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When will we get over this constant search for holy grail therapy targets in the body?
When will we run out of tissues to build castles of sand, dogma, gurus, and money out of?
When will people realize the basic facts of pain perception and pain physiology? To treat painful problems, our target is and always has been the nervous system.
Some days I just get so tired of people trying to convince each other of the supreme relevance of some connective tissue they are all excited about.
Enough is enough already.
First it was all about joint dysfunctions. Manual therapy was about finding and correcting misalignments and restoring normal position or movement to these dysfunctional segments. Then the research started to come in. Poor reliability between clinicians to find these misalignments. Plenty of "dysfunction" found in the asymptomatic. No valid way to demonstrate them or to connect them to any painful problem or show them changing as a result of treatment. But wait, the JointHeads say. We know that facet joints are innervated. We know they might play a role in proprioception. They are innervated for nociception, too. Its too early to not consider how important facet joints might be, they say.
The treatments they propose to change these facet joints involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the JointHeads can't even be sure its the facets that are being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
Then it was all about the intervertebral disk. Therapy was about finding and correcting bulges in the disk through exercises. Then the research started to come in. Poor reliability between clinicians to find these misalignments. Plenty of "dysfunction" found in the asymptomatic via imaging. No valid way to demonstrate them or to connect them to any painful problem or show them changing as a result of treatment. But wait, the DiskHeads say. We know that disks are innervated. We know they might play a role in proprioception. They are innervated for nociception, too. Its too early to not consider how important disks might be, they say.
The treatments they propose to change these disk derangements involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the DiskHeads can't even be sure its the disks that are being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
Then the MuscleHeads came around. Physical therapy should be about identifying postural dysfunction, weakness, trigger points, or inhibited muscles, and correcting them with various manual therapy or exercise techniques - hey maybe even poking them with needles. Then a little research came in. Poor reliability between clinicians to find these supposed problems. Plenty of "dysfunction" found in the asymptomatic. No valid way to demonstrate them or to connect them to any painful problem or show them changing as a result of treatment. But wait, the MuscleHeads say. We know that muscles are innervated. We know they play a role in proprioception. They are innervated for nociception, too. Its too early to not consider how important muscle dysfunction might be, they say.
The treatments they propose to change these muscle problems involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the MuscleHeads can't even be sure its the muscles themselves that are being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
Then the FasciaHeads came on the scene. Manual therapy should be about identifying restrictions in fascia and fascia mobility and correcting them with various manual therapy or exercise techniques - hey maybe even poking them with needles. There's almost no research on identifying these supposed fascial problems, and it's likely that its similar to other manual assessments - you know how this goes. Poor reliability between clinicians to find these supposed problems. Plenty of "dysfunction" found in the asymptomatic. No valid way to demonstrate these fascial restrictions or to connect them to any painful problem or show them changing as a result of treatment. But wait, the FasciaHeads say. We know that fascia is innervated. We know it plays a role in proprioception. Fascia is innervated for nociception, too. Look how it connects all these body regions like train tracks connect stations. Its too early to not consider how important fascial dysfunction might be, they say.
The treatments they propose to change these muscle problems involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the FasciaHeads can't even be sure its the fascia itself that is being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
People, we don't need any of these things to be important. If we are talking about pain, we are talking about something that occurs in the brain, not in the spine, or the muscles, or the joints. The nervous system and the complexity of perception and processing of pain is more than adequate as an explanatory model to drive our treatments. Approaches that target the brain or nervous tissue first would seem most concordant with the existing science. Traditional types of manual therapy are perfectly aligned with modern science if they rely on patient response to drive treatment decisions rather than stories about joint positioning, alignment, or "restrictions" of some kind.
We need to collectively get over this pointless speculation about fascial restrictions, joint positioning, and trigger points. If people want to handle or treat their patients in ways traditionally associated with these methods, that's fine. But keep the neuroscience of pain at the forefront, pay attention to the great research coming out on manual therapy mechanisms, and for crying out loud don't give patients a giant nocebo by telling them they have fascia restrictions, inhibited muscles, or joints out of place. Because then I have to explain to them that that's not accurate. And that's exhausting. It's less about what you do and its more about how you explain it to patients and colleagues. You can explain it like a science-based practitioner or you can make up a story.
Frankly, I'm tired of correcting the messes people make by transmitting these ideas to patients about pain and function that don't have any relation to modern pain science.
Are you a JointHead, a DiskHead, a MuscleHead, or a FasciaHead?
Don't change your tools, change your explanatory models.
The thread "Crossing the Chasm" might help.
Because really - enough is enough.
ps Hey have you read this great new book by Professor/Doctor/Master [insert name here]? He's a [insert impressive credentials] who studied in all these cool universities in [insert countries here]. He says these problems have to do with restrictions in the mobility of the veins. He's shown in the lab they are innervated and look how they spread through the body like a web! Just pay $1000 for our three-day Level One VeinTherapy course and totally change your practice! Take the Level One Certified VeinTherapy Practitioner test (additional testing fee applies) and...
When will we run out of tissues to build castles of sand, dogma, gurus, and money out of?
