An Interview With Tony Friese, PT

by Walt Fritz, PT on April 17, 2013

The Foundations in Myofascial Release Seminars draw from a fairly wide range of health professionals, including physical therapist, occupational therapists, massage therapists, athletic trainers, nurses, and osteopaths. All of these professionals have a huge number of continuing education opportunities to choose from, which led me to wonder “Why take a Foundations in Myofascial Release Seminar?”. Tony Friese is a physical therapist from Wisconsin who recently took the Foundations I Seminar in Illinois. I asked him if he would agree to answer a few questions along this line and he graciously agreed.

Walt:

Hi Tony,
Thanks for the interview. As a physical therapist, what drew you to take a Foundations in Myofascial Release Seminar? Have you done any MFR training in the past and how did it compare to the Foundations class you recently took?

Tony:

In my last few years of practicing PT, I have experienced a renewed interest in the treatment of painful disorders which has led me to update my knowledge and skills accordingly.  Some of the more important things I’ve learned are that manual therapy techniques can be very helpful in reducing pain, but not for the reasons we may have originally learned and thought, for example the notion that we can physically stretch connective tissue such as fascia.  Also, that when it comes to pain, the nervous system is king.  Pain is a protective output of the brain based on its perception of threat to the body, and to reduce pain, reducing this perceived threat must occur.  Therefore, therapy techniques, whether manual, exercise or modalities, that are painful, are going to be counter-productive.  Finally, patients are going to seek touch-based therapy to help their pain.  So, in my attempt to improve my ability to help people in pain, I realized I not only needed to improve my tool bag of hands-on techniques, but that those techniques needed to be mild and gentle enough so as to not be threatening to the person’s nervous system. 

 
Many teachers of myofascial release describe their work as being gentle and non-threatening in nature and in years past I have been to other myofascial release courses.  These courses did have some value but overall I found them lacking for a couple of reasons.  Firstly, they all continued to promote the scientifically unsupported notion that, by our hands-on pressure, we are able to physically, lastingly stretch tight tissues.  Secondly, the courses tended to teach you to look heavily at postural alignment to determine where to treat to relieve pain.  I never was able to get the hang of this, and, based on the current science available, it’s a shaky-at-best premise anyway!  Finally, and most importantly, I left almost all of those courses being able to “go through the motions” of the techniques that were taught but really didn’t know what I was supposed to use when, or supposed to be feeling for under my hands and how to relate that to the symptoms of the person I was trying to help.
 
What drew me to the Foundations in MFR seminars was that these seminars include in their description and objectives the gentle nature of the work, the teaching of “getting the feel” of the method, as well as offering explanations for how MFR works that are more plausible in light of the science available at this time.  I wanted simple, scientifically sound explanations of what MFR does.  I wanted instruction in where to look for problems in the body, what to feel for with my hands, and what to do with what I find.  I got the basics of all of that in the Foundations I seminar.
Walt:
Moving myofascial release from the realm of the pseudoscience, as it is typically explained by many of the popular teachers, has been a mission of mine. That and getting people to understand that this work need not be hard to learn. How far did one Foundations Seminar take you toward improving your effectiveness in dealing with patients in pain?
Tony:
Taking one Foundations seminar has taken me quite far in helping me better work with patients in pain.  The particular aspects of the class that have been most helpful have been the teachings to identify, by touch, areas of distressed tissue, to connect findings of distressed tissue with the patient’s complaints of pain/tightness, to incorporate more of the body in my search for such distressed tissue, and, when treating my findings with MFR, to make sure to engage that tissue for a long enough period of time to facilitate change in mobility and symptoms.  I felt the instruction I received in these areas was done in a simple, straightforward manner and the theoretical explanations given for how MFR works were grounded in plausible neuroscience with really very little mention of any specific properties of fascia.  I am still a bit overwhelmed at how many different body areas can affect or contribute to a particular painful condition in a given patient, and how to prioritize which areas to check out first for specific conditions, but I feel with further practice this will improve.
Walt:
Myofascial release has been greatly criticized over the past many years in our physical therapy profession, mainly due to its lack if scientific grounding. Do you see a place for myofascial release in the modern physical therapist’s arsenal?
Tony:
I don’t know how modern I am, but obviously MFR definitely has a place in my own arsenal as a PT.  I would hope it would for others as well, particularly any that are treating people in pain, especially now that some plausible explanations for how MFR works are emerging.   Hopefully, though, MFR won’t get lost in the shuffle of “glitzier” methods like dry needling or instrument assisted scraping methods that are in vogue these days but, to my knowledge, don’t have any better science backing than MFR.
Thanks, Tony!

