I remember reading once that you have not mastered a new language until you begin to dream in that language (or maybe I dreamt that, I’m not sure). Either way, I have long realized that the “structuralist” mentality that I possess is a hard one to shake. What is a structuralist? One who sees pain/dysfunction as a result of a structural problem in the body; a problem with alignment. I evaluated posture to check for asymmetries, checked for pelvic issues, recorded scoliosis, etc, etc. All of these observations were based on the opinion that all treatment can be based on the results of these findings. I was taught this manner of evaluation/treatment and I dutifully followed through on it. Of course myofascial release is more than just a collection of structural observations translated into treatment.
Then Paul Ingraham messed up another perfectly good dream. In a post entitled Your Back Is Not “Out” and Your Leg Length is Fine – The story of the obsession with crookedness in the physical therapies, Paul does a quite decent job undoing most of which I was taught in my myofascial release training, as well as perfectly describing structuralism. And, he places a firm reminder that I need to revisit much of this for my own Foundations in Myofascial Release Seminars (No, I have not changed the name of them yet. I know you think that as long as I keep those words in the name, I am only playing lip service to change. I don’t plan on changing the name.) Talk about the baby and the bathwater!
Structure does have importance, but it ranks right in there with all the rest, maybe higher, probably lower. I saw this coming, though. For years (decades), pelvic blocks or wedges were a regular part of every treatment day. But over the years I’ve used them less and less, without every realizing why. Now I drag them out at most once a month. In a recent blog post titled “1.6%“, I spoke of just how common scoliosis is in our society, when viewed as any lateral deviation of the spine. Scoliosis IS the norm, as well as all that comes with it; unlevel hips and shoulders, leg length discrepancies, pelvic torsions, etc, etc, etc. In my myofascial release training, I was taught to look at these asymmetries and “fix” them. And you know what? It worked many times. Reducing what was the apparent pelvic torsion, for instance, often reduced or eliminated the offending low back pain. I bought into this for years, I even taught it. I developed a language for all of this as well. If the patient came in with back pain and the pelvis was asymmetrical and their leg lengths different, I told them how these asymmetries can create “crushing pressures” and cause pain. They listened politely, but waited for the results. I dutifully placed the wedges under their pelvis, as I was taught, and performed myofascial release in an “Operator” fashion (Intrigued by the concept of operator vs. interactor model, check out SomaSimple. You are going to have to use the search feature). Most of them improved…but why? Was it because I “balanced their pelvis”, or was it other things that were happening under my hands? This is my interest right now. What is happening under our hands?
There was a wonderful article written by Eyal Lederman, PhD, DO in 2010 titled “The fall of the postural-structural mechanical model in manual and physical therapies: Exemplified by lower back pain”. This article was reprinted in 2011 in The Journal of Bodywork and Movement Therapies, along with four “rebuttals” to the original article. You can read the entire article here. When I first read Lederman’s original article, well before I began crawling out from the sea and growing appendages, I complained and disagreed loudly as I read the article. I had “but what if’s…” to nearly every point. Then, as my appendages took shape and I began to walk, I read through the rebuttals and noted that all of the writers of these rebuttals were saying “but, what if..”. OK, I am making myself sound a bit superior, as if I have now reached a point of understanding what mere mortals have yet to achieve. Not so, I have just begun to learn a new language. I am learning what is happening under my hands and am a happier person for it. Why? Because I am not continuing to buy into the pseudoscience that I was taught. Looking at pain from different perspectives is a very different language for me, and a hard one at that. That perspective tends toward basic, simple neuroscience, which was gathering dust in the back of my brain, long forgotten.
Learn a new language; question what is happening under YOUR hands!
For now,
Walt Fritz, PT
Bye, bye, wedges?
Nice article, Walt! I am enjoying reading about your ongoing evolution as a therapist.
For good reading and/or listening about being an “interactor” instead of an “operator”, check these links:
SomaSimple discussion: http://www.somasimple.com/forums/showthread.php?p=98314
Letter on the topic published in the Journal of Manual and Manipulative Therapies: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172949/
Blog post by Diane Jacobs, PT: http://humanantigravitysuit.blogspot.com/2010/10/touch-is-good-humanprimatesocialgroomin.html
BlogTalk Radio interview with Diane Jacobs, PT and Jason Silvernail, PT on the “interactor” model of therapy: http://www.blogtalkradio.com/3-d_optimal_performance/2011/08/10/moving-beyond-the-technique-from-operator-to-interactor
Great links, Jason, thanks a bunch. It saves me having to search them out for posting!