When will people realize the basic facts of pain perception and pain physiology? To treat painful problems, our target is and always has been the nervous system.
Some days I just get so tired of people trying to convince each other of the supreme relevance of some connective tissue they are all excited about.
Enough is enough already.
First it was all about joint dysfunctions. Manual therapy was about finding and correcting misalignments and restoring normal position or movement to these dysfunctional segments. Then the research started to come in. Poor reliability between clinicians to find these misalignments. Plenty of "dysfunction" found in the asymptomatic. No valid way to demonstrate them or to connect them to any painful problem or show them changing as a result of treatment. But wait, the JointHeads say. We know that facet joints are innervated. We know they might play a role in proprioception. They are innervated for nociception, too. Its too early to not consider how important facet joints might be, they say.
The treatments they propose to change these facet joints involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the JointHeads can't even be sure its the facets that are being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
Then it was all about the intervertebral disk. Therapy was about finding and correcting bulges in the disk through exercises. Then the research started to come in. Poor reliability between clinicians to find these misalignments. Plenty of "dysfunction" found in the asymptomatic via imaging. No valid way to demonstrate them or to connect them to any painful problem or show them changing as a result of treatment. But wait, the DiskHeads say. We know that disks are innervated. We know they might play a role in proprioception. They are innervated for nociception, too. Its too early to not consider how important disks might be, they say.
The treatments they propose to change these disk derangements involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the DiskHeads can't even be sure its the disks that are being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
Then the MuscleHeads came around. Physical therapy should be about identifying postural dysfunction, weakness, trigger points, or inhibited muscles, and correcting them with various manual therapy or exercise techniques - hey maybe even poking them with needles. Then a little research came in. Poor reliability between clinicians to find these supposed problems. Plenty of "dysfunction" found in the asymptomatic. No valid way to demonstrate them or to connect them to any painful problem or show them changing as a result of treatment. But wait, the MuscleHeads say. We know that muscles are innervated. We know they play a role in proprioception. They are innervated for nociception, too. Its too early to not consider how important muscle dysfunction might be, they say.
The treatments they propose to change these muscle problems involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the MuscleHeads can't even be sure its the muscles themselves that are being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
Then the FasciaHeads came on the scene. Manual therapy should be about identifying restrictions in fascia and fascia mobility and correcting them with various manual therapy or exercise techniques - hey maybe even poking them with needles. There's almost no research on identifying these supposed fascial problems, and it's likely that its similar to other manual assessments - you know how this goes. Poor reliability between clinicians to find these supposed problems. Plenty of "dysfunction" found in the asymptomatic. No valid way to demonstrate these fascial restrictions or to connect them to any painful problem or show them changing as a result of treatment. But wait, the FasciaHeads say. We know that fascia is innervated. We know it plays a role in proprioception. Fascia is innervated for nociception, too. Look how it connects all these body regions like train tracks connect stations. Its too early to not consider how important fascial dysfunction might be, they say.
The treatments they propose to change these muscle problems involve touching skin and moving joints, muscles, fascia, nerves, blood vessels, and lymph channels - whether its a treatment or exercise program. So the FasciaHeads can't even be sure its the fascia itself that is being primarily targeted by their treatments. There are nonspecific and placebo effects to consider as well as natural history of mechanical pain disorders to consider.
People, we don't need any of these things to be important. If we are talking about pain, we are talking about something that occurs in the brain, not in the spine, or the muscles, or the joints. The nervous system and the complexity of perception and processing of pain is more than adequate as an explanatory model to drive our treatments. Approaches that target the brain or nervous tissue first would seem most concordant with the existing science. Traditional types of manual therapy are perfectly aligned with modern science if they rely on patient response to drive treatment decisions rather than stories about joint positioning, alignment, or "restrictions" of some kind.
We need to collectively get over this pointless speculation about fascial restrictions, joint positioning, and trigger points. If people want to handle or treat their patients in ways traditionally associated with these methods, that's fine. But keep the neuroscience of pain at the forefront, pay attention to the great research coming out on manual therapy mechanisms, and for crying out loud don't give patients a giant nocebo by telling them they have fascia restrictions, inhibited muscles, or joints out of place. Because then I have to explain to them that that's not accurate. And that's exhausting. It's less about what you do and its more about how you explain it to patients and colleagues. You can explain it like a science-based practitioner or you can make up a story.
Frankly, I'm tired of correcting the messes people make by transmitting these ideas to patients about pain and function that don't have any relation to modern pain science.
Are you a JointHead, a DiskHead, a MuscleHead, or a FasciaHead?
Don't change your tools, change your explanatory models.
The thread "Crossing the Chasm" might help.
Because really - enough is enough.
ps Hey have you read this great new book by Professor/Doctor/Master [insert name here]? He's a [insert impressive credentials] who studied in all these cool universities in [insert countries here]. He says these problems have to do with restrictions in the mobility of the veins. He's shown in the lab they are innervated and look how they spread through the body like a web! Just pay $1000 for our three-day Level One VeinTherapy course and totally change your practice! Take the Level One Certified VeinTherapy Practitioner test (additional testing fee applies) and...
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