CT Myofascial Release; The Great Conversation

[Walt Fritz]

Diane, Nari, and Barrett,

Nari, I will start a thread on Myofascial Release (thanks for the help). But first I want answer and respond to a few of the questions and comments that have been made. To start, I want my background to be clear. I took my first MFR seminar from John Barnes in 1992, at the height of the “crushing” (more on this later). I began instructing with John in 1995 and have assisted at over 50 seminars with him over the past 10 years. I have seen John demonstrate techniques on hundreds of students and treat many patients over the years. I have a very successful cash practice where I do 100% MFR, or as close to this as one can get. I tend to work more on the structural end of the MFR scale, but anything can happen in the treatment room.

I understand that many readers may have a negative opinion of MFR, but what has fostered this? Is it the lack of research? Search around a bit, including on PubMed. You will find many citations. A friend, Carol Davis, PT, PhD at the University of Miami, recently presented a poster research study regarding MFR and the treatment of kyphosis in the elderly at an APTA conference. Pretty mainstream stuff. We all pull from many disparate sources to explain our work, and John is no different. Ask yourself whether the proof you use to explain your work is rationalization or reality. Search PubMed for many of the other treatment modalities we practice and see what you find. Many will come up blank.

Diane, I can’t break my MFR practice down to “outside the body” or “interior renovating” type, as you referred to it. How can any of us reduce what we do to one or the other? Has none of you put your hands on someone and they report that they felt an emotion or memory of some sort? Much has been written on Rehab Edge about MFR encouraging repressed emotion and memories to be brought to the surface. People have gone as far to say that what we are doing is illegal (this pretty much sums up “Not in Kansas Anymore”). Had any of the people who commented on this bothered to attend one of John’s seminars, they would have heard him say that he teaches every therapist never to counsel, and never to tell anybody what to think, feel or do, never try to make anybody express emotions, or to do anything that does not feel natural to them. We have found that creating safety and mutual respect allow the individual to express themselves in their own way. We never force, we never lead. Lurking on an MFR chat line or blog, where enthusiast patients and therapists talk about a method that really works for them can be rather misleading, especially if one really knows little about how MFR is taught by John. But disparaging a patient’s experience in healing as rubbish is insensitive and churlish. Do some folks go overboard? Surely they do, but this is not how John teaches MFR. Having a patient go through a release or unwinding and finding a connection with an earlier event in their lives, either physical or emotional, is one of the beautiful things about this work. BUT, it is their discovery to make. Is it illegal or unethical for a patient to discover things about themselves? I think not. Maybe others should look inward as to whether they allow their patients feel safe enough to actually feel.

Diane, of course a person’s nervous system has bearing on treatment effects. You may call what you see as a result of treatment easily explainable through your knowledge of the nervous system, and you would be correct. You are successfully working within the paradigm of your treatment methodology. Let me give you an example. On another thread on SomaSimple, Barrett posted two photographs of a patient’s lower extremities when viewed from the head. (http://www.somasimple.com/forums/showthread.php?t=1835)
He postulated that the rotated right leg was caused by uneven neural tension. If, in treating by this rationale, the legs were brought back into a more normal alignment, he was correct, or at least he used a rationale that fits with his treatment method. From a basic MFR perspective of evaluation, one may find that the right hemipelvis is anteriorly rotated, relative to the left, causing the femur to roll inward due to the orientation of the acetabulum. If I use MFR to treat accordingly and the legs are more even afterward, then my paradigm works. MFR treats the body as a whole, not a reduction of parts.

Barrett, I’m not sure what you are referring to when you say that MFR people were “crushed” in the early 90’s. If you mean the PT Bulletin’s attempt to discredit John in the early 90’s, I might remind you that during that time period, John was asked, by the APTA, to lecture on MFR, sponsored by the APTA research foundation to generate money for Physical Therapy research. And that, in the 80’s, he was appointed to the council of Advisors to the American Back Society and lectures annually for them. I was one of the sheep you often refer to, who almost believed what the Bulletin was trying to accomplish. But, unlike many involved, I chose to think for myself and see what John had to offer. Like the many thousands of other therapists who were curious enough to investigate further. I’ve read some of the words of Jon Childs, and how he is bashing you for lack of research. I hope that this episode brings you the success that it brought to John back in the early 90’s. I know that you do good work. Let others do good work as well without so much judgment and negativity.

