There are many techniques performed in physical therapy that can be incorporated into your own self-treatment regimen. Skin rolling is one of easiest because there isn’t necessarily a wrong way to do it (or at least none that I have discovered). For those of you who think I am referring to some type of ancient form of torture, let me assure you that skin rolling is not as scary as it sounds.

Skin rolling is a type of myofascial release. You can find a lot of information just by typing “myofascial” into your favorite search engine, but here’s my abbreviated definition. The “myo” means muscle and “fascial” is pertaining to the fascia or connective tissue that surrounds every muscle, bone, ligament, and organ in our bodies. Thus, myofascial release is simply a way of releasing tension or constriction in the connective tissue around our muscles. I find skin rolling a pretty interesting technique because it so clearly demonstrates the presence of constricted fascia and muscles (I’ll get into this further after I describe the technique).

Step 1: Show some skin!

Start with bare skin—your abdomen is a great place to begin because it often holds a lot of constriction and is also easy to access when skin rolling on yourself. Use a small amount of a massage cream or lotion (don’t use oil because it will be too slick). You want enough that your fingers can glide over your skin, but with enough resistance that you can still grasp with your fingers. I will take a small amount of massage cream to rub on the tips of my fingers, and then use the tips of my fingers to spread a light even layer over my stomach. If you don’t put enough at first it is easy to add more, likewise you can always wipe off excess with a towel if you use too much. I recommend laying comfortably on your back with a pillow under your head.

Side note: Of course, make sure you start with clean hands, and for the ladies with long nails, you might want to use latex or non-latex gloves. I prefer to keep my nails relatively short, especially my thumb nails as they can get in the way and can make the skin rolling somewhat uncomfortable (no one likes to accidentally scratch themselves with their own fingernails). You may also want to try to warm your hands up a little so the touch to your bare skin doesn’t come as quite a shock.

Step 2: Grab a handful!

Have you ever grabbed a bit of your belly fat between your thumb and forefinger, maybe to show off that extra inch that you gained? (If you don’t know what I’m talking about maybe ask one of your female friends as I’m sure someone has done this technique once or twice.) Basically you are going to grab the surface of your stomach between your thumb and index finger. It is easiest to bend or curl your index finger so you are making sort of a loose fist with your thumb pointing straight. Using this technique allows you to grab enough surface area to start with. Now do the same thing with your other hand so that your thumbs are touching and you have grabbed a handful of your skin (along with the fascia, or connective tissue that is connecting your skin to your abdominal muscles).

Step 3: Let the rolling begin!

Now that you have a good grasp of skin and fascia, slowly transition your fingers out of the fist to lie flat against your skin. I keep my thumb and forefingers firmly in place while I first unravel my middle, ring and pinky finger. As you are unraveling your fingers, ever so slowly move your thumbs downward (toward the rest of your fingers) while you shift your index finger out of the way to allow the handful of skin to roll downward through and past your fingers. As your thumbs continue their downward motion, keep walking your fingers along the path to continue the rolling movement of your skin.

Once you get the hang of it you can start at the top of your stomach, just at the base of your ribcage and roll downward until you reach below the belly button to where your mons pubis begins (that’s the fleshy padded area where your pubic hair grows…read Female anatomy: the basics for a refresher). Move your starting position a couple centimeters to the left (or right, depending on which side you started on) each time you begin a new roll. You also don’t need to move quite so slowly once you get comfortable with the technique, and get past enough of the initial constriction so it is not so painful.

Step 4: Ouch, you didn’t say it would hurt!

This is the part where I find skin rolling so interesting. If you are certain that you are performing the technique described above correctly and your skin glides through your fingers without the slightest hint at pain, then you don’t have fascia constriction (at least in the area you are skin rolling) and you likely don’t have issues with hypertonic pelvic floor muscles (especially if you have no pain when skin rolling on your abdomen). Hooray for you! Although hypertonic pelvic floor muscles are often found in people suffering from pelvic pain and painful sex, whether as the primary cause or as a side effect, not everyone will experience this.

Side note: Just because you do not experience pain with skin rolling or other myofascial release techniques does not guarantee that you would not benefit from seeing a pelvic floor physical therapist. I always recommend seeing a physical therapist who specializes in pelvic floor therapy before trying more drastic tests or treatment options because it is so easy for them to confirm that therapy isn’t right for you.

For the rest of you who are questioning my earlier comment about skin rolling not being a form of torture, you definitely have myofascial constriction. And, until you perform enough regular skin rolling so as to release that constriction, it is going to be painful. I remember having a hard time performing skin rolling on myself at first. It was easier for me to let my physical therapist do it because I could relax with some deep breathing while her fingers worked out those constrictions. But when I was at home trying to make progress between sessions, I could only do a little at a time. Take it slow and you can build up over time. The pain will slowly reduce until it is non-existent. If I skin-rolled every day I would probably rarely feel any pain when doing so. Even though that isn’t the case, the pain I do feel with skin rolling through constricted fascia is much more manageable than those first few months of treatment.

You may be wondering how your physical therapist can tell that you have myofascial constriction if you don’t actually mention that you’re feeling pain (Side note: you should always communicate with your therapist!). You may not notice it yourself because the pain takes your attention, but as you roll through constricted areas you will feel little bumps or nodules under the skin. My physical therapist likes to say it feels “grainy” in those areas. Think of rubbing a tight muscle, perhaps in your shoulder—where the muscle knot is you will feel a large bump or mass of tight muscles. These constricted areas of fascia are the same type of thing but on a smaller scale, and just like you need to work out those muscle knots you need to release those myofascial constrictions.

Step 5: Still don’t get it?

For the visual learners, or for those who just aren’t following my rambling descriptions, here are two YouTube videos that I found as well as a link to another blog post that describes skin rolling from a physical therapist. This first video is from a college instructor teaching the skin rolling technique to his students. You can skip to about 8 minutes in for the skin rolling demonstration, but there are some other helpful techniques and information in the rest of the video. This second video is much shorter but still gives a visual picture of what skin rolling is. Lastly, I follow the Pelvic Health and Rehabilitation Center on Twitter, a physical therapy clinic that provides great insight on various aspects of pelvic pain and pelvic floor physical therapy. This blog post is specifically about skin rolling from a physical therapist’s perspective, including why it is so important in the healing process.