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A Map of the Body and the New Myofascial Release

by Walt Fritz, PT on March 3, 2013

If there were one map of the body for all to follow, a map that showed all areas of injury, trauma, and pain, along with the necessary route to take to eliminate those issues, life would be simple.

I received a new GPS this past Christmas. My old GPS had become unreliable due to a few quirks and I did not have full trust in my iPhone’s GPS, given a few wrong turns along the way. While my new GPS offers me nearly a nearly foolproof ability to find my way around while traveling, it lacks in some key areas. I learned this a few years back, while traveling to teach one of my Foundations in Myofascial Release Seminars. My hotel was not terribly far from the seminar venue, but each morning and night, I followed the female mechanical voice on my GPS, dutifully turning when she told me to turn. Prior to this, I had always carried a map while traveling and studied it beforehand, as well as before venturing off on a new destination. While near the end of my trip, my old GPS began exhibiting one of its quirks and forced me to find my own way. After spending nearly 4 days in that city I realized that I had no idea how to get to where I wished to go, even though the distance was small. I had previously relied on some internal ability to see a place on an internal map in my mind. I did find my way to my destination eventually, but it was a very good lesson to me.

In order for us to benefit from a map, we need to decide on our route preferences. What factors go into deciding which road to take? When one initially programs a GPS, it will query you to see if you wish to prioritize shortest distance, shortest time, avoiding highways, etc. However, I think most of us forget about these variables each time we plunk in our destination and follow the voice. If we are reading an old-fashioned paper map, we have choice that is more overt; highway or country road, scenic route or “just get there”. If we are curious, we may choose a route that takes us past places of interest.

Choosing a map to follow in the body is no different. Many maps are offered, from the ones we learned in school, which tended to be more simplistic, the maps offered through continuing education, and the ones offered by our own experience. I learned a map of the body and followed this map for many years. That map stated that the body behaved in very specific ways. This method was influenced by the theory that fascia was the “great unknown” when it came to unresolved pain. The mysteries of the fascia were there for anyone to perceive, if you only chose to follow the teacher who taught this work. Sounds a bit mysterious, does it not? My introduction to myofascial release was explained in a manner that made sense, at least from my very superficial level of understanding, as well as cherry picking the available evidence to suit my needs. It really lacked any plausibility from a scientific perspective, but I skipped over any lingering questions I might have, as what I learned to do with my hands was incredibly effective. Occasionally my instincts caused me to question my teachers, but the all-important “results” quickly put any doubts to rest! I know now that much of what I learned was either outdated or wrong. In essence, I became a good listening and follower, but not a good questioner. I began applying the principles with my patients and quickly began to notice things that seemed more important to me that did to my teacher, and things my teacher thought were important mattered less to me. Sounds like maturation, correct? What was apparent to me was that dysfunctional tissue (non-specific tissue), presented with a characteristic density that was easily palpable. At first I attempted (rather successfully, I thought) to equate this density to “fascial restriction”, as that was what I was taught. However, over time, the “Feel” became the most important element. Fast-forward a decade or two. A few years back I began to expose myself to a neuroscience approach to pain; one that used basic neurology to explain the changes we feel with bodywork. I at first rejected this as skeptical nonsense; how could the results I saw with MFR be wrong? The results were not wrong, just the explanation. The transition from an old-school mentality of myofascial release to embracing these newer concepts was not difficult, as under my hands I still felt what I had felt in the past. Only now, I had much more plausible explanations to use.

