Massage Today
Massage Today dotted line
dotted line

dotted line
Share |
  Forward PDF Version  
Massage Today
August, 2012, Vol. 12, Issue 08

Freeing the Heart: Enhancing Central Circulation

By Dale G. Alexander, LMT, MA, PhD

Enhancing central circulation is a notion that has emerged over many years from my work with clients who typically present with exceptionally difficult chronic somatic difficulties. It's combined therapeutic intentions have been to:

  • Enhance the heart's ability to pump more blood by reducing the resistances to its expansion.
  • Enhance the inferior cylindrical movement of the diaphragm and the ease of dorsiflexion/plantar-flexion of the ankle/foot complex.
  • Restore the mechanisms that naturally assist venous and lymphatic return.
  • Lessen the tone of the sympathetic division and enhancing the outflow of the parasympathetic division of the autonomic nervous system.
  • Reduce or remove common obstacles to the return of raw blood products.

Here, we seek to identify the what and where of these therapeutic intentions. Many possible "how to's" are possible when one's treatment goals are clear.

Freeing the Heart - Copyright – Stock Photo / Register Mark It is postulated that this orientation of enhancing central circulation can serve to reduce the workload required of the heart and may slow the build-up of plaques within the coronary arteries. Further, it is postulated that a dedication to assisting cardiac output, neurological balancing and venous and lymphatic return in each bodywork session will assist the autonomic nervous system to more equitably deliver fresh blood to ischemic tissues associated with stubbornly chronic problems.

From our common training base in Swedish massage, we were taught stroking patterns and a general sequential protocol that was intended to assist systemic venous and lymphatic return. Little attention, however, was given to restoring the underlying mechanism(s) by which the body can reset its efficiency of facilitating the flow of these fluids within itself nor, to balancing the functioning of the two divisions of the autonomic nervous system or to enhancing diaphragmatic and ankle/foot range of motion. Absolutely no attention was given to reducing the resistances to the heart's expansion. That is what makes this construct of enhancing central circulation both useful and unique.

To my sensibilities, there are three great pumps which are designed to move the fluids of the body (arterial, venous, lymphatic and interstitial). These include:

  • The expansion and contraction of the heart (100,000 x's/day).
  • The up and down cylindrical descent of the diaphragm (25 -27,000 x's/day).
  • The dorsiflexion/plantar flexion movements of the ankle/foot complex during walking (5200 - 7100 steps/day).1

Now, add the notion of equalizing the pressure between the body's three great cavities which is proposed to allow for the natural flow of fluids back to the heart based on restoring normal pressure gradients.2,3 Full credit is given to Dr. Jean-Pierre Barral, DO, for introducing me to this golden anatomical nugget in 1987.

Consider the importance of enhancing the movements of these mechanisms which are the prime pumps of fluids and the importance of restoring the appropriate pressure differentials which assist these fluids to more efficiently move back toward the heart. Consider how therapeutic attention to these factors may together "reduce the need" for the heart to work harder or for the arterial system to narrow. Consider how these intentions might be a contribution our profession could make toward the prevention of high blood pressure.

The notion of reducing sympathetic tone and enhancing parasympathetic outflow is a core construct of craniosacral therapy as was taught by Dr. John Upledger, DO. I was first introduced to this foundational premise in 1986 and my years of clinical practice since vivify the effectiveness of this treatment goal. This relates to all aspects of activating the body's self-corrective capacities and especially to the regulation of a normal heart rhythm as it is the sole duty of the vagus nerve to slow the heart.4,5

Let us now consider the equally important therapeutic intention of reducing or removing obstacles to the flow of fluids back to the heart from below the diaphragm. Obstacles may be many and varied in their presentation but in distillation, they slow the return of raw blood products either by making the fluids take alternate routings, by adding resistance to the speed of normal drainage or by building congestion as the fluids are held back from moving. Similar to being stopped by a traffic snarl, we either seek another route around the tie-up, crawl our way along hoping the problem will clear itself, or when traffic is completely stopped, we wait in frustration for the road to open ahead of us.

My clinical experience suggests that congestion around or inflammation within the liver, gall bladder and pancreas complex is one of the most common obstacles to blood return. Let us appreciate that the liver is suspended from the inferior surface of the diaphragm muscle and its portal vein is the main tributary for venous blood returning to the heart through the inferior vena cava. Together with the gall bladder, its common bile duct and the sphincter of Oddi which is shared with the pancreas, any inflammation in these organs or their tubes can impair venous and lymphatic return. This is why learning to mobilize and gently stretch these organs and tubes, along with others, is such an important skill for touch practitioners to add to their therapeutic tool boxes.3,6,7

Above the diaphragm, another common area where blood seems to become congested is at the cranio-cervical junction. This is a crucial area to evaluate and treat with whatever therapeutic tools you possess. My experience supports another notion that Dr. John Upledger postulated some 26 years ago: that the brain sometimes holds onto blood. And that the bilateral jugular foramen openings in the cranium serve to drain 85% of the fluids leaving the cranium.4 It is through these same openings that the vagus nerves, who have the task of helping to regulate the heart, exit the cranium.8 A simple way to evaluate this notion of vascular congestion is to lift your client's head and feel for its weight in your initial evaluation. Later, if your bodywork has successfully normalized the flow of fluids leaving the cranium, their head will kinesthetically weigh less.

The Inside-Out Paradigm continues to explore the inner workings of how we may assist our clients to both maintain or to regain their functional capacity and quality of life. Enhancing central circulation is proposed to not only to assist the heart itself but may be a key component toward facilitating the autonomic nervous system to increase its delivery of fresh blood to stubbornly chronic somatic tissues as well.


  1. National Geographic Magazine, "Healing the Heart", February, 2007, Vol. 211, No.2
  2. "The Inside-Out Paradigm: Equalizing the Pressure," Dale G. Alexander PhD, LMT, Massage Today, March 2005, Vol. 05, Issue 03.
  3. Jean-Pierre Barral, DO, Developer of Visceral Manipulation, Course Notes,1987 - 93, I do encourage you to learn these skill sets from them.
  4. John Upledger, DO, Developer of CranioSacral Therapy, Course Notes, 1986 - 91, I do encourage you to learn these skill sets from them.
  6. Williams PL, Warwick R, Dyson M, Bannister LH. Gray's Anatomy. London: Churchill Livingstone, 1989; pp. 1393-96.
  7. "Part II: Chronic Problems Related to Gallbladder Dysfunction/Disease," Dale G. Alexander PhD, LMT, Massage Today, July, 2007 (Vol. 07, Issue 07).
  8. Atlas of Human Anatomy 4th Edition, Frank H. Netter M.D., Plate 7, Saunders/Elsevier, 2006.

Click here for more information about Dale G. Alexander, LMT, MA, PhD.


Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
dotted line