Unit 1 · Practical · New Routine
Back Routine
This page follows the sequence taught in the New Routine materials. Learn the order first, then connect each movement to anatomy, body mechanics, draping, palpation and clinical reasoning.
Source-of-truth rule
The routine sequence below is based on the instructor's New Routine documents. Supporting explanations are here to help you understand what you're doing, but they don't replace the demonstrated classroom technique. If a generic massage sequence conflicts with this page or the instructor demonstration, follow the New Routine.
Prone setup & regional map
Client
Prone. Adjust face support and bolstering for comfort before beginning.
Prone. Adjust face support and bolstering for comfort before beginning.
Therapist
Expect to alternate horse and archer stances and change orientation around the table rather than reaching.
Expect to alternate horse and archer stances and change orientation around the table rather than reaching.
Low back targets
Quadratus lumborum, thoracolumbar fascia, iliac crest attachments, sacral region and lumbar paraspinals.
Quadratus lumborum, thoracolumbar fascia, iliac crest attachments, sacral region and lumbar paraspinals.
Mid-back targets
Intercostal region, erector spinae, teres major/minor region, rhomboids and scapular borders.
Intercostal region, erector spinae, teres major/minor region, rhomboids and scapular borders.
Upper-back targets
Trapezius, supraspinatus/infraspinatus regions, posterior shoulder girdle and suboccipital attachments.
Trapezius, supraspinatus/infraspinatus regions, posterior shoulder girdle and suboccipital attachments.
Finish
Reconnect the entire back and deliberately taper pressure deep → moderate → light.
Reconnect the entire back and deliberately taper pressure deep → moderate → light.
The New Routine sequence
Transition into the opposite side
Forearm wringing of the trunk
Use the wringing movement as the transition to the other side rather than breaking contact and simply walking around the table.
Use the wringing movement as the transition to the other side rather than breaking contact and simply walking around the table.
Low Back · approximately 6 minutes
Left hip · archer stance
Set your base before beginning focused low-back work.
Set your base before beginning focused low-back work.
Face the feet: QL effleurage / thumb stripping
Work the quadratus lumborum toward the sacrum. Keep the pressure in soft tissue and orient yourself so the movement comes from weight transfer rather than thumb force alone.
Work the quadratus lumborum toward the sacrum. Keep the pressure in soft tissue and orient yourself so the movement comes from weight transfer rather than thumb force alone.
Effleurage the lower back
Reconnect broadly before the more focused iliac-crest work.
Reconnect broadly before the more focused iliac-crest work.
Iliac crest trace
From the left, use thumbs and then fingers with circular friction. Begin near the sacrum and trace laterally along the iliac crest toward the hip.
From the left, use thumbs and then fingers with circular friction. Begin near the sacrum and trace laterally along the iliac crest toward the hip.
Elbow fascial-line glide and compression
Position the elbow to glide and compress slowly along the fascial attachments at the iliac crest. Use sustained pressure rather than driving forcefully into the region.
Position the elbow to glide and compress slowly along the fascial attachments at the iliac crest. Use sustained pressure rather than driving forcefully into the region.
Optional QL forearm roll
Roll the forearm perpendicular to the QL fibers, leaning body weight medially toward the lumbar vertebral region while maintaining control of depth and avoiding direct bony pressure.
Roll the forearm perpendicular to the QL fibers, leaning body weight medially toward the lumbar vertebral region while maintaining control of depth and avoiding direct bony pressure.
Raking transition
Use raking to switch sides, then repeat the low-back sequence on the opposite side.
Use raking to switch sides, then repeat the low-back sequence on the opposite side.
Middle Back · approximately 6 minutes
Rake the intercostals
From the left, use the hand-over-hand, fingers-interlaced contralateral raking technique taught in class.
From the left, use the hand-over-hand, fingers-interlaced contralateral raking technique taught in class.
Scoop the lateral border
Use the scoop as your transition into thumb-over-thumb stripping of the teres major/minor region.
Use the scoop as your transition into thumb-over-thumb stripping of the teres major/minor region.
Forearm effleurage of erector spinae
Glide with the forearm/elbow along the erectors. Reduce pressure as you approach the cervical region, then finish through the trapezius. Maintain stabilization with the lateral hand on the shoulder.
