“Myofascial release” and “evidence-based” are phrases that are seldom spoken together. Papers exist telling us how and why myofascial release (MFR) is not an evidence-based treatment model/modality. In today’s therapeutic culture, one that demands that we work from evidence-based perspectives, it is at time difficult to find much in manual therapy that appears to meet the test. I believe MFR suffers from such doubts more than many other similar modalities due to some dubious and outlandish claims made over the past generation which further tarnished it reputation.

I recently wrote an article for Multibriefs that comments on these topics and I would like to share it with you. As always, comments are welcome.

Fitting myofascial release into an evidence‑based culture.

Cheers,

Walt Fritz, PT

Foundations in Myofascial Release Seminars and The Pain Relief Center in Rochester, NY

Catch one of my upcoming continuing education seminars in:
Sioux Falls, SD
Philadelphia, PA
Western, NY (Batavia)
Seattle, WA
Miami, FL
Los Angeles, CA
Brirmingham, AL
Letchworth Garden City, England
Bathgate, SCotland
Burlington, Ontario
Tucson, AZ
Northern, New Jersey (Belleville)
Chicago, IL
Knoxville, TN
Miami, FL (Again!)
Erie, PA
Grand Rapids, MI
And many more in 2018, including Australia

Read about them and find out how to register at www.FoundationsinMFR.com.

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A patient-directed model of manual therapy

by Walt Fritz, PT on April 15, 2017

I think our patients deserve more.

We are the experts. Be it myofascial release, manual therapy, massage, or any of the countless other terms used to describe what we do, we are trained to call ourselves the soft tissue experts. Patients seek us out due to our experience and expertise with pain and movement dysfunction. The longer you’ve been in practice the higher your regard may be. Folks come to see us because they believe we will help them and, as a result, will often gives us a fair amount of latitude in terms of what we say and what we do, often offering little feedback under the assumption that they need to let us do our job.

You may agree with some or all of what I just wrote, but I am moving farther away from those thoughts every day I practice and teach. Over the past few years my work, in both my physical therapy practice and Foundations in Myofascial Release Seminars, has become more patient-centered. Patient-centered sounds like what we should all strive for, but I hold to a stricter meaning. For many years I have taught that my patient should completely understand why I am doing in the area I am working at all times, or I quite possibly am not doing my job well enough. While I understand that any forms of manual therapy work from a method that necessitates building block work, or working in areas thought to be the sources of the problem, even if they are far-removed from where issues are felt. Or, that work must be done to balance a person’s body/system and, as such, work is done in areas that the patient may not realize there were issues. While I understand some of those methods (I was trained in a model of myofascial release that stressed, “find the pain, look elsewhere for the cause”, which sounded nice but ended up being a coercive method of convincing the patient of things that they may not believe), I think our patients deserve more. I use a very simple model of evaluation that requires patient validation if I feel an area has been found that may be implicated in their issues.

As manual therapists, we tend to be fairly good at palpating problems/pathologies, whether real or metaphoric, but what do those palpatory findings indicate? We may cite the things we feel, be they myofascial restrictions, trigger points, knots, spasms, energy cysts, joint subluxations, inhibited muscles, etc., but I think that we need to circle the wagons back to the patient. The keen observer may note that two therapists may palpate the exact same area but cite two totally different problems or pathologies, hence the probable inaccuracy of palpatory findings. Given the lack of reliable knowledge of just what we are feeling, I think it makes sense not to sell our patients but yet another pathology; rather we should locate areas of sensitivity to mechanical pressure (that’s what all palpation intends, right?) and then determine if that area reproduces a sensation that is relevant and familiar to the patient. If it is, stick around and treat. If what we have located is in no way relevant/familiar to the patient, we should not try to sell them on its importance. There are enough pathology-peddlers in our shared professions; I think we should base our treatment on what is important to the patient, not selling pathologies.

Each time I teach one of my Foundations in Myofascial Release Seminars, the lesson of assuring that treatment is only done when fully validated as relevant by the patient is emphasized.  I truly feel that if we are supplied with a simple means of determining patient-centered and patient-valued evaluation findings, no matter what the modality is called, we will increase efficacy and allow the patient more input into the work. We need to move away from being perceived as the expert who should be listened to, just because they are experienced. I know nothing if I am not providing work that my patient understands and agrees with. Some of this may sound rather vague, so I wanted to share some feedback posts from a class I taught very recently in Fayetteville, Arkansas.

 

OK, that was a lot, but I wanted to allow you to see how a very simple, patient-directed model of evaluation and treatment can improve both communication as well as efficacy. It might be hard to see how this can fit in with your current work, but I believe it can.

I think our patients deserve more.

Cheers,

Walt Fritz, PT

Foundations in Myofascial Release Seminars: The Upper Body, The Lower Body, and Seminar for Neck, Voice, and Swallowing Disorders.

www.FoundationsinMFR.com

 

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The Placebo Effect in Manual Therapy: An interview with Brian Fulton, RMT

March 14, 2017

In April of 2016, I had the pleasure to meet Brian Fulton, RMT, who was a co-presenter at the Registered Massage Therapists’ Association of British Columbia’s Biennial Conference, “Manual Therapy: an Interdisciplinary Approach to the Science and Practice”. His talk involved the understanding of the placebo effect in manual therapy and since that time I have been […]

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Say Nothing

March 3, 2017

Finding errors on an article or post that has been out there on the internet is irritating. having someone else point it out is irritating times two! Here is a link to an article I wrote last year for Nik Ng’s Massage & Fitness e-magazine (subscribe here) titled, “Say Nothing”. Regular readers will recognize by […]

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Reflections and notes from the road

February 26, 2017

Just finished teaching my Foundations Approach Upper Body class this weekend in Las Cruces, New Mexico and have a few hours of free time at the airport before the flight home. Reflections on a class are best stated immediately, as memories fade quickly. The professions of participants in my classes vary widely, with interest spread […]

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The Good (and Bad) of a Simpler Narrative

January 21, 2017

What we do, ultimately, is help people feel more comfortable in their bodies so that they can move more easily and, in effect, heal themselves. The past ten years of my professional career has been devoted to working toward a more accurate narrative to explain the work I do. The story of how this came […]

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More Mental Floss for the MFR Brain: Changing Your Story

November 20, 2016

With a broad-based education, credible continuing education, and critical thinking, I do think we can be less wrong about the work we do. I do not mean to criticize those who believe differently and certainly not those who taught me these concepts. Science moves forward and I thank those in my past. What if I asked […]

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Dialoguing in the Foundations in Myofascial Release Seminar Approach

October 8, 2016

Every form of manual therapy has its unique way of engaging a patient/client, both physically and verbally. Talking is often frowned upon in massage/manual therapy, as it is believed to interfere with the relaxation response or allowing the patient to go deep. Those things are important aspects of some work, but not mine. My Foundations […]

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New Video: MFR for the Anterior Shoulder and Intercostal Regions

August 27, 2016

I’ve posted another free Foundations in Myofascial Release Seminars MFR Treatment Tip to my YouTube channel. This one highlights some unique and simple ways to engage familiar aspects of upper thoracic/intercostal/shoulder region pain and dysfunction. What is different about my Foundations Approach? Small group trainings with a high level of one-on-one hands-on instruction directly from […]

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The Simplicity of Myofascial Release/Manual Care

June 27, 2016

“We can only touch in so many ways. But it’s the choices we make with the findings of our touch that makes the difference.” A while back I wrote a blog titled “Jiro Dreams of Sushi” (The original article can be viewed here). The blog references the movie by the same title, which follows a 85 […]

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