. The following video link demonstrates one way you can loosen your own myofascia without having anyone else manipulate your body, which is the whole point of teaching self-care:   

https://www.youtube.com/watch?v=m9OOV1ns_p0&feature=youtu.be

            The video describes Tongue Pulsing, which is the easiest way to understand how you can control your own fascia, starting at the neck. Place the underside of your tongue (near the tip) against the upper gum behind your upper teeth inside your mouth, and pulse it (like your heart beat) into the front of the hard palate for a few seconds to see how it activates the tissues in the back of your head. By doing this you will affect the tissues holding your cranium in place and eventually relax the sutures. The reason this is important is the fascia surrounding the cranium affects many other tissues, so if you can expand the cranial sutures, you will find it much easier to release other parts of the body. 

            Note: If you have a headache or migraine, it is better not to pulse the tongue. Just allow it to press gently against the palate and relax. Keep in mind that the tongue controls the fascia in the neck, and it can loosen other tissues through that connection.    

 

THE PROCESS OF MITIGATING GRAVITY 

            So, how does gravity fit into massage therapy? Well, ask yourself, how does it affect your clients? The most common effect of gravity on the body manifests as lower back pain (LBP) from compression of the intervertebral discs and the entire spine downward against the sacrum. Since this is one of the biggest problems adults face, we must decide how to release the thoracolumbular aponeurosis when it freezes. 

            In Asian cultures fascia is thought to be like Elmer’s Glue. It’s a liquid when it comes out of the tube, but it hardens when it is allowed to stay in place and dry out. Fascia does the same thing when the spine compresses and the surrounding tissues can’t breathe, so they freeze in place. If you compare x-rays of a child’s spine with x-rays of an elderly person’s spine, you’ll notice the discs between the child’s vertebrae are full and thick, whereas the elderly person’s discs look thin and compressed. Compression occurs over time when the discs between the vertebrae flatten and the soft tissues surrounding them are allowed to harden like Elmer’s Glue. Studies have shown that compression of the discs is a long-term effect of gravity (Boocock et al., 1988; Bloomfield et al., 2016, Wu et. al., 2017). Further, muscle tension can exacerbate compression, leading to numerous back problems.   

            With this in mind, how would anyone be able to stop gravity? Would you yell at it, throw rocks at it, or just ignore it? Well, have you ever considered it might help to stop fighting it? I’m proposing here that you can relax your muscles and let the force of gravity shift your internal mass rather than allow it to compress your tissues and vertebrae. This is because a major function of muscle tonicity is to maintain the body’s structure against gravity, but you can mitigate the tension by learning to relax that function.   

            Since the sheaths of superficial fascia work on a different principle than the muscles, their resting tonicity is variable as each sheath can slide through others like a telescope. Since the muscles and fascia both have different resting tonicities, relaxing them will yield different extended lengths and thereby differentiate the two tissues for the central nervous system to identify and use. Also, by relaxing the muscles and decreasing fascial tonicity, the joints can separate as needed, and the body can accommodate gravity rather than try to resist it. In short, using gravity means allowing the fascia to absorb it so the CNS can differentiate and motivate tissues by shifting their mass. The deep fascia and the tendons will ultimately follow suit.   

            Most of us have little understanding of gravity, and resisting it with our muscles has prevented us from utilizing it properly, so we need to change our muscular dependence in order to learn about it.  What I’m suggesting is therapists can use the relaxation principle to refocus the weight of their clients’ tissues and thereby help them change their overall tonicity. It’s a difficult thing to describe, so I recommend Tai Chi Chuan as a self-care program to get an idea of what that feels like. Watch some videos of Tai Chi masters to see how they use gravity to increase their connections to the earth in their forms and in combat. Adepts of the art can connect to the ground so effectively that students and onlookers will not be able to move them, regardless of how hard they push. Less adept practitioners can eventually develop this skill by relaxing their tissues and allowing gravity to pull their fascia downward, which is a common goal, but it takes years to achieve.  

