I am a physical therapist, though my job is unlike most physical therapists’. Myofascial Release (MFR) has been a modality approved by the medical community and insurance companies for many years. At one time it even had it’s own CPT code. So why are so few physical therapists drawn to this work?
When I started learning MFR in the early 1990’s seminar classes were filled with Physical Therapists, along with Occupational Therapists and Massage Therapists. That trend slowly changed in the past twenty years. I believe a number of factors are to blame: Changing reimbursement for payment of continuing education dollars to therapists from their employers had an impact, though there was an increase in requirements for CE Hours to renew licensure. Evidence based practice (EBP) trends certainly has played a part, as my profession attempts to elevate itself to a level above where they think they were at. Myofascial Release has always struggled with hard “proof” of its mechanism of action and response. While much has been published over the past decade, the basic science of MFR still remains somewhat unanswered. This does not even take into account some of t more esoteric aspects of MFR, such as unwinding, which is simply a means of self correction. Many “experts” have woven intricate tales linking this phenomenon to energy science, but these tales further distance them from the physical therapy profession. Myofascial Release is now considered a joke amongst many therapy professionals.
I think it is time to bring Myofascial Release back to the physical therapy profession. This would certainly require me to abandon much of the New Age explanation models that have become common. I don’t have a problem with this, as I always try my best to use what science is available to best explain what is happening under my hands. Myofascial Release, as a physical modality, does have a great deal of supporting research (see my research page). Maybe it is time to start thinking forward. Though there are those who say they are far ahead of the rest when it comes to MFR, what they are doing is setting us back.I think it is time for this to change.
Pioneering thoughts, Walt . . and you have the tools to do it. Go for it!
Thanks, Peter! Your work complements my points here perfectly. Take a theory, test and explain it, and get it published. Your treatment protocol for the Migratory Fascia Syndrome has greatly improved my effectiveness. I love sharing this work at my seminars as well.
Cheers,
Walt
It’s great that you will work to get more respect and use for these effective methods amongst PT’s and in the medical mainstream. I am all for that. For myself, I am fine with staying in a less medically respected specialty, massage therapy, as the evidence based paradigm is prone to reductionist thought and sometimes to self limiting choices. As you state,”my profession attempts to elevate itself to a level above where they think they were at.” Journal worthy testing of protocols makes the chances of error less, but also reduces the possibility of success since not every therapy can be tested by setting up an experiment using a single variable double blind model. My successes may sometimes be based on erroneous theory or dubious paradigms, but they are validated by the client, not the insurance company. Understanding the philosophy and method of science, one can appreciate it’s strengths without making it a substitute for religion (Rational Positivism is not the experimental method). Understanding the weaknesses of energy based methods, one can still appreciate areas where they do help people. I hope we can make a better synthesis out of all of this and include more therapists into our cohort!
Ricardo,
Your views are well expressed. Rather than argue, I would add this. If science is available to support what you do, use it. But if the science runs in conflict with what you have been taught, one must be at least willing to explore the newer views. Patient feedback and outcomes are vital to what we do. But what we may be teaching or explaining as “fact”, may in fact be a lie.
In your response to Ricardo you state “but what we may teach or explaining as “fact”, may in fact be a lie. When you look at most explanations of modern medicine it is in fact mostly unexplained. When I studied e-stim and ultrasound the books state in fact they are not exactly sure how they work. Then they go on to give you theory about ultrasound and e-stim. Many of the medications that are administered every day state on the labeling that comes from the manufacturer that they do not know exactly how they work. I do not think that research is any better on modern medical procedures than it is on soft tissue manipulation. I do think that it is very funny that after all these years many of the other professions are taking a much more interested look at structure and function of fascia. Rolfers and massage therapist have been working with it for decades and now other professions are beginning to take notice. I love massage and bodywork and welcome those who want to explain the technicality of what is going on but I am not going to wait until they do. Your clients and patients deserve your intuitive treatment.
Hi Michael,
Indeed my clients deserve my intuitive treatment, but they do not deserve mistruths spoken to them as well. How can I combine those two seemingly disparate entities? Speak with as much truth as you are able and tell your client when you do not know. The problem comes when you are repeating information that was taught to you as truth, but in fact is not. We can circle around this forever.
