Many of you have followed my journey over the past few years and a few of you have cried "heretic"! My journey as a human has thus far been one of questioning and change and the past few years are no different as I question what I was taught about fascial science and therapy. Many have weighed in on these debates, both to me and to others, and suffice it to say that nothing will be solved with any certainty for many years to come. I am not a scientist, nor do I pretend to think like one. Until a solid consensus is reached, I will continue to teach and practice a modality that physically resembles myofascial release, but with added twists, both in technique as well as explanation. I'll call it myofascial release, at least for now, in spite of many who disagree with me on this point. Follow your gut and you are usually following the right path.


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There are a few thousand of your reading this newsletter, many of whom have taken myofascial release trainings. I may have taught some of you, while others may have trained with different teachers. While practicing a single named modality, such as Myofascial Release, should produce very similar technique amongst all involved, it is shocking to many, therapist and patient alike, when the end product of technique varies so wildly. I  long ago gave up trying to convince anyone that my form of MFR was the best. Let go of ego...let go of trying to be an icon (or calling yourself one!).

So what is occurring in the photo shown above? This is a self-stretch that I teach to many of my patients who suffer from hand pain/dysfunction and I often perform this stretch on myself. I came upon this stretch a few years back when I had a run on patients who did various forms of needlework. They complained of pain at the base and "meat" of the thumb. Most had an x-ray report from their doctor, which determined that there were degenerative changes in the joint at the base of the thumb. (I cynically keep my snarky remarks to myself, but what would the doctor have seen if they had taken an x-ray of the opposite, non-symptomatic hand?) Upon evaluation, marked apparent tissue density was noted in the thenar eminence and there was often a cupping of the palm (thenar eminence drawn tight toward the hypothenar eminence). Previously, I had assumed that fascial shortening had occurred as a result of cumulative use/overuse. Was I wrong? I'm not sure, but I have now added to my repertoire of reasons of causation.

This self-stretch, and accompanying treatment, was nearly always very effective in reducing pain and improving function, so there was little impetus to scratch deeper to look for underlying cause. After all, if what I believed was occurring followed easily with what I thought I was impacting with the treatment and self-stretch, what else could be accomplished? This pretty much sums up how I practiced and taught for the past 20 years. What I was taught seemed to follow what I felt under my hands and what I was taught seemed to make people better, so why argue?

The internal argument began when I was exposed to DermoNeuroModulation, by Diane Jacobs, PT. DermoNeuroModulation, DNM for short, stresses the fact that the only tissue we can be absolutely sure that we are affecting is the skin. Being able to impact any/all deeper structures is open to question. (Please note that Diane and her approach are diametrically opposed to myofascial release as a treatment construct. I just so happen to see her views on pain and changes in pain in the body as very valid explanations for most, if not all, of the changes we see and feel every day.) I would direct the reader to this blog post, on Joe Brence's blog, where Diane sums up her approach.



Comparing the photo at the top of this post with the diagram from VisibleBody (www.VisibleBody.com for an awesome app for the ipad), note the thenar eminence's distribution of  nerves that originate from the median nerve. Thinking form a nerve-centered approach, we can use very gentle stretching into the skin, thereby affecting the Raffini receptors, which are slow-adapting nerve endings particularly suited to responding to lateral stretching of the skin. (Slow lateral stretching of the skin..sounds a lot like what we do) Being slowly-adapting, the Raffinis will fire as long as the stimulus is held, in this case a gentle shearing stretch to the skin. This modulatory input is sent up  through the sensory portion of the median nerve, and is interpreted appropriately by the brain, allowing the nervous system time to modulate, or alter, the motor output and pain output from the brain and spinal levels. The end product is a reduction in local tone or tightness. What we may have been taught as a local response of the connective tissue may, in fact, have a more centrally locus of control.

How did the pain develop in the thenar eminence and why does it feel (to me) so "congested", or dense? Any sort of trauma or injury can create a nociceptive event, but it is the job of the brain to determine if the threat is sufficient enough to warrant the sensation of pain.

I have written elsewhere not to "throw out the baby with the bathwater". I am not suggesting that we abandon all of our successful treatment strategies. I am advocating looking at them in a new light. I have used a highly refined sense of touch and awareness to locate areas of concern within the body for many years. This has not changed. I have simply added neuroanatomy to my repertoire. Instead if "trusting my intuition" (what the heck does that mean anyway?), I now can find logical reasons for how and why tightness/pain develop and choose more plausible courses of treatment based on anatomy, not pseudoscience.

This is a process of learning and unfolding for me and I hope you will follow me along this journey. If you are looking for a guru to follow, look elsewhere. If you are looking for simple, sound training, consider the Foundations in Myofascial Release Approach...The Anti-Guru Approach to Therapy!

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2012- 2013 Seminar Schedule

(check the website, more classes are being added regularly)

 

 

Foundations I 

   

Tucson, Arizona   NEW DATE
January 11-13, 2013
Sponsored by:
Medicine Wheel Wellness

March 22-24, 2013
Sponsored by:
Two Rivers Bodyshop

May 17-19, 2013
Sponsored by:
Institute for Therapeutic Massage and Bodywork, Inc.

June 14-16, 2013
Sponsored by:
Cortiva Institute, Boston Campus


August 5-7, 2013

September 16-18, 2013
Sponsored by:
Las Vegas Therapeutic Academy

September 27-29, 2013
Sponsored by:
NC Massage School



Sponsored by:
Relax! Massage Therapy Inc.

October 25-27, 2012
Sponsored by:
Stark State College

April 12-14, 2013
Sponsored by:
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St. Simons Island, Georgia
October 11-13, 2013
Sponsored by:
A Balancing Act

 

All Foundation in Myofascial Release Seminars are 20 contact hours/over two and one-half days and it are packed with techniques, theory, and practical application. Building upon a deep model of evaluation, you will leave this seminar ready to use Myofascial Release on your first day back to work. Developing the "Feel"  for soft tissue restriction and connecting this to your patient's pain is an essential element missing in other lines of MFR education. Foundations Seminars delves into learning the "Feel", making you a more effective therapist.  

 

NCBTMB CE hours continuing education credits are approved. Physical Therapy CE Hours are available in many circumstances, as well as CE Hours for other professions available; please inquire. 

 

For full details and to register, please refer to the 

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