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. 

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

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 your feedback on how things have worked using these techniques.

My two “go-to” techniques for neck pain and lower back pain are the following:

The Thoracic/Cervical lift has taken a front row in my treatment of upper thoracic, cervical, and occipital region pain syndromes. The ability to directly both assess and treat the local nerve tissue, as well as surrounding soft tissue, has made it my most successful upper body technique. The Anterior Lumbar Technique, and also combined with sacral traction, makes up approximately 75% of my lower back and pelvic pain technique.

How about you? Have you had success with these (or other) of the techniques and core concepts you learned either by attending a Foundations in Myofascial Release Seminar or by viewing the videos?

Walt Fritz, PT

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

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 therapists who take my Foundations Seminars; I’m crooked! But, so are about 99% of the people out there in the world. Some look like ducks, some like pigeons, some like Quasimodo, others like who-knows-what! Look around you, how many people look like that chart hanging on the wall at school, showing “perfect posture? It will be a small number that fits this “norm” of perfect posture. Do a bit of man/woman-on-the-street interviewing. Are those people who have imperfect posture suffering from pain? A certain percentage will have pain, but most will not. So why do we apply different standards to those who walk into our clinic/practice?

Physical Therapy 101 taught me to look at posture as a means of determining asymmetry. Asymmetry leads to pain. MFR 101 taught the same thing. Both are quite incorrect. I have said many times in this blog that, in the past, I treated with the mindset of returning the body to a more perfect postural alignment will bring about diminished pain, but now I realize that much more is happening than just a change in alignment. If the imperfect posture as a cause of pain logic was true, everyone with less than perfect posture would have pain. We all know that this is not true.

The lesson? Stop looking for ducks. Posture is a very small part of a much deeper assessment that therapists must perform. Think of all of the things we are accomplishing every time we touch and interact with someone. It is a rich, deep body that we impact when we treat. Postural correction, if that is a patient’s true goal, is fine. But, please consider letting posture play a more minor role. Quack.

For Now,

Walt Fritz, PT

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

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 what I had believed I had observed over the 20-plus years as a manual/myofascial release therapist and nearly 30 years as a physical therapist.  Whenever I check my blog statistics page, this page is always at the top in terms of daily views. People around the world have read what I wrote and came away informed…sort of. Traditional logic (actually, internet logic) says that prolonged sitting leads to shortening of the hip flexors (iliopsoas) and shortened hip flexors lead to an increase in anterior pelvic tilt and lower back pain. I used to recite that mantra to nearly every patient who had lower back pain. The kicker was that when I did myofascial release treatment to address what I thought was short hip flexors, my patients nearly always improved. So if the “sitting shortens the hip flexors and tight hip flexors lead to an increase in anterior pelvic tilt and lower back pain” logic is false, what IS happening? What I did/do with my hands, when I am in treatment, apparently had little to do with what I thought that I was accomplishing.

Todd Hargrove, in his Better Movement blog, wrote a few articles titled “Does Excessive Sitting Shorten the Hip Flexors?” as well as “Does Anterior Pelvic Tilt Cause Low Back Pain?“. (Thanks, Todd, I like the way you think and write) He pretty much dispels all of these myths quite succinctly. There is simply no plausible evidence that any of these conditions lead to an increased incidence of lower back pain. These facts do not negate the positive outcomes that I have had over the years treating issues that I believed existed, it just shows me that there are other things happening under my hands that need to be better explained.

When I interview a new patient with lower back pain complaints, I ask them a few very specific questions. I ask them to distinguish between extended sitting with their back relaxed against a chair back with sitting while leaning forward, as if working at a computer. They will typically answer that the second scenario is more problematic. I will also ask them if prolonged standing, especially with a slight forward lean (as if standing at the kitchen sink, washing dishes) increases their low back pain. My patients will often answer in the affirmative for this questions as well. My takeaway was that there was shortening of the hip flexors, which I would attempt to objectify through a test of hip flexor length (Thomas Test). I would then perform some gentle palpation to the region of the hip flexors while my patient relaxed in supine. Many times these tests would reproduce the pain, all of which brought me to my stunning conclusion that the hip flexors were at fault. No harm done, as for nearly 20 years I did not know any different, or ignored those who told me different. I would then do what it was that I do with all of my patients, myofascial release treatment, and they improved.

