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