The maps that I now use are based on simple anatomy and mostly neuroanatomy. It is not sexy stuff, like other explanations of body work and MFR, and doesn’t try to bridge any chasms between body work and parts of the process that we, as body workers, have no business addressing. I am a huge fan of the Visible Body app. While it can be purchased in modules, the Visible Body Atlas is a comprehensive guide to the body and will be the map we use.

For those of you with an enlightened sense of feel, learning this new form of myofascial release work will come easily. The most difficult part may be asking yourself to put aside your beliefs on how best to make changes in the body. Over the past 20 years, I have lightened my touch considerably and enlightened my mind even more. I do not work to any level of uncomfortable depth and never elicit pain.

There are those who feel that the term “myofascial release” is so scientifically incorrect and unrealistic that it should be abandoned. While I believe we are influencing much more than just the fascia, and that fascia is not the magic tissue it has been made out to be, I do feel there is logic in sticking with it, if nothing more than the name recognition value. Ultimately, I will not try to convince you of anything; your process may be as long and tortuous as mine was. In the end, I hope that you simply come away with a better ability to help someone in pain. That is where we start.

The new myofascial release differs little when it comes to what we do with our hands. But it differs wildly with what we do with our minds. Enjoy!

Walt Fritz, PT

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A Dialogue on Techniques

March 2, 2013

Hi Everyone, Many of you I’ve met over the past few years while traveling the country. I’ve had a chance to share my approach and technique for Myofascial Release, one that certainly has evolved and continues to do so. Many of you may remember which techniques I’ve said were my favorites and I would love [...]

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If It Walks Like a Duck, Does the Duck Have Pain?

February 4, 2013

A few things about me: I have one foot that points out a bit. I walk like half a duck. Nothing big, I’m probably the only one who notices this, but it’s there. If you stood me up for a postural examination, I would be in pretty much the same place as 99% of the [...]

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Sitting and Back Pain

February 3, 2013

A number of years back I wrote an article on sitting and back pain that was posted on the website for my private practice, the Pain Relief Center, in Rochester, NY. (You can view the original article at the bottom of this page) I had based the article on what I had been taught and [...]

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Waiting Room Magazines

February 2, 2013

In my private practice, I’ve gotten used to receiving unsolicited magazines. You know the type; Reader’s Digest, Ladies Home Journal, Highlights (I LOVED Highlights since I was a kid and read it in my doctor’s office). Most don’t even make the cut and end up in the recycling bin. Occasionally, though, one catches my attention. [...]

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The Foundations in Myofascial Release Seminar Approach… in a Nutshell, Part Two.

January 31, 2013

I shared my introductory thoughts on the new approach and direction that Foundations Seminars have taken in the December edition of this newsletter. If you would like to read this again, please click here. I’ve had the chance to share this information with a good number of therapists over the past few months at various [...]

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Pattern Recognition and Streamlining Evaluation

January 18, 2013

Changing from a mechanical/postural model to one with more plausibility has entailed numerous modifications to both evaluation and treatment. Myofascial release is traditionally based in the mechanical/postural model, with treatment following from an evaluation based on said mechanical/postural (MP) findings. While my conscious shift away from this model started less than six months ago, I [...]

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The Foundations in Myofascial Release Seminar Approach… in a Nutshell

January 3, 2013

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 [...]

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New Foundations Seminar Pricing Structure

December 31, 2012

The seminar business is rewarding but challenging. Locating appropriate venues, attracting therapists/students, etc., is all part of the business. Having an accurate idea of the number attendees is crucial for success. As a result, we have instituted a lower pricing tier. If you register two months prior to any seminar the registration fee will be [...]

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