The outcome I try to achieve with MFR is not unlike any others in our field. My outcomes are very good. I’m sure yours are as well. Barrett, I’m intrigued by your work and was sorry to be unable to attend your class in Rochester recently. There is enough room for all of us here. Enjoy the ride.

Walt

[nari]

Walt

Thanks for your post here. I will leave replies at this stage to others, as I am quite unfamiliar with MFR and need to do some homework.


PTupdate:

Welcome to SS. Pleased to see you here, and look forward to your posts.

Nari

[Diane]

MFR deconstructed

Hi Walt,
Thanks for sharing your thoughts. Something in me tells me that this conversation is a long time coming, long overdue. I commend you for hangng in and sharing your thoughts. I'm sure it will be a very interesting conversation.

I took the liberty of moving your post to here, as I thought it contained a lot of content, too much to let it stay in the arrival lounge, which is for arrival chit chat. If you would prefer a different name, let me know, I'll change the name of the thread. I chose "deconstruction" because I expect we will all want to get to the bottom of the concepts.
Thanks,

[Barrett Dorko]

Walt,

You say, “…anything can happen in the treatment room.” Are you sure about that? How about outside the treatment room? This willingness to accept anything is a classic postmodern stance and reveals an ignorance of physical law that places much of Barnes’ theory outside the realm of physical possibility. You guys constantly assign qualities to the connective tissue it simply doesn’t possess (demonstrated in your hemipelvic rotation example) and thus add to your theoretical problems the biologic implausibility that will always plague your community of believers. Next thing you know you’ll be telling us that the fascia can move us.

Calling your work just another paradigm doesn’t make it acceptable. Offer us some rational explanation that you can defend and then we’ll talk, but don’t expect us to be impressed with your claims of success.

You say, “…finding a connection with an earlier event in their lives, either physical or emotional, is one of the beautiful things about this work.” And, “Is it illegal or unethical for a patient to discover things about themselves?” I don’t assume you are purposely misinterpreting what I’ve written so I can’t explain how you came to that conclusion. Obviously you’ve not read “The Memory War” as I suggested. There you’ll find that encouraging a patient to “remember” things that had seemingly been inaccessible to them before their contact with the therapist led to the worst sort of family tragedy several thousand times. This wasn’t determined to be unethical on the patient’s part as you amazingly suggest is implied, but it was established as unethical on the part of the therapist and for many there were dire legal consequences. What I’ve just said is well documented and well known in the psychological and other mental health communities. How is it that you are unaware of this? Do you think you are immune from the same problems?

Your claim that Barnes doesn’t teach this is something I must reject. Your friend Carol Davis posted a note to the MFR listserve a while back claiming that she often feels “the hands of a dead relative (of the patient’s) on her shoulders” while performing MFR. Is this something else Barnes doesn’t teach or does it fall into the category of “anything can happen”?

I’ve much more to say of course. Tell you what-tomorrow I go to Idaho and then on to Washington. I will be glad to specifically report what I might learn from my students about what they’ve been taught at your courses. There’s always a few around and I've heard the same story many, many times. We’ll see what they heard Barnes claim and what their experience with his courses has been.

[Jon Newman]

I understand that many readers may have a negative opinion of MFR, but what has fostered this? Is it the lack of research?

For me, it is the lack of a biologically plausible theory and the spreading of the implausible theory for monetary gain as well as the recent description by a participant of MFR work (done in Sedona, by those that are representative of MFR).

I no longer have access to that blog to post here. That person's description seems to stand apart from some of the contentions in your post. Perhaps she was lying, I can't know. I've heard anecdotal evidence by those who have taken MFR courses that the work described in the blog is a logical extension of what is taught in MFR courses although many MFR practitioners don't actually do what was described (in the blog). Walt, you could shed some light on whether her description was accurate or not assuming you've read the blog. Is her experience what someone could expect from an MFR retreat?