I do not have the full answers as to why when gentle treatment is applied to the areas in the region of the hip flexors/anterior lumbar area; lower back pain lessens or goes away. I now believe we are looking at the effect that we have on the entire nervous system. This region is richly innervated with nervous tissue, from the superficial cutaneous nerve, which by itself possesses the ability to modulate the type of changes we see, to the deeper nerves of the lumbosacral plexus. I am curiously exploring these models of explanation and enjoying the realization of how wrong I was in the past. Don’t change what you do, change how you think. When you think in different ways, what you do may then change for the better!

Sitting and Back Pain

(Old version, 2009)

For many people, sitting poses no problem at all. Sitting in any position for any length of time produces no ill effects. However others are not so lucky, as sitting for even short periods can be painful. The pain may occur while they are sitting or afterward, when they try to get up to stand and walk. Many, many variables can create these conditions of pain, so trying to generalize regarding prevention and treatment can be difficult and potentially misleading. Being aware of your options can create a huge shift in the pain that you suffer.

We are constantly being told what a correct sitting posture looks like. These images tend to be one of the buttocks pulled back into the chair back, a mild lumbar curve in the small of the back (often supported by the lumbar support of the chair or a lumbar cushion), and feet flat on the floor. You may strive for this posture, but continue to suffer back pain during and after prolonged sitting. Next, you might purchase an ergonomically correct chair with no real change. What might be missing?

In my practice, when a patient is experiencing back pain with sitting or coming up to stand after sitting for a period of time, I always pay close attention to the hip flexors (psoas). The function of the hip flexors is to…flex the hips. When you stand or lie down and contract the hip flexors, your thigh will move up toward head. However, if there is shortness of the hip flexors, due to the upper attachments of the hip flexors, standing will cause the low back and pelvis to pitch forward. When lying on your back the shortness will increase the arch in your low back. Both of these scenarios frequently lead to back pain and even more serious disorders of the discs. So where does sitting fit in?

Numerous studies have show that sitting creates more pressure in the discs of the spine than does standing. Further, sitting with the trunk pulled forward over the hips (as in leaning forward while working at a computer) creates more pressure than sitting with your back against the chair back. Opening the hips into a more open angle (reclined back) further decreases the pressure in the discs. A great summary of some of these findings can be found here. Also, when you sit with your back and pelvis forward for a length of time, the hip flexors will shorten. Returning to stand will pull on the lumbar spine and discs, eventually leading to failure and pain. Thus, the shortness of the hip flexors can create back pain when arising from sitting and improper sitting posture can create an increase in pressure of the discs. Neither scenario is desirable.

While many resources exists (both in print as well as on the internet) that address various views on proper sitting posture, few address the background muscle tone that takes place while a person sits on various surfaces. One very important topic that I address in my practice is the amount of contraction that the hip flexor assumes during sitting. If the hip flexor is held in a contracted state for extended periods of time, one will experience difficulty coming to stand, not to mention the long-term changes that can take place in a muscle that shortens over a period of time. Given the attachment of the hip flexor to the lumbar spine and discs, these are issues that are vital to back health and comfort, both short and long term. Altering your holding patterns while sitting can reap great benefits, both for comfort as well as for long-term diminishment of back pain.

At the Pain Relief Center, I take care to address both the shortness of the hip flexors as well as educating you on how to hold your body for maximum relaxation of these very important areas.

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. The recent issue of Popular Science showed up last week. I’ve not seen that magazine in many years, so I took it home to read. There was some pretty interesting (nerdy) stuff in there! An article on how leeches may be able to track down rare/unseen members of the animal kingdom, one on how zebrafish may replace lab mice as the great test tube of medicine, and another on how cars in The Netherlands are being tested with EXTERNAL airbags, to better protect bicycle riders in the event of a car/bicycle crash.

The article that really caught my attention was one devoted to an MIT faculty member who has a passion for play as a means of moving into research. Erik Demaine is a computer scientist and his use of play has led him to a great many published research papers. His story (see link below) is entertaining in its own right, but leads me to look at the world that I occupy in therapy. Treatment, teaching, documentation, internet interactions; all can seem rather serious. But instilled in me is a sense of curiosity that allows me to have fun with what I do. My patients move through treatment, shedding pain, with humor. Play is about investigation, and isn’t that what a good therapist should be about? I love connecting the dots that other practitioners were not able to connect and I try to teach this in my seminars. Our work should be like play, not that we don’t take it seriously, because we should, but play in the sense that we learn and help through exploration. This exploration is bounded by both science and insights, but is play-oriented nonetheless. I may not start my day playing games at a Wii, as Demaine does, but treatment should have a certain joy to it that one can view as play.

