For those of you who may have missed my countless tourist photo posts on Facebook, I was recently in the U.K. to teach two workshops. The classes were 2-day, whole body classes and it was an incredible experience for me to travel and share my views on manual therapy, myofascial release, and plausible narratives of what we do with some really great people. Both the Letchworth Garden City, home of the very first roundabout/traffic circle in the world (more about that later), just north of London, and Bathgate Scotland, situated midway between Edinburgh and Glasgow, workshops were lovely, small group classes, which makes for a really nice opportunity to learn and share. A number of the therapists who took each of the classes had prior training in MFR, which made the compare/contrast aspects of the lecture and labs quite interesting. Still others had heard of me and my approach through the various pain science-related groups on Facebook, while the rest were simply seeking more learning. I really love teaching this work, but I love traveling too, so this trip was really great. In between workshops my wife and I had lots of time to explore England and Scotland and after nearly two weeks behind the wheel of my Peugeot car hire, I think I maneuvered through those thousands of darn roundabouts quite well, manual transmission stick shift in the left hand, all while on the wrong side of the road, thank you very much. A big thanks to Karyn Clark (Letchworth) and Lisa Beveridge (Bathgate) for patiently facilitating my workshops and an even larger thanks to everyone who took the workshops.

Most of my workshops are held in the United States, though I’ve taught a few times in Canada (and again in two weeks) and once in Jamaica, so this was a really special event for me.

Despite warnings to the contrary before I left the US, the food was really great and the only way I managed to not gain weight was by walking endlessly up and down the stairs at every castle we visited. We even managed to spend one night in a castle.

Not being a well-known name in the U.K., I hoped my simple message would be well received; that most, if not all, of manual therapy (including myofascial release) consists of nearly identical things that we do with out hands. We may work dry or with lubricants, we may work with slow, still holding of the body, we may use quicker, deeper/more aggressive strokes, or we may slide/glide. We may use our hands or tools to coerce things into ways we see them working. We tell tales of what we feel is the cause of dysfunction, based more upon our training and experience than actual supported evidence, even though most of us feel our work is entirely validated by science. Now someone selling/teaching continuing education should not be saying such things. I am supposed to try to convince each of you that my form of myofascial release/manual therapy is unique and special, and is more effective than the other guy’s teachings. But this just isn’t so. We all do really incredible work that improves with experience. Additional training seems to help, though it may be more about reinforcing the narrative than actually learning more skill. Continuing education is about teaching recipes. Even those modalities or versions of a modality that advertise themselves as having a non-protocol basis teach recipes, and I do not use the word recipe in a negative way. By recipe, I mean the manner in which we are made to understand a view and narrative, as well as how to apply it. Outcomes tend to improve, or at least from the very biased and limited manner in which we can self-report, as the recipe is more deeply ingrained. Repetitive learning of the narrative and the recipe of the modality improves the narrative we speak to patients, which in and of itself can improve outcomes (indirect/placebo effects), but tricks us into believing our hands-on skills are improving. Those of you who have worked their way through one or more long modality training series may take issue with these statements and I respect your opinion, even if I do not agree.

So why do I teach if there is such remarkable similarities in all of the work we do and the teachings that are given? I teach to share my views. I like to talk and tell stories, most of them related to our therapy. I like to share my views on what I feel to be the most important aspect of manual care, which is not what we do with our hands, but how we engage the patient in a model of evaluation and treatment that they control. My work and brilliant findings mean nothing if it has no meaning to them. I teach to share a view that we can provide positive changes with nearly any manner of touch, but if the patient does not have a stake in the process we are simply pushing our beliefs upon them. I’ve written elsewhere on this blog about my patient-directed model, but each time I teach my workshops the message becomes clearer and more received. So, I continue to teach (and travel), both in the US and Canada, but also in Australia next February. I hope to return to the U.K. very soon and probably will, as well as in other countries (invite me, I just may come!). By the time I reach the U.K. again my message will have deepened and changed somewhat. Growth and change are good. Myofascial release is the thing I do with my hands, but working from a pain science-informed patient-directed narrative is what has become my passion. I hope you join me someday so that I can share my passion with you.

Cheerio,

Walt Fritz, PT

Foundations in Myofascial Release Seminars

An addendum

As a Monty Python fan since the mid-1970’s, I had my inner-geek satisfied while touring a castle in Dunblane, Scotland. If you’ve watched, “Monty Python and the Holy Grail” enough times you will remember the scene where guards were told to not let the prince leave the room.

Most of the interior shots for this movie were shot in Dunblane Castle (along with the pilot for Game of Thrones and some of The Outlander series), with the above linked scene filmed at/in this doorway. The crew built doors around this opening for the scene. Terry Jones, one of the original members of Monty Python, is tjhe commentator for the audio guide that one lists to as you make your way through the castle. Geek addendum over.

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Pathologizing: Our Words Matter

by Walt Fritz, PT on August 3, 2017

As a physical therapist trained in the early 1980’s, biomechanical explanations for pain and movement disorders were the norm. As I drifted into a myofascial release manual therapy in the early 1990’s, the biomechanical model was reinforced and made more narrow through the beliefs that pain and movement dysfunction stem from issues of fascial tightness/restriction. All had both evidence to support their views, as well as well-presented logical assumptions. Myofascial release suffered from testimonial-type of evidence which seemed very compelling to a casual scientific observer (me), who was unwilling to question the sources of presented information. Biomechanical views still are well represented throughout the manual therapies, as evident by the daily squabbles regarding such things as the importance, or lack of, with such issues as posture, weakness, and asymmetry when it comes to both pain as well as movement disorders. This post is not intended to address these issues, but to briefly discuss the language we use when conversing with our patients/clients.