[Diane]

Hi Walt,
OK, Barrett has laid out a few of his concerns, and Jon.
I have two (for now), that I will try to explain as clearly as I can.

1. By "interior work," I wasn't referring so much to the psychic side as I was to the actual internal pelvic work conducted by the man himself with two to four aids present, coupled with plenty of "emotional release." This took place at his "center," was described by an adventuresome blogger, and brought to the bullypit's attention by Barrett. Do you support this, in light of all that is known about therapeutic transference and countertransference?

2. The concept itself: that it is possible to get at anything, really, myofascia or what have you, to "release" it, through skin/brain defences. (To be ruthlessly honest here, it isn't just MFR I have a problem with: As a neuronut I think that all mobilipulation concepts took off with "premature cognitive committments" and have continued to forge forth mistakenly ever since.) But back to MFR, you say that you do feel the nervous system is involved. Do you teach that in your classes or do you teach that idea about hands-on being able to unravel fascia as if it were an ill-fitting, lop-sided sweater?

You mentioned that research has been done; could you bring us some links?

PS: I'll see if I can find the woman's blog link. Barrett can you remember the name of the thread? It was in crosscountry I think.

[Barrett Dorko]

Here's the blog Jon refers to:

http://mfrjourney.blogspot.com/

[Luke Rickards]

We have found that creating safety and mutual respect allow the individual to express themselves in their own way. We never force, we never lead.

Hi there Walt,

There are many types of manual therapy that suggest the therapist approach the patient in the way you have descibed; Biodynamic osteopathy, Balanced Ligamentous Tension Technique, Craniosacral Technique, Functional Technique, Simple Contact. I wonder why it is that only MFR causes the patient to have emotional outbusts and explicit traumatic memories.

Luke

[Walt Fritz]

MFR

Diane,

Thanks for repositioning my post, though I’d prefer something other than “deconstructed”! Barrett, check out this latest research, if you think the fascia is so passive, again, right here on PubMed:
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

I’m assuming those present have not taken an Upledger class, or at least an advanced one (SomoatoEmotional Release?), in addition to a Barnes class. John does not hold the mortgage on allowing patients to feel safe enough to release fully. As for doing internal work, I can only speak for myself. I New York State, our PT practice act allows internal treatment when indicated and this has proved invaluable for many of my clients with longstanding pain syndromes. I remember a thread on RehabEdge where this was brought up, I believe in negative references to John’s woman’s health seminar. When properly trained, the therapist can release a wide variety of problems, which are simply inaccessible from the external. There seems to be a bit of professional jealousy over John’s success which has guided many of these posts in the past, at least from how I interpret them. Yes, John has been wildly successful, with two clinics and after having taught over 50,000 therapists his work. But students keep coming back and patients willingly come to his clinics because MFR works. (Yes, Diane, a lot of this has been a long time coming!). As to other therapists being in the room during the internal work, every patient has the right to request a private session, as many of my patients who went for work at one of john’s clinics have requested.

As to your second question, Diane, I’m not sure what you are asking. Yes, I feel that MFR allows you to get at the entire body, including the nervous system. If, for example, freeing an ulnar nerve that has been trapped under layers of muscular and fascial restriction via one simple cross handed technique is accessing the nervous system, I believe so.

Barrett, if we are comparing stories about what happens in classes, and relying so heavily on another person’s experience rather than our own, I must relate a story told by a friend who attended one of your one day seminars. When she was “found out” to have taken some MFR classes and as you were demonstrating a technique on stage, you angrily (her words, not mine) asked her if she sees any emotions coming from this student. It is doubtful whether anyone would feel safe enough to let such things out with this kind of judgment hovering over them. As to “us guys” assigning properties to the connective tissue that it simple does not possess, here are a few references from peer reviewed journals that you may have missed along the way:
-Fascial Plasticity- A new neurobiological explanation, Robert Schleip, J of Bodywork and movement therapies, Vol 7 No 1, Vol 7 No 2, 2003
-Myofascial release of carpal tunnel syndrome. Sucher BM, J Am Osteopath Assoc 1993 Jan:93(1):92-4, 100-1
-Vaginal surface EMG analysis in women with interstitial cystitis and vulvodynia treated with Myofascial release, Anderson, RU et al http://www.ichelp.com/research/2000A...Abstracts.html
-The basic science of Myofascial release, Barnes, MF J of Bodywork and Movement Therapies (1997) 1(4), 231-238.
-Myofascial Release therapy for category 3 chronic prostatitis, RU Anderson, MD, et al