How does play enter into your work day?

You can read the story for yourself here.

For Now,

Walt Fritz, PT

Foundations in Myofascial Release Seminars and Pain Relief Center

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 seminars around the country and the reception has been very good. New tools are great, but new mindsets are even better. This month I wish to take you a bit farther on this journey. Please note; myofascial release need not be a difficult modality to learn, nor does changing your mindset in order to accept other theories of explanation.

So what is happening in the photo shown above? This is a treatment that I use quite regularly with my clientele who suffer with shoulder region pain and related issues. It is quite different to the form of MFR that I was taught, but I have discovered that there is more than one “true form” of myofascial release.

This stretch utilizes Dycem, a great therapy product modified for use in this setting. The Dycem concept comes from Diane Jacobs, PT, a talented colleague who taught me the principles of this work in her DermoNeuroModulation Seminar. She posits that simply by stretching the skin, we influence the superficial mechanoreceptors, which in turn influence levels of tone, etc. in the body. In many ways I feel that I am covering a lot of bases while treating in this manner. Theories abound in our field and arguments are even more common when it comes to firmly believing what we are affecting when we treat. “Fascially”, I would have said that we were taking the tightness under tension and causing it to release. The term “release” has fallen out of favor with many in the science-based community, who state that fascia lacks the potential to change in the manner as it has been described for the past few decades. “Magical Thinking” is another way this model has been described. Magical or not, skin-based or not, lightly treating from a perspective as shown above has profound effect on pain, perceived tightness, and dysfunction.

The concept might seem too simple to be effective.  Don’t take my word for it, try it yourself. While Dycem is not necessary, it does provide a marked increase in grip and sensitivity. Liquid Chalk works fine as well. Gently place your hand on the shoulder (or whatever part of the body is involved) and gently stretch the skin in any direction. You are interacting with your client, not dictating action. Note the tissue quality under your hand; can you feel general flexibility, or are there areas that feel bound down or snagged? Moving the skin in a certain direction may decrease or eliminate the pain. This is a direction to hold the skin stretch. You may also find a direction that brings your client’s awareness to the pain, while not actually increasing the feeling. This is another direction to hold the stretch. Stretch times are much like traditional MFR hold times, 3-5 minutes or more. You are waiting until you sense a change, which may be a softening, warmth, or a change in the perception of pain. Treatment easily blends with self-treatment education. Simple, right?

Can you create an entire treatment paradigm based on this information? Yes, especially if you educate yourself on how the body actually works. Is this myofascial release the way I learned it? Certainly not, this is the new myofascial release.

For Now,

Walt Fritz, PT

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 had been experiencing a shift away from MP evaluation for the past few years. It was not a purposeful shift; rather it was one built on outcomes. Evaluation always guided my thought process for pending treatment. But after so many years of treating based on the MP findings, I believe that I moved into a more automatic assumption-based treatment. Nearly every one of my clients presented with forward shoulders, for instance, so why test for it? If the norm was asymmetry, how can it matter? In actuality, it often doesn’t matter. A vast percentage of us have marked asymmetries that do not necessarily create issues/pain. (Note the “not necessarily”, as occasionally the asymmetry does seem to create a problem). We are complex beings and determination of “cause” is often so complex a concept that we alone cannot get to the cause. But we can make educated and experienced-based observations and, yes, guesses, to at least start the treatment process.

When I was first presented with treatment concepts that stated that posture and symmetry did not matter, I was troubled. I had previously evaluated posture and symmetry, determined that things were out of balance, corrected them (or so I believed), re-evaluated, and found that the problem lessened or went away. This created a reluctance to move away from my original base of knowledge. The model seemed to work perfectly. But there came occasions when a patient presented with lower back pain, for instance, accompanied by a severe pelvic torsion. Previously I would have included what is termed “pelvic balancing” into my treatment. This would take the shape of pelvic wedging to move the pelvis back into a neutral alignment, as well as treatment to the soft tissue to correct fascial tightness patterns (pardon the now abandoned describers). But on certain occasions I left the pelvic asymmetry alone, treating only elsewhere. Voila! The pain was reduced in the same fashion as if I had done pelvic correction. This would seem to be in conflict, but I don’t believe this is so. It is plainly obvious that there are many ways to skin this therapeutic cat and I’ve long resolved myself to not have to know everything.

