Based on my WordPress Statistics Page, there are a few thousand of you reading this blog, many of whom have taken myofascial release training. 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. There are some very effective therapies out there. The MFR that I practice just happens to be one of them.

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 of 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 causes. 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.

Visible Body Thumb

Comparing the photo at the top of this post with the diagram (linked above) from VisibleBody (Visible Body Human Anatomy Atlas 2), 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 Ruffini 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 slow-adapting, the Ruffinis 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 central locus of control.

How did the pain develop in the thenar eminence and why does it feel (to me) so “congested”? 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 neuro-anatomy to my repertoire. Instead of “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.

For now,

Walt Fritz, PT

Foundations in Myofascial Release Seminars

The Pain Relief Center, in Rochester, NY

Author: Walt Fritz