There are more, but these are all I have at hand this morning. As for trying to denigrate another PT, Carol Davis is a very talented therapist as well as an established PT educator and researcher. What you picked up while lurking on the MFR chat line from her is not, nor is any, designed to show proof of anything. That is one limitation of the MFR chat line format, you are listening in on peoples personal experiences. So picking a post from quite a while ago in order to prove some obscure point seems irrelevant. By the way, doesn’t our APTA Code of Ethic (principle 11) say, “A physical therapist shall respect the rights, knowledge, and skills of colleagues and other health care professionals”? Seems like you are in violation with the constant inflammatory barrage that you heap on John as well as the rest of us in the MFR community.

I have not read “Memory Wars”, as you suggested. But I’ve seen countless times where you send posters to you website to read your articles as if they were proof of something. As I’ve already stated, we all find information and research that we think bolsters our claims. You, I believe, are guilty of the same offense. As I stated, John encourages nothing to be pulled out of the subconscious. I, by chance, someone on your table came up with a memory, what would you do? If I follow your line of reasoning, you just committed a heinous act, as the blame cannot be place on the patient. To be in the room with someone when they remember something, when no effort was placed on the therapist’s part to elicit this memory can be unavoidable. Patients are always encouraged to seek proper mental health counseling as a part of our MFR training. This reminds me of an event that happened when I was sharing a new office space with a massage therapist. She was concerned that there may be too much noise coming from my treatment room and it would upset her clients. If a client began to express emotions, she wanted me to stuff a pillow over their mouths. I asked her what she would do if they began such an event. She responded that she would ask them to do so at home, not in the treatment room. Barrett, can’t you acknowledge that there is an emotional aspect to our pain? No injury, no matter how simple, lacks emotional quality. Take a class from John; this is not as scary or unethical as you may believe.

As you canvas you audience over the next few days, searching for MFR proof, reflect on your demeanor to see whether you foster the totality of your client’s best interests, or whether your biases are holding you and them back.

[Diane]

Hello Walt,
Thanks for your reply, and providing some links. I'm aware of Robert Schleip's heroic efforts to get to the bottom of things, have him bookmarked even.
In the interests of containing this conversation so as to not have you feeling barraged overmuch, and have you not jump on Barrett directly for having demonstrated a bit of a curmudgeonly attitude, perhaps, in the past, let's get our queries and concerns answered one at a time.

I will go first, because I am here. Let's pick this one, to start:

As to your second question, Diane, I’m not sure what you are asking. Yes, I feel that MFR allows you to get at the entire body, including the nervous system. If, for example, freeing an ulnar nerve that has been trapped under layers of muscular and fascial restriction via one simple cross handed technique is accessing the nervous system, I believe so.

My simple question on somasimple: How?.. I.e., by what mechanism?

(On a different topic, what word would you suggest I put up in the thread title instead of "deconstructed"? Another small thing, your second link doesn't work, any chance you could fix it? Thanks.)