            Every vertebra is a separate joint, and by allowing the muscles to relax, each of those joints will eventually loosen and separate in small increments. Gradually the surrounding fascia will stretch to hold the joints together. Why is this important? First, it will re-train a client’s nervous system to locate and isolate his or her myofascia. Second, it will give the CNS more control over the body’s structure as the joints loosen and free up irritated peripheral nerves. With better neurological control, all system functions improve. 

            So, to summarize, muscles resist gravity; fascia absorbs gravity. Since fascia responds to nerve impulses differently from the muscles, when the muscles relax, the fascia can take over (though some physiological muscle tension will remain). The sliding sheath principle of the superficial fascia allows it to unfold to greater lengths than the muscles, which helps the body to expand rather than compress. Keep in mind the sensation also includes expanding the joints as if the body is being inflated.  

            The reason I say fascia absorbs gravity is because it expands with the downward pull gravity exerts on one’s body. And by adding some intention to the relaxation process, one can use gravity to sink the sliding sheaths and also cause them to fill with interstitial fluid to enhance the expansion process. The human body will not support any empty space, so it initiates a form of diffusion to fill empty spaces between the fascial sheaths with fluids. Further, the diffusion process helps the joints to expand as the tendons soften and the connecting muscles lengthen. This also cushions the joints with synovial or interstitial fluids. 

CONCLUSION: Relaxing the muscles allows the fascia to reshape in accordance with gravity as it supplants muscular strength. In Asian internal arts, this is called “filling”, which essentially means to inflate the body with gravity.    

 

USING A MASSAGE CHAIR VS A MASSAGE TABLE 

            I believe a major part of correcting gravity’s effects on our clients is to start each massage from a massage chair instead of a table. The reason I say this is that lying on a table changes how a client’s muscle tonicity resists gravity. On the other hand, sitting upright changes which muscles activate and how much tension they’ll need. In other words, sitting upright requires more muscle activation, which actually helps any pain therapy methods that use activation to reduce tension. Applying techniques from an upright position also helps keep the clients focused and aware of what the therapist will need them to do, so interaction is critical in pain therapy, and falling asleep on a table is not an option.    

            Anyone who trains in ancient healing systems might notice some massage techniques which look similar to the modern modality known as Proprioceptive Neuromuscular Facilitation (PNF). The differences are profound, however. I use an approach derived from the Kaya Kalpa system called PNF Tech, but unlike modern PNF work, the system emphasizes expanding the joints and releasing activated tendons rather than compressing them and improving one’s proprioception (as in other modalities). 

            In practice, therapists using this approach will have their clients stretch a muscle in the same manner as a normal PNF, but they will then ask the clients to internally expand that muscle like a balloon while the therapists petrissage the tendons and provide resistance to the activating muscle. This releases the tendons while decompressing any trapped nerves. But unlike the parent system, which uses herbal formulas to heal and revitalize a body, the focus of PNF Tech as a massage modality is simply to release constricted tendons, loosen muscle bellies, and reduce fascial tension.     

            The video link below demonstrates PNF Tech in a lower back pain routine and how it can change a therapist’s interactions with his or her clients. It is often easier from a chair to help clients re-train their bodies and counter the effects of gravity on their organs and soft tissues. Table work is also fine, but fifteen minutes of therapy in a chair preceding the table work is usually best, so the most effective massage work should include both. If a client complains about pain, my first question is always where the pain is and what they want to do about it? I then explain why lying face down will not be useful in reducing their pain if they relax too much. The reason again is that positioning is critical for proper muscle activation, which allows a therapist’s techniques to become far more effective at reducing pain.   

https://www.youtube.com/watch?v=w85_0voTgno&feature=youtu.be

            As the video demonstrates, regarding lower back pain, it is recommended for all therapists to experiment with ways to reduce the effects of gravity on the spine and sacrum since gravity is a common cause of this problem. The best interventions always free up irritated nerves, but the way to maintain that treatment while mitigating the negative effects of gravity is to teach clients how to relax the spinal column and the tissues surrounding the sacrum. MTs will find that massaging the quadratus lumborum and erector spinae muscles while they are fully stretched and activated (as in the video) will release the thoracolumbar aponeurosis and open up the neural pathways. “Activation” simply means the client is pushing against the MT’s resistance from a fully stretched position. For LBP they should stretch their spines upward and out to either side before pushing back.   