If treatment from the PM model was not necessary, why spend so much effort in evaluation from this model as well? Was it true that I had transcended treating from the PM model, or had I simply made certain therapeutic assumptions, casting aside superfluous techniques and thoughts? Had treatment become so automatic that I found less need to look into certain mechanical minutiae and simply move right past them? Therapeutic knowledge/assumption is not witchcraft, ancient wisdom, or intuition, but is simply hard-earned knowledge and experience. We do learn patterns and trends that can apply to a group larger than a single person.

In the past, my “standard” evaluation could easily take 30 minutes, if I felt the need to be thorough. That is quite a bit of time out of a typical 50-minute session to spend before applying any treatment. I firmly believed that this was time well spent (and still do at times). I continue to teach this thorough, in-depth model of PM evaluation at my Foundations in Myofascial Release Seminars, but now I insert a caveat: all of this MAY not matter. How unsettling is that? How can a therapist, new to my form of Myofascial Release, determine what is necessary and what is superfluous? Experience and time are what will make the difference, and both of them are great teachers.

Diane Jacobs, PT, to whom I am deeply indebted for sharing her knowledge and patience, said something in her DermoNeuroModulation Seminar (DNM) that resonated. In essence she said that we all use our unique set of pattern recognition skills to identify issues from our own unique frame of reference. I may palpate for tissue density while she may palpate for something completely different, but we both identify a disruption in the desired or ideal, me which seems connected to the pain; this seems universal and should be what we strive for in any form of bodywork. What pattern recognition skills do you utilize?

I had a new client the other evening that presented with acute right shoulder pain. My client believed that a few years of sedentary lifestyle followed by what she felt was an excess of yoga seemed to bring on the pain. After talking for a bit, taking her history, etc., I stood her up and went through the first portion of what used to be my standard evaluation. “Face me, turn right, turn left, face away” all the while I am dutifully making note of postural asymmetries. My client’s shoulders were pulled forward and if I looked hard enough, the right shoulder may have been even more anterior, but I stopped the observation there. I could have asked her mother, who was out in the waiting room, to stand up for postural evaluation and I would have probably found similar findings, but without the symptoms. Look around at your family, friends, colleagues, or just folks walking past you. Check out their posture; I can guarantee you that most of them will have varying degrees of forward shoulders, with further asymmetries as well. But question them; do they have shoulder pain? Some may, most will not. So instead of completing my PM evaluation, I moved my patient right to the treatment table and spent some time palpating for tissue quality, which is the primary means that I utilize to connect with pain. I discovered characteristic tissue density in the anterior shoulder region and when I put added pressure or skin drag into this area, my client confirmed that this engaged her pain. How simple can it get?

Let me return to my past dilemma for a moment. Had I seen this client for the first time a few years ago, I would have done the full PM evaluation, finding forward shoulders, right >left, and treated her based on these findings. I would have done a cross-handed “release” across both shoulders, feeling what I thought was fascial restriction all along the way. She would have most probably improved. But she improved the other evening, too, but from a different therapeutic mindset. In her session I spent a good amount of time performing a simple skin stretch (DNM). Yes, I drop a bit deeper than I was taught, at times, but don’t we all develop our own style? I used Dycem, my latest obsession, to improve my tactile awareness. I then engaged my client with some basic pain education, explaining possible causes of pain from a neuroscience perspective. I also taught her simple skin stretching. Skin stretching, as it was taught, strives to find a direction that lessens or eliminates pain. I add a 180-degree twist; if the skin stretch brings the pain to their awareness, you have found another reason to hold the stretch. (Note, this does not mean that the stretch increases the pain, it simply makes one aware that they have connected with it.) Pain which lessens or is made more distinct; hold the stretch. She left with much greater ease of movement and diminished pain. She also left without re-visit scheduled. I believe in empowering my clients to keep the gains we made during the initial session, taking it even farther on their own. She may return, if for nothing else but to clean up the remaining loose ends, but she has the power to make that determination, not me. Skipping my past complete evaluation caused no negative outcome. Each time this occurs I feel more empowered to seek a more streamlined approach to evaluation, one that diminishes the reliance on the PM model. There are times when pelvic symmetry SEEMS to matter, and I acknowledge this. I’ve not figured it all out yet, but give me some time. Take your time in all of this, as there is no rush.