[Walt Fritz]

Link corrected

Diane,
Here is the corrected link, will respond further when time permits.

http://www.ichelp.com/research/2000A...Abstracts.html

Walt

[Diane]

Thanks Walt.
Here is the abstract that is pertinant to this discussion:

20. Vaginal Surface Electromyography Analysis In Women With Interstitial Cystitis And Vulvodynia treated With Myofascial Release
R.U. Anderson, D. Wise, M. Meadows. Stanford, CA
Women who suffer from IC and vulvodynia often have pelvic pain from myofascial trigger points and pelvic floor dysfunction. Physical therapists are able to perform myofascial release and monitor progress with surface vaginal electromyography (EMG) sensors.
At the Stanford Urology Pelvic Pain Clinic, women with pelvic pain and painful internal trigger points were studied. They had an exam along with a visual analog pain score (VAS), pain questionnaire and a urinary score. These patients were then treated with weekly myofascial release massage, trigger point compression and biofeedback for two months. Of the 43 women (ages 23-85) evaluated and treated in this study, 49 percent had interstitial cystitis and 51 percent had vulvodynia.

The study concluded that internal myofascial release therapy can be a complimentary physical therapy treatment for women with chronic pelvic pain syndrome. The EMG sensors were a useful tool in measuring the improvement of the pelvic floor dysfunction.

Again, the point is, by what mechanism?
(Also, I see a mention here of "trigger points", another topic worth some perusal/potential deconstruction or at least decompression of meaning.)

[bernard]

Hi All,

These patients were then treated with weekly myofascial release massage, trigger point compression and biofeedback for two months.

Diane, I agree with you, all the three "treatments" act on an unique site: Brain.

[Barrett Dorko]

Walt,

Let’s begin with this: You’d probably be better off not telling me how to behave. I’m nice enough I suppose, but I’m not especially charming. Charming is for con men. Perhaps you didn’t know this. And as far as that remark about jealousy goes, you might assume that I wouldn’t want what you call Barnes’ “success.” After all, I can still get my courses approved for CEUs for PTs in every state in the union. I know MFR courses struggle with this increasingly. Why do you suppose that is?

This thing about recovered memories seems to have you confused. It isn’t the patient’s statement that they remember something that is the problem, it’s what the therapist does with that information. When they treat it as if it is the authentic origin of the patient’s problem and go on to encourage its fuller expression (this includes profound emotive responses) they are at best beyond the depth of their knowledge and training and at worst acting in a fashion proven unethical over a decade ago. I hope that clears up what I’ve said many times in many essays and posts though I have my doubts. You ask if I “can’t acknowledge that there is an emotional aspect to our pain.” When and where did I ever say there wasn’t? Such a question simply implies that I am something other than human. I recite poetry to my patients for cryin’ out loud.

If Carol Davis chooses to say publicly in 2003 that she is evidently asking her patients (“often,” by the way) about their dead relatives during the course of care and that this "boosts the energy," I must presume that this is a common practice in her office. I make no apologies for objecting to this sort of thing being done and billed for as physical therapy. I’m suppose to respect that to such a degree that I remain silent about it?

Can’t do it.

[Jon Newman]

Walt states:

Had any of the people who commented on this bothered to attend one of John’s seminars, they would have heard him say that he teaches every therapist never to counsel, and never to tell anybody what to think, feel or do, never try to make anybody express emotions, or to do anything that does not feel natural to them. We have found that creating safety and mutual respect allow the individual to express themselves in their own way. We never force, we never lead.

Dottie, in her blog about her MFR experience in Sedona, reports:

Then it was time for my session. Tina was my therapist. As I type this, I don’t remember a lot about this session except that at one point Tina had me trapped face-down on the table. Now Tina has a tiny body, but she has a HUGE essence and when she is on top of me holding me down, it feels like I have a brick house on top of me. And I know that she was holding onto the other side of the table adding even more weight on me. I seem to have a lot of “fight” in me so I assume I was fighting or needing to fight. I struggled and struggled to get her off of me. Of course, she was encouraging me to “get away.” I was crying and getting angrier and angrier, and finally got her off of me and swung my feet off the table and onto the floor. I turned and shoved her away and then turned back to the table and shoved it hard across the room and onto its side. I desperately wanted to get away. But there wasn’t anywhere to go. The room was small and this one didn’t have a deck attached. I ran to the corner of the room and shoved my face into the corner. When Tina told me that I was safe and had gotten away, I cried “Then why am I hiding in this f**king corner?” She told me to come out of the corner – to find my power – and that I could stop hiding.

One of these things is not like the other.