What if today was the first day of your education in bodywork, where you were sitting down in your first class as a budding MT/PT/OT/Whatever T? Your instructor started the lecture with “You know all of those hard/ropy/toughened areas that we feel under the skin? Well the best thing to get rid of those is light, sustained pressure. Make it light enough so that the nervous system does not view it as a threat. If you dig in too deeply, you are only exacerbating things.”…what would you think? If you had no preconceived notions as to how to best deal with this situation, it would make sense, right?
I know many of you (myself included) were taught that the only way to rid the body of deep tissue tightness is through deep tissue massage/soft tissue mobilization, or whatever term you use to denote AGGRESSIVE WORK!
Yesterday evening, I had the pleasure of being interviewed by Ryan Hoyme, AKA The Massage Nerd. Great guy, by the way. This morning I had the time to read through the text from the live chat that is happening as the interview is taking place. There seemed to be a considerable amount of disbelief that light pressure can rid the body of the tough stuff, the Beef Jerky. (That was a descriptor one of the chatters used) You know what I’m talking about; the leathery, gristly, gritty tissue that feels more like beef jerky than muscle. I was taught in physical therapy school a variety of interventions to deal with this, thinking that the goal was to break it up to reduce pain and improve range of motion/function. I was taught in my MFR training that the lighter techniques will get to most of the “fascial restriction”, but there are times when you need to roll up your sleeves and dig in the the elbows, knuckles, finger tips, etc. OUCH! So, I rolled up my sleeves and dug in for many years. Did I have results? Yes, it seemed to make a difference, but it was real hard on my body as well as on my patients. Some expected it, even asked for the deep stuff. They paid the money, who was I to argue, right?
Flash forward a few years. I found that there were less aggressive means to deal with that jerky. I coined the phrase MyoMobilization™ to speak of a more gentle method of performing soft tissue mobilization. I’ve taught this version in my seminars for the past 3-4 years and most, if not all of the therapists who have taken my classes have seen that it can be just as effective as deeper/painful work. Now, with the more recent teachings of the nervous system I’ve been exposed to, I have lightened my approach even more.
Where did the model of aggressive work come from? Is it based in research or experience? As far as I am aware, it is experimentally based. And, WHAT exactly is that beef jerky? Some call it scar tissue, others describe it as a dried up (dehydration) mass of muscle. I’m sure all of you could supply me with many more descriptors, based on what you were taught. But, what if someone had taught you, from the beginning, that gentle pressure was not only sufficient to make change, but actually superior, because no one got hurt in the process? I think that would have changed a lot of attitudes. We can’t undo what we were taught. But, we can change what we believe today.
A suggestion: Give the gentle method a fair trial. Myofascial release or other forms of bodywork, performed with a lighter touch will produce similar, if not better results. See if the beef jerky changes. Your money back if not satisfied!
For now,
Walt Fritz, PT
Walt, very good interview but the audio is very choppy. for the first 20 minutes.
I like the part about your practice going from myofascial release to one encompassing more attention to the nerves espically in dealing with acute pain. I totally agree with your thoughts on first releasing congested painful areas instead of strengthening them
I made the personal journey of going from deep tissue massage for dancers to Rolf SI to St. John NMT to be more effective (precise,) in dealing with acute/chronic pain. I use both approaches but approximately 80% St. John NMT.
I also liked hearing that you do approx. 70-80% of treatment time working in the abdominal areas for low back pain. I too typically spend about 60-70% of my time treating supine and much in the abdominal area, except I also spend considerable amount of time treating the intestines, mesentery and omentums. After studying and applying Barrel’s VM and St. John’s visceral massage I have seen the importance of the visceral/somatic relationship.
Let me know if you do a seminar in LA.
Sorry about the sound quality issues. As I stated in the video, there are so many good, effective modalities out there. Choosing the best for you can be tough. Just look at the rationale that backs it up; does it make sense?
Hi Walt,
I’ve really been enjoying these posts of yours! This last one is my favorite!
Warmly,
Rajam
Thanks, Rajam!
I know I’m a little late coming to this article, but I thought I’d leave a comment anyway.
The “no pain no gain” philosophy that some manual therapists use doesn’t work for everyone, in fact I think it works for fewer people than we think.
I also work anteriorly while supine or sidelying quite often for the majority of the session; these places that many others miss yet are so important.
Thank you for the great article. I am looking forward to reading the rest of your blog.
~Lizz Pugh, LMT from Florida
Hi Lizz,
Glad you found me and my blog! While I think aggressive/painful approaches can be helpful and perceptions and expectations are relevant from the client’s standpoint, I think it is important for all of us to understand that there is little, if any, credible evidence that shows more aggressive therapy is better than less aggressive when it comes to the remediation of pain. As I said, perception is worth considering, as are expectations. I am also a fan of working in supine as it allows me better access to non-verbal cues given off by my clients and I rely strongly on feedback to assure relevance in my work.
Cheers,
Walt