I don’t disagree with what you’ve stated. I just ask the therapist to evaluate what it is that they believe.
Hi Walt, I am so glad to have found you on Facebook, I will read all of your research articles. MFR is my speciality and what I want to do more of. Right now I am having a time to get on somewhere here in the Greater Seattle Area to do this modality. The power of MFR is astronomical. Two very severe Fibro clients, bedridden, body numb and sensitive, Under In-home care, I was able to bring about remission within 6 weeks or less. I do not have a small bank roll to start out, even paying $600 rent to have a place. So I am taking MFR to the clients home. Just getting started on this with bedside services or in a chair. I will not be put down. 17 yrs licensed, in my 60’s with artifical leg sure does not help getting employes. That don’t matter, the skill is in my hands, not my legs or age.
I have written an article on MFR triggerpoint tracing or tracking. Do you know about this, how TP’s can form a link with other TP’s?
I can send it to you when I can find your email.
Using Energy or Reiki, I cannot explain it, or how it works. It is a thing the doctors or PT’s don’t want to touch. Certainly no codes on it. Some people “have it” a little more than others. Can’t explain that either. By others that use this and in Reiki groups I have been told that this energy is quite strong with me. One person needed MFR on her shoulder & neck. I asked to try this first. The Force was with me that day. Had chills running down my arms and heat out of my hands. Three minutes later it backed off and she did not need MFR. That was one of my most profound experiences. I tell people I would like to try this “energy treatment” to get their feelings, thoughts or opinion on it. And then do massage or MFR. There was a time I did not believe in this till I tried it on others.
Allan,
Energy therapy can certainly elicit changes. We are speaking of a wavelength of energy. MD’s and PT’s, as you speak of, may accept energy medicine if it is defined in stricter terms. Ultrasound, for instance, has a specific wavelength. We can certainly argue and discuss whether one particular wavelength achieves an outcome better than the wider wavelength that human touch can provide. Some groups want proof, and the only way to provide that proof is to narrow the variables. Human touch may never meet those narrow parameters of proof. That doesn’t mean you need to stop, just understand the implications. Acceptance may be the implication you need to deal with.
Hey Walt,
For me, it comes down to, “what is truth?” The best answer I can come up with is that which is self evident. And, according to Schopenhauer, it has three stages: first it is ridiculed, then it is violently opposed, then it is self evident.
For me, we are in the second stage of this paradigm shift. Energy based modalities are making gains. Science with its linear restrictions isn’t satisfied yet (also known as pain).
We live in exciting times! Enjoy the change!
Peace,
Sandor
Schopenhauer’s stages, along with those people who use them to rationalize their strange theories, only hold true if there is a demonstrable and plausible means of predicting that what is being claimed will EVER be proven. Some use this to say “everyone else hasn’t caught up to what we know”. While this sometimes can have merit, it is more often an easy way out of having to proving what you say or believe.
Hi Walt,
I always like your perspective and use of studies with an open mind. As a PT and LMT, I have the objectivity with and the intuitive side that come together in my treatments. I have found the MFR, assessment and movement work of Aston Kinetics serve both having the client have a real sense of healing and objective improvements in their mobility, range of motion and alignment. There is a place for MFR in PT and massage therapy. For me it is the application with ease in my body and my clients experience that makes it work. I found that the Barnes techniques are very tiring and difficult to sustain over time. How does your work solve that issue?
Michelle,
In my Foundations in Myofascial Release Seminars, I strive to connect the therapist with the sensory experience of what their patient is experiencing as pain. Can what the therapist feels beneath their hands be validated by the patient? Once this connection is made, treatment becomes quite easy. This connection can be made a wide variety of pressures, depending on both the strength, as well as the beliefs/interests of the therapist. I like to work deep, but not invasive. Deeper exploration need not mean forceful pressures.
Many therapists come away from MFR trainings with beliefs that all MFR must be light/deep/energetic/unwinding-based/emotion-based (or fill in any other belief). This says more about the teacher than about what works best for the patient. Myofascial Release need not be “hard work”. While any new task or skill may be demanding to the body when you first begin using it, one should quickly develop the ability to sustain the work with little effort.
I’m not sure if this answers your question. I am not Barnes, nor do I try to pretend to be him.