An article came to my attention within the past few days, one that really challenges what I have been taught and practice. Titled “The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain”. I’ve posted the link on my website Research page, #210.
I am aware that there always have been, and probably always will be, challenges and changes to therapeutic paradigms, but this one is a big one for me. It also challenges much of the information that I was taught about the foundations of Myofascial Release.Many therapists are happy doing what works, without regard for the proof. This has been the mantra for the past few decades with much of the lack of research regarding MFR. But can we stay in that place when something more objective conflicts with those views?
I’d love others to read through the article and share your thoughts.
Walt
Interesting article. They state there is no correlation between the postural asymmetry and pain. How did they factor into their scientific analysis of causation the emotional state at time of injury?
Joel
Joel,
As the paper is a literature review to support a hypothesis, there is little mention of emotional state. On page 7, they write:
“Within a biological dimension the structure (spine) is capable of self-repair and is able to adapt and change according to needs and demands (Fig. 2). But crucially, being a human with a highly evolved nervous system means that the structure is within the awareness. It is also under the influence of our emotions as well as the will and the actions taken. There- fore a person’s cognitions and behaviour will have important implications to their recovery from LBP (Lederman, 2010a, see Discussion)”
On page 10 they state:
“Several studies have shown that as much as 80% of serious LBP events and 93% of LBP disability events can be better predicted by biopsychosocial factors such as gender, abnormal psychometric testing, smoking and compensation issues (Carragee et al., 2006)”.
While acknowledging the role that emotions may play in LBP, to me it seemed beyond the scope of this paper (and possibly beyond their comfort zone) to try to factor this in. While I have not specifically searched for an article covering this question, it remains a compelling question to ask. Do you have any insight?
Walt
(above from “The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain”, by Eyal Lederman CPDO Online Journal (2010), March, p1-14)
Hi Walt,
Thanks so much for starting this blog. I appreciate your insights and ideas. I also came across the paper you mention here on MFRchat.
I too was surprised by the findings. It seems implausible that there is not a correlation between structural integrity/alignment and symptoms.
It’s interesting how little discussion there seems to be about this. Surely these findings are a wee bit uncomfortable for us. What are we really to do with them after all? They don’t change the fact that our work does, in fact, seem to help people. These findings leave us only to question the very foundation of our work.
I’ve thought about this paper a lot lately, which is why I bother to chime in here. My thoughts ping pong between so what and now what. I’m not much of a philosopher, but I’d like to hear others who are bring their ideas on this forward.
Where are you with it?
Hi Owen,
Nice to hear from you. I think that sitting with the discomfort allows me to reassess how I view the body. Certainly this paper directly conflicts with what you and I have been taught. It is entirely possible that what we have been taught has no credence. Many are happy to say “I don’t care whether Myofascial Release (or any other modality) can be proven; I know it works”. I think they are missing out on an opportunity to learn more deeply.
I have written much on some of the conflicts with the traditional model of how Myofascial Release acts on the body and how this is often in conflict with prevailing research an science. This does not mean that I do not continue as an MFR therapist. I have simply allowed myself to break free from the dictum of what I was taught. It has not been without repercussion, but the information and freedom I have seen are well worth the risk.
You mentioned the ping pong effect this article and post has created in you. Is it acceptable to question what you’ve been taught and seen over the years?
The paper I referenced has a bias, as all research does. So does every teacher and student. Researchers often follow their bias to validate their beliefs. What he has written is correct, but one may ask whether all reference research was consulted which may not agree with his premise. It has often been said that it is possible to prove or disprove anything via research. It is the nature of the beast.
But I do feel that this paper and discussion brings into question using a postural based evaluation and treatment approach only with MFR.
Regards,
Walt Fritz, PT
http://www.MyofascialResource.com