Glide with the forearm/elbow along the erectors. Reduce pressure as you approach the cervical region, then finish through the trapezius. Maintain stabilization with the lateral hand on the shoulder.
Rhomboid friction · horse stance
Use circular and/or cross-fiber friction with fingertips or knuckles through the rhomboid region, moving from the medial border of the scapula toward the spinous-process region while keeping contact in appropriate soft tissue.
Use circular and/or cross-fiber friction with fingertips or knuckles through the rhomboid region, moving from the medial border of the scapula toward the spinous-process region while keeping contact in appropriate soft tissue.
Repeat on the right
Reposition your body and repeat the middle-back sequence rather than reaching across the client.
Reposition your body and repeat the middle-back sequence rather than reaching across the client.
Upper Back · approximately 6 minutes
Neck petrissage transition
From the left, use neck petrissage as you transition around the table.
From the left, use neck petrissage as you transition around the table.
Superior nuchal line friction
Use thumb or fingertip circular friction along the superior nuchal line, focusing on trapezius and suboccipital attachment regions with controlled pressure.
Use thumb or fingertip circular friction along the superior nuchal line, focusing on trapezius and suboccipital attachment regions with controlled pressure.
Contralateral upper trap / supraspinatus friction
Perform circular friction through the upper trapezius and supraspinatus region from the acromial area toward the occipital region as demonstrated.
Perform circular friction through the upper trapezius and supraspinatus region from the acromial area toward the occipital region as demonstrated.
Infraspinous fossa glide
Use an elbow or reinforced-thumb glide through the infraspinous fossa from the acromial side toward the medial border of the scapula. Stay aware of the scapular bony landmarks.
Use an elbow or reinforced-thumb glide through the infraspinous fossa from the acromial side toward the medial border of the scapula. Stay aware of the scapular bony landmarks.
Upper-trap petrissage
Lift and knead the upper trapezius while keeping your own shoulders and hands relaxed.
Lift and knead the upper trapezius while keeping your own shoulders and hands relaxed.
Posterior shoulder sweep
Finish the side with knuckling or broad palmar effleurage sweeping across the posterior shoulder girdle, through the rhomboid region and out toward the deltoid.
Finish the side with knuckling or broad palmar effleurage sweeping across the posterior shoulder girdle, through the rhomboid region and out toward the deltoid.
Repeat on the right
Reposition and repeat the upper-back sequence.
Reposition and repeat the upper-back sequence.
Close Out Full Back · approximately 1 minute
Remain at the head
Use forearm compression / windshield-wiper work across the bilateral upper trapezius.
Use forearm compression / windshield-wiper work across the bilateral upper trapezius.
Full-back integration
Use full-back effleurage / meltdown or forearm effleurage sweeping laterally over latissimus dorsi.
Use full-back effleurage / meltdown or forearm effleurage sweeping laterally over latissimus dorsi.
Three finishing passes
Perform three passes with intentionally decreasing pressure: deep → moderate → light. This is the completion signal for the back sequence.
Perform three passes with intentionally decreasing pressure: deep → moderate → light. This is the completion signal for the back sequence.
Anatomy that makes the routine make sense
Quadratus lumborum
Runs between the iliac crest, 12th rib and lumbar transverse processes. It participates in lateral flexion and stabilization of the lumbar region.
Runs between the iliac crest, 12th rib and lumbar transverse processes. It participates in lateral flexion and stabilization of the lumbar region.
Erector spinae
Iliocostalis, longissimus and spinalis form longitudinal columns associated with spinal extension and lateral flexion. Palpate lateral to the spinous processes.
Iliocostalis, longissimus and spinalis form longitudinal columns associated with spinal extension and lateral flexion. Palpate lateral to the spinous processes.
Rhomboids
Deep to trapezius between the vertebral column and medial scapular border. They contribute to scapular retraction and downward rotation.
Deep to trapezius between the vertebral column and medial scapular border. They contribute to scapular retraction and downward rotation.
Teres major & minor
Both live near the lateral scapular border but have different humeral actions. Use the scapula as your map instead of treating the posterior shoulder as one vague area.
Both live near the lateral scapular border but have different humeral actions. Use the scapula as your map instead of treating the posterior shoulder as one vague area.
Rotator cuff fossae
Supraspinatus occupies the supraspinous fossa and infraspinatus the infraspinous fossa. The scapular spine separates the two.