This is such a great article. Thanks for this! Sometimes just because we teach a technique or we have years of experience, therapists forget that we love learning and evolving.
Thanks, Taya! I am really enjoying this part of my life/career.
I’ve got a set of pelvis balancing wedges for sale. 🙂 Hardly ever used.
Any takers?
Goes back to your post about the “feel.” When i feel a condition I ask what dose the body want to do about it? Whether I use one of Taya’s methods one of yours ore one of my own does not matter; It is what the body wants that matters.
Great words of wisdom…again. Like I always say to my staff “You don’t know, what you don’t know.”
Hi Walt,
Sorry if I missed it, but I’d like to learn more about what neuroscience is saying about what’s going on under my hands. Can you link me to a discussion about this? Thanks!
Hi Owen,
I would refer you to SomaSimple.com. Not exactly known as a friendly place for us MFR’ers, but the depth of information contained there is vast. It required me to let go of preconceived notions and allow some different views to sink in. The forum threads are certainly helpful and once you have paid your dues (not $, but once you have posted 10 times), you are allowed into the vaults, where there is even more information, research, books, etc.
Walt,
I’m glad that you have made a clear choice! And I surely understand the battle of the mind over philosophies and techniques. Wow!
What we as body workers need to understand is that we’re all in this together, making strides to give more choices for patients in their treatments – not just having them listen to an MD where they pop pills and endure surgeries.
You, as well as John Barnes, Thomas Myers. Eric Dalton, et al., have given me a great perspective and immense knowledge into treating my patients. We are all evolving away from a bigger societal paradigm within the health care industry and that is a good thing!
Peace…
Check out Eric Dalton’s new book the Dynamic Body. Judith Aston, my mentor and others you mention are in there. Eric has chapters from Judith and many important practitioners with some very interesting concepts on this topic. Though it does not go into her amazing bodywork approach, Judith Aston integrates it all into a paradigm not just a bunch of techniques.
Thanks, Michele! I was aware of that book and will be adding it to my library!
Hi Walt
do you remember this ?http://www.massageprofessionals.com/forum/topics/when-is-it-time-to-alter-your-1
By challenging your beliefs you proved mine ! LOL
Keep an eye on Robert Schleip’s and Jean Claude Guimberteau’s work and don’t beat yourself up too much 🙂
Hi Walt,
I have just finished reading two of your links (lederman and structuralism). Let’s say that they are challenging and interesting on several levels indeed. Thank you.
Fred
Thanks Walt Fritz for this blog post about feeling what is under your hands, there are some good points about really feeling what is going on under our hands- and to question our preconceived structural notions of what we think is source of someones pain. The scientific method is about breaking things down into the simplest components to be studied, however the human body is very complex, so making assumptions and basing your entire practice on that over-simplified evidence is a bit simple minded. Open minded curiosity and clinical expertise should be considered as, if not more important than some pre-prescribed protocol. I liked the link which advises cause no nocioception. I do believe there is a lot to say about treating as a human primate social groomer (that is probably why I had to take all those psych classes for PT school) vs operator. I also believe we can effect different structures albiet through the skin and in addition to the nervous system. I am a PT turned social groomer when I found a body of work which healed my pain. I now embrace techniques that are not painful, honoring the whole person and not just their parts. I am on a mission as it appears you are to change the “touch” of PT and more aggressive techniques. I wish all PT’s and “structural practitioners” would have a more thoughtful, caring and intelligent approach to healing.
Thanks for the comments, Michelle. Talking science opens a firestorm of disagreement and disapproval from one side and a welcoming embrace from the other. Funny how that works…
Thank you Walt Fritz for your article. I also was trained originally in a visual assessment and checking for landmarks for evenness and balance, and then making a plan to “fix it”. I also got good results and immediate changes. But I have since learned, partly by getting more and more challenging and complicated clients, that what we are seeing is the compensation, not the problem, and the compensation is the body’s best attempt to manage what is happening to it. When we take this away, we do not “fix”,the problem, we might force another compensation, possibly not the ideal one. We also contribute to diminishing the body’s capacity to make further adaptations. Listening to what is happening in the body and finding where there is flow and movement and where there is not, and working to assist what is trying to occur, is profoundly helpful. I t requires close observation and good skills, but it is also not intuitive on the part of the therapist. It is taping into the incredible intuitiveness and self healing capacity of the client.