Patients pay us to help them. This help is most often accompanied by the thorough evaluation, after which we proclaim our findings on both what is wrong with them and what should be done to rectify the situation. We may call this our assessment or diagnosis, depending on the scope of practice allowances and limitations of your profession. Patients expect it and we feel it necessary to give them what they want and deserve, but is it always in their best interest, especially when there is a lack of consensus on the validity of our assessment’s claims? Biomechanical factors and judgement, such as poor posture being the cause of pain, are popular and logical assumptions which many of our patients believe and you may believe it to be true as well, but is it always true?

While at the computer, I leave my Facebook notifications turned on, which is probably one reason I am so easily distracted. As I was writing this post a notification came in that I will sanitize and post here:

I’m new to this group, but curious as to many issues a (named surgical procedure) could help with. My biggest issues are forward head posture – my (type of) therapist once told me it was the worst she had ever seen – neck/shoulder/upper back tension that my chiropractor gave up on treating because he didn’t understand why he couldn’t fix it, jaw clenching, anxiety, etc). Anyway, does anyone have a recommendation for a practitioner in (certain city)?”

The writer of this post was speaking from genuine self-concern and must have found some solace in her therapist’s statement about the severity of her forward head, but what does she now do with that? If she is the worst case her health professional has ever seen, it would seem to me that makes it less likely that she can be helped. There is information easily available that casts doubt on the degree of forward head posture and neck pain, but that therapist has planted a seed in the patient’s brain that she is one of the worst out there, at least from her therapist’s perspective. Do we really need to say things like this?

Below are some studies that were recently posted to a thread on one of the many groups there, all speaking to the effect of the power of our words. If you’ve never given this much thought, please read through some of the abstracts and papers. Our words have power, and often the message conveyed negatively impacts outcomes.

Easy to Harm, Hard to Heal: Patient Views About the Back.

CONCLUSION: Negative assumptions about the back made by those with LBP may affect information processing during an episode of pain. This may result in attentional bias toward information indicating that the spine is vulnerable, an injury is serious, or the outcome will be poor. Approaching consultations with this understanding may assist clinicians to have a positive influence on beliefs.

The enduring impact of what clinicians say to people with low back pain. (Full text link)

CONCLUSIONS: Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.

Importance of psychological factors for the recovery from a first episode of acute non-specific neck pain – a longitudinal study. (Full text link)

CONCLUSIONS: Psychological factors emerged from this study as relevant in the early phase of acute neck pain. Particularly persistent anxiety and depression at baseline might be risk factors for a transition to chronic pain that should be addressed in the early management of neck pain patients.

‘Talking a different language’: a qualitative study of chronic low back pain patients’ interpretation of the language used by student osteopaths. 

CONCLUSIONS: The language used by student osteopaths’ influences patient beliefs about LBP in a variety of ways. The current study furthers understanding of how language contributes to these beliefs, identifying ways through which communication can contribute to improved healthcare through enhancing patient engagement.

Words That Harm, Words That Heal. (Full text link)

Both positive and negative beliefs are important in patients with spine pain: findings from the oioc registry.

CONCLUSIONS: Our study demonstrates that both negative and positive beliefs are associated with perceptions of disability however, in this study only positive beliefs were associated with treatment outcome.

Do you have any studies to share regarding this topic? I’d love to have a look!

Cheers,

Walt Fritz, PT

Foundations in Myofascial Release Seminars

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Whitney Lowe: Fantasy Physiology and the Post Hoc Fallacy

July 20, 2017

Moving a profession’s knowledge-base forward is not an easy task. As a species I believe we hold fast to what is familiar and to resist change. My colleague, Whitney Lowe, has written an excellent article that addresses these issues and it may not be an easy read. Not that the technical jargon loses you, but […]

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An Interview: Marci Daniels Rosenberg, M.S., CCC-SLP

June 25, 2017

An Interview: Marci Daniels Rosenberg, M.S., CCC-SLP The new series of interviews I’ve posted here have thus far been with individuals involved in manual therapy from the massage/fitness end of the spectrum. For this interview, I wanted to branch into the other world I interact with; that of the voice and swallowing-related dysfunction. I’ve been […]

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Notes from Walt Fritz’s Workshop at the 2017 Voice Foundations Symposium

June 4, 2017

Many thanks to The Voice Foundation for making me feel welcome and inviting me to present my version of myofascial release for vocal dysfunction. I had prepared for my Friday workshop expecting 20-30 participants and, needless to say, I was a bit surprised at the very large turnout. As a result I lacked supplies for […]

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Myofascial release in the head and neck cancer patient

June 2, 2017

“Ignore the claims, as belief that one can somehow selectively target fascia, muscle, or other structure without providing simultaneous stimulation to  all structure is fantasy.” (This post was written over a year ago but remains relevant. The evidence used to validate this work and this continuing education seminar is constantly updated, with the latest version […]

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An Interview: Massage & Fitness Magazine’s Nick Ng

April 28, 2017

I met Nick Ng face-to-face two years ago, though he and I had co-existed on some Facebook groups long before that time. He took my Foundations in Myofascial Release Seminar for Neck, Voice, and Swallowing Disorders class in San Diego and, as I viewed him as decidedly science-literate, I was curious how he would interpret […]

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Fitting myofascial release into an evidence‑based culture

April 19, 2017

“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 […]

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A patient-directed model of manual therapy

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. […]

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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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