Supraspinatus occupies the supraspinous fossa and infraspinatus the infraspinous fossa. The scapular spine separates the two.
Trapezius
Spans the posterior neck and upper back. Different fiber directions contribute differently to scapular elevation, retraction, depression and upward rotation.
Spans the posterior neck and upper back. Different fiber directions contribute differently to scapular elevation, retraction, depression and upward rotation.
Latissimus dorsi
Broad superficial tissue of the lower/posterior trunk that extends, adducts and medially rotates the humerus.
Broad superficial tissue of the lower/posterior trunk that extends, adducts and medially rotates the humerus.
Suboccipital region
Small deep muscles at the skull base require precision. The goal isn't to overpower this region with pressure.
Small deep muscles at the skull base require precision. The goal isn't to overpower this region with pressure.
Body mechanics cues
Archer stance
Use front-to-back weight transfer for long glides and stripping. Move your pelvis with the technique instead of reaching from the shoulder.
Use front-to-back weight transfer for long glides and stripping. Move your pelvis with the technique instead of reaching from the shoulder.
Horse stance
Useful when working square to the table. Keep knees soft and let your center of mass lower rather than rounding your spine.
Useful when working square to the table. Keep knees soft and let your center of mass lower rather than rounding your spine.
Forearm work
Pressure comes from leaning and positioning. Don't push the forearm down using shoulder effort.
Pressure comes from leaning and positioning. Don't push the forearm down using shoulder effort.
Thumb work
Keep thumbs supported and wrists aligned. The New Routine includes thumb techniques, but the thumb shouldn't be sacrificed to create depth.
Keep thumbs supported and wrists aligned. The New Routine includes thumb techniques, but the thumb shouldn't be sacrificed to create depth.
Stabilizing hand
The hand on the shoulder during erector work gives the client stability and helps you control the direction of force.
The hand on the shoulder during erector work gives the client stability and helps you control the direction of force.
Transitions
Raking, wringing, petrissage and other transitions are part of the routine. They're not filler between the “real” techniques.
Raking, wringing, petrissage and other transitions are part of the routine. They're not filler between the “real” techniques.
Safety checkpoints
Know where the soft-tissue target ends and the vulnerable structure begins. Modify direct pressure over spinous processes, scapular bone, the kidney region, acutely injured or inflamed tissue, altered sensation, suspicious skin findings and any locally contraindicated area. Focused elbow, knuckle and thumb techniques require especially clear anatomical orientation and client feedback.
Don't promise to “break adhesions” or interpret every palpable texture as pathology. Describe what you feel and what the client reports, then use reassessment to guide your next choice.
Practical checkoff
Perform the low-back sequence in the correct order on both sides.
Demonstrate the iliac-crest trace and identify the QL and iliac crest before beginning.
Use raking as the taught side-to-side transition.
Perform the middle-back intercostal rake, lateral-border scoop, teres stripping, erector forearm glide and rhomboid friction in sequence.
Demonstrate the stabilizing hand during forearm erector work.
Locate the scapular spine, supraspinous fossa, infraspinous fossa, medial border and lateral border.
Perform the upper-back sequence on both sides without losing flow.
Close with bilateral upper-trap windshield-wiper compression and full-back integration.
Finish with the three-pass deep → moderate → light pressure taper.
Maintain appropriate draping, communication and body mechanics for the entire sequence.
Clinical reasoning & MBLEx check
Why does the routine change therapist stance and orientation repeatedly?
Repositioning lets the therapist align body weight with the direction of the technique, maintain safer mechanics and control pressure instead of reaching across the table.
What landmark separates the supraspinous and infraspinous fossae?
The spine of the scapula.
Which muscle lies between the iliac crest, 12th rib and lumbar transverse processes?
Quadratus lumborum.
During focused rhomboid work, what important landmark should you be able to identify?
The medial border of the scapula, along with the nearby vertebral landmarks, so your technique stays oriented to the intended soft tissue.
Why reduce pressure near the cervical region during the long erector forearm glide?
The anatomy, tissue depth and vulnerability change as you approach the neck. Pressure should adapt rather than remain mechanically identical from lumbar to cervical regions.
What's the purpose of deep → moderate → light finishing passes?
They create a deliberate sensory transition out of the focused work and signal completion of the back sequence.
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