As I asked above, what pattern recognition skills do you use to determine dysfunction?

Enjoy.

For now,
Walt Fritz, PT

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 all involved, it is shocking to many, therapist and patient alike, when the end product of technique varies so wildly. There are some very effective therapies out there. The MFR that I practice just happens to be one of them.

So what is occurring in the photo shown above? This is a self-stretch that I teach to many of my patients who suffer from hand pain/dysfunction and I often perform this stretch on myself. I came upon this stretch a few years back when I had a run of patients who did various forms of needlework. They complained of pain at the base and “meat” of the thumb. Most had an x-ray report from their doctor, which determined that there were degenerative changes in the joint at the base of the thumb. (I cynically keep my snarky remarks to myself, but what would the doctor have seen if they had taken an x-ray of the opposite, non-symptomatic hand?) Upon evaluation, marked apparent tissue density was noted in the thenar eminence and there was often a cupping of the palm (thenar eminence drawn tight toward the hypothenar eminence). Previously, I had assumed that fascial shortening had occurred as a result of cumulative use/overuse. Was I wrong? I’m not sure, but I have now added to my repertoire of reasons of causation.

This self-stretch, and accompanying treatment, was nearly always very effective in reducing pain and improving function, so there was little impetus to scratch deeper to look for underlying causes. After all, if what I believed was occurring followed easily with what I thought I was impacting with the treatment and self-stretch, what else could be accomplished? This pretty much sums up how I practiced and taught for the past 20 years. What I was taught seemed to follow what I felt under my hands and what I was taught seemed to make people better, so why argue?

The internal argument began when I was exposed to DermoNeuroModulation, by Diane Jacobs, PT. DermoNeuroModulation, DNM for short, stresses the fact that the only tissue we can be absolutely sure that we are affecting is the skin. Being able to impact any/all deeper structures is open to question. (Please note that Diane and her approach are diametrically opposed to myofascial release as a treatment construct. I just so happen to see her views on pain and changes in pain in the body as very valid explanations for most, if not all, of the changes we see and feel every day.) I would direct the reader to this blog post, on Joe Brence’s blog, where Diane sums up her approach.

Visible Body Thumb

Comparing the photo at the top of this post with the diagram (linked above) from VisibleBody (Visible Body Human Anatomy Atlas 2), note the thenar eminence’s distribution of  nerves that originate from the median nerve. Thinking form a nerve-centered approach, we can use very gentle stretching into the skin, thereby affecting the Ruffini receptors, which are slow-adapting nerve endings particularly suited to responding to lateral stretching of the skin. (Slow lateral stretching of the skin..sounds a lot like what we do). Being slow-adapting, the Ruffinis will fire as long as the stimulus is held, in this case a gentle shearing stretch to the skin. This modulatory input is sent up through the sensory portion of the median nerve, and is interpreted appropriately by the brain, allowing the nervous system time to modulate, or alter, the motor output and pain output from the brain and spinal levels. The end product is a reduction in local tone or tightness. What we may have been taught as a local response of the connective tissue may, in fact, have a more central locus of control.

How did the pain develop in the thenar eminence and why does it feel (to me) so “congested”? Any sort of trauma or injury can create a nociceptive event, but it is the job of the brain to determine if the threat is sufficient enough to warrant the sensation of pain.

I have written elsewhere not to “throw out the baby with the bathwater”. I am not suggesting that we abandon all of our successful treatment strategies. I am advocating looking at them in a new light. I have used a highly refined sense of touch and awareness to locate areas of concern within the body for many years. This has not changed. I have simply added neuro-anatomy to my repertoire. Instead of “trusting my intuition” (what the heck does that mean anyway?), I now can find logical reasons for how and why tightness/pain develop and choose more plausible courses of treatment based on anatomy, not pseudoscience.

This is a process of learning and unfolding for me and I hope you will follow me along this journey.

For now,

Walt Fritz, PT

Foundations in Myofascial Release Seminars

The Pain Relief Center, in Rochester, NY

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 $395, effective for anyone signing up after 01/01/13. The previous cut-off dates will remain unchanged; $445 if registered three weeks prior to a class and $495 if registered during the final three weeks before a class.

Warm regards and Happy New Year!

Walt Fritz, PT and Foundations in Myofascial Release Seminars