            As of this writing, research has not told us exactly what motivates the myofascia. Even newer studies say further research is needed, but they still suggest efferent nerve responses are part the reason for the fascia’s internal accessibility. We do know that fascia can contract, expand, elongate, congeal, fold, shrink, and separate into individual sheaths as needed. This indicates gravity in motion as orchestrated by the CNS. And utilizing gravity is a powerful form of energy work. So, the mind is quite capable of directing the nervous system to change the fascia’s tonicity, and gravity is part of the process. Even deep fascia has many of the same qualities though it is fixed in place. So, does this satisfy the criteria for calling massage “energy work?” I doubt it. But does energy work belong in massage therapy? I’ll leave that up to you to decide. The point is, allmassage involves energy, and we all work with that energy to help our clients. It’s not magic. It’s just a labor of love.

 

REFERENCES AND SOURCES

Bloomfield SA, Martinez DA, Boudreaux RD, Mantri AV. Microgravity Stress: Bone and Connective Tissue. Compr Physiol. 2016 Mar 15;6(2):645-86. 

Boocock MG, Garbutt G, Reilly T, Linge K, Troup JD. The Effects of Gravity Inversion on Exercise-Induced Spinal Loading. Ergonomics. 1988 Nov;31(11):1631-7. 

Ingrassia. P. Videos on Chair Massage 

 

Many videos demonstrating how every technique used on massage tables can be translated into a chair massage format. Here is a sample video:

https://www.bing.com/videos/search?q=Patrick+Ingrassia+chair+massage+videos&view=detail&mid=F169D53E4F4B0DC67B31F169D53E4F4B0DC67B31&FORM=VIRE  

Guimbiertu J.C. Videos on fascia research. Example: https://www.youtube.com/watch?v=QD82pKNFnPE 

Jinkins JR, Dworkin JS, Damadian RV. Upright, Weight-Bearing, Dynamic-Kinetic MRI of the Spine: Initial Results. Eur Radiol. 2005 Sep;15(9):1815-25. 

Jwing-Ming, Y. The Root of Chinese Qigong. YMAA Publication Center, 1997 

Maneewan Chia, M. Healing Tao. Books, 1988.  

Soupios, C. New Strategies for Pain Relief: An Introduction to PNF Tech Therapy. Self-Published. 2016. Free pdf download at: 

https://drive.google.com/open?id=1FGsG9NVH3L5XI897dv19aJdwlDoqfVEL 

 

Tai Chi Classes    

Totora, G.J., Dickerson B. Introduction to the Human Body. John Wiley and Sons, Inc., 2012

 

Maton, M. The Massage Therapy Institute of Colorado (MTIC): Student Textbook (basic anatomy) 

Wu D, Zheng C, Wu J, Huang R, Chen X, Zhang T, Zhang L. Aerosp. Molecular Biological Effects of Weightlessness and Hypergravity on Intervertebral Disc Degeneration. Med Hum Perform. 2017 Dec 1;88(12):1123-1128.  

Yamamoto M. Nihon Seikeigeka Gakkai Zasshi. Radiographical and Anatomical Studies on the Pathogenesis of Degenerative Spondylolisthesis. 1979 Dec;53(12):1745-65 

 

About the Author 

            Charles Soupios, LMT has a rather interesting background in relation to massage therapy and the writing of this article. He had just graduated with a BA in English at Long Island University in 1987 when he was hired as a ghost writer for a renowned Qigong master who became his first teacher. Then in 2003 he met a Tai Chi teacher who taught him Chen style Tai Chi and Qi Gong for almost 10 years.

            In 2012 Charles began attending the Massage Therapy Institute of Colorado to learn more about healing arts while he continued to practice Tai Chi and Qigong. During that period he met two massage teachers who visited the Tai Chi studio and taught him parts of the Kaya Kalpa system.

            After many hours of practice, Charles offered to teach his accumulated knowledge to other students. After much scrutiny, the school’s owner, Mark Manton, became Charles’s mentor and helped him to develop those techniques for classes at the school. Together they created a program which has been praised for benefiting many students by protecting their joints and for making a tangible connection between Tai Chi and massage therapy.  

 


Category: Medical Massage

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