What if the effects of manual therapy/myofascial release were less about the things we think we are doing with the tissues and more about the engagement we are having with the patient?
I just finished putting the finishing touches on another full syllabus revision for my Foundations in Myofascial Release Seminar for Neck, Voice, and Swallowing Disorders workshop, with the Introduction significantly shortened/condensed (Yeah for bullet points!) as well as a condensing of the Hands-On syllabus. The sequences below apply to all aspects of my work and seminars, and quite possibly to other work. My hope is to create a new way of viewing ourselves and our patients, allowing the roles to become equalized. Here is the list of the evaluation process, which easily leads logically into treatment:
The Foundations Approach Evaluation Method
• Fully explain the purpose of the session and hand placement, followed by obtaining permission.
• Begin in the area of complaint.
• Lightly place a hand/hands on the area, but initially, do nothing.
• Using graded touch, pressures, and stretch, seek out areas of tightness.
• If tightness or similar is found, lightly “snag” the area to bring awareness.
• Ask patient, “Is that sensation familiar (or similar)?”
• If no, linger a bit unless sensation is too negative for them, allowing them to process the feeling.
• If not familiar, move on.
• If familiar, assure safety by asking 0-10 pressure/pain question, followed by 0-10, “At what number would you stop me?”
• Adjust pressures accordingly.
• Ask, “Does this stretch feel like it might be helpful or useful?”
• If yes, stick around and treat, allowing processing to alter sensations.
• If no, ask, “Is there anything about this stretch that feels like it might be harmful?” If so, immediately stop.
• Treat until symptoms subside, until you fatigue, etc. Follow with functional activities and home engagement, as appropriate.
Comments? Questions?
Regards,
Walt Fritz, PT
I am a proud member of the Medbridge Massage team of educators. I have 8 online courses, all presented from my updated, science-informed model of myofascial release. Take advantage of some pretty great discounts with a 12-month package of viewing, learning and CEUs with unlimited viewing of not only my (pretty great) courses but also over a dozen of the top educators in the massage profession. Approved for CEUs for all US MTs. Use the discount code FRITZmassage for the $49/year price by using this link: Medbridge Massage.
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I really appreciate your reminders to put the client in charge.
With regular clients that are familiar with the work the simple question, does this feel negative or positive” has become an effective tool. Often a slight rotation or change of direction will change the negative to a positive.
Getting the client to freely comment on changes at a distance from where we are working is important in my work because it is intended to relieve repetitive stress from protective reflexes holding antalgic posture.
Hi Hans,
Though our work and methods are different, adding a dosage of patient input is typically a helpful addition. I take it a step farther, introducing it to even patients who are not familiar with the/my work. It has become how I work, vs. a choice. They can refuse to participate, but few do.
Cheers,
Walt