Myofascial Release; The Great Conversation

[Walt Fritz]

Barrett,

Don't lose interest just yet. Viewpoints in opposition makes for a wonderful discussion. By the way, being openly critical of another's ideas is not inappropriate. "11.3 Disparagement

Physical therapists shall not disparage colleagues and other health care professionals" (APTA Code of Ethics)...........Seems like a fine line to walk.

So lets see if we close the circle a bit.

Barrett:

But here’s the thing, buy his own admission Walt is not a scientist. He went to college and he has a license, but using scientific principles to treat patients with physical means-the definition of physical therapy-doesn’t evidently apply to MFR practitioners. There’s a certain convenience here, especially when you consider what Barnes’ students are asked to believe.

Ian Stevens in England recently suggested I read Science and Poetry by Mary Midgley. She points out that social scientists cannot use the methods available to physical scientists. What they often end up doing is philosophy, whether they notice it or not. During my years of observing the conversations on the MFR Chat I saw numerous references to MFR as something much more than a treatment approach but rather an entire way of seeing the universe and living our lives. Of course, this isn’t science, it is philosophy, and, in my opinion, not a good one-given all the “power animals,” “spirit guides,” “past lives” (intruding on this one) and “energy” involved. Some people like this stuff and feel it is an appropriate way of explaining what happens in the clinic, but they aren’t scientists.

Let me see if I follow you. You seem to be saying that we are practicing a form of social science or philosophy. So, when a client comes to see us, they give implied consent to recieve treatment based on science, not social science or philosophy. By not overtly imposing our will to do so, you seem to be claiming that we are guilt of not practicing in a scientific way, right? (you may claim we do it overtly, but we will differ on this) Forget the fact that if a person comes up with a notion of a past life, it was not overt on our part.

Barrett:

I recite poetry to my patients for cryin’ out loud

Now, I've yet to read anywhere that poetry falls into the category of hard science, much less social science. (Maybe it can be called philosophy, depending on how good you are at it) You, choosing to recite poetry to your client is certainly a willful insertion of non-scientific beliefs, views, or opinions. Even you must recognise that words can have an equal potential impact on patients as any physical action that you seem to accuse us of. (Don't we all have a memory of something said to us earlier in life that remains with us in a negative way?) You are overtly and purposefully inserting non-scientific information that has the power to influence (and possibly harm, depending on a person's state of mind), which is EXACTLY what you are accusing us of. It is doubtful whether any of us can truthfully say that every technique we perform and word we mutter during a treatment session has infallible scientific backing. This is not splitting hairs. Choosing to recite poetry to a client at a certain time during a session is inserting non-scientific matter into a setting where supposedly none should be allowed. Barrett, please recognise what you are asking us to believe. You are committing the same crime as you accuse us of. If I might speculate, you probably choose a certain passage of poetry (yours or someone else's?) to insert at a particular moment...unless you are reciting them like Muzak in the background....say, Robert Frost's The Road Not Taken when someone is at a crossroad of life. You have imposed your will. You may want to claim that this is far-fetched, but not so. Insertion of non-scientifically based information into a treatment session, if we are to follow your line of reasoning is wrong.

Why did John Barnes not come on to debate you himself? Don't know, why don't you ask him? And don't worry, maybe a few more friends will show up.

Barrett:

I’ve had about 4000 students in 72 cities this past year. All have been informed about the location and usefulness of Rehab Edge and when I speak of the ease with which they might discuss issues and have questions answered here they all nod their heads. To date, two have actually contributed to the discussion

, from: http://www.somasimple.com/forums/sho...light=students

Lets face it, the readership of any site like this is low, and if I hadn't talked to Dave about it, he wouldn't have known a thing. Not to demean the value of this and other site, I think they are invaluable sources of information and dialog. This is why I feel that we are, at present, the only two who have shown up.

Barrett, I still truly believe that you teach good work and would like to attend one of your classes some day, that is if I'd still be welcome. Just realize we are all working in the gray zone.

Walt

[Dave Vollmers]

Barrett -

Here are the definitions of subjective and objective per Websters dictionary

Subjective
Adjective
1. Taking place within the mind and modified by individual bias; "a subjective judgment".
2. (philosophy) of a mental act; occurring entirely within the mind.


Objective
Adjective
1. Undistorted by emotion or personal bias; based on observable phenomena; "an objective appraisal"; "objective evidence".
2. (grammar) serving as or indicating the object of a verb or of certain prepositions and used for certain other purposes; "objective case"; "accusative endings".
3. Emphasizing or expressing things as perceived without distortion of personal feelings or interpretation; "objective art".
4. Belonging to immediate experience of actual things or events; "concrete benefits"; "a concrete example"; "there is no objective evidence of anything of the kind".

I am utilizing the 1st definition in each word. In working with patients and chronic pain, everytime you ask your patient to describe their pain or to rate it on a universal pain scale of 0-10 (0 = no pain and 10 = worst pain ever) or even utilize a 10 inch line and asking a patient to point to a place on that line that would describe their pain you are getting a response based on the patient's exeriance and tolerance of pain. The only objective data that can be derived from patients is ROM and even that depending on their pain theshold they will gaurd or at best during PROM you will have descrepencies between how much force you are exerting to obtain that PROM as well as the placement of the goiniometer. Therefore unless you have some equipment that measures pain (maybe an EMG) you are only getting subjective data. Even when you ask a patient to rate how much/little improvement they have had with treatment you are still only getting a subjective response regarding their pain levels or their ability to perform ADLs and again only the ROM measurements can be considered objective but even that there are reliability issues that you must admit to.

If you have found a way to eliminate a patients bias or life experiances to gain objective data in your research than I would love to know about it.

Hope this clarifies things for you

Dave

[Walt Fritz]

Hi Bernard,

Dave,

I'll take no offense about the last sentence but without the external machinery, have these human beings some chance to live?
Have they a chance to say something or feel something we may recognize (a facial expression)?

It remains a dramatic situation where all actors have difficulties to move freely.

Is there a chance that a paralysed limb may be cured/treated by MFR?
Just take some minutes to think about this riddle?
__________________
bernard

I'd like to give you an example of MFR at work, using a variant on the "paralysed" limb. I know that case studies are frowned upon by many, but that's what I work with! I have a 3 year old with a severe brachail plexus lesion (BPI) from childbirth, with 4 major surgeries for nerve grad=fts, neorolysis, diaphram placation, and "mod quad" procedure. Poor use of the left limb. She has been recieving PT and OT since around 6 months of age. Mom brought her in recently to see what could be done after recieving information on MFR at a national BPI conference. She had gotten Botox injections in the right forearm flexors a few weeks prior, in an attempt to allow the extensors to be worked and exercised by the OT. I see her for 25 minute sessions. At the start of the session, she demonstrated no active writst extension, as she has done all along. Full passive range of motion. I performed 25 minutes of cross-handed myofascial release to the wrist extensors, lateral epi to wrist. After 25 minutes, mom asked her to extend her wrist and she did it on the first try. Weak, but full active ROM. It has maintained itself over the 3 weeks since this treatment, via active encouragement and therapy by all involved. Did I take the pressure off of the nerve? Maybe. Was there so little extensibility of the neuromuscular complex that active motion was unavailable? Maybe. Was the strength actually present, but the compressive forces of the fascial system were too great for her to overcome? Maybe. Take your foot off of the garden hose and the whole system can work. Hope this helps.

Walt

[nari]

Dave

Tell me how an EMG objectively measures pain. The rest of the world doesn't seem to know this....

Nari

[Luke Rickards]

Dave,

You have completely misunderstood Barrett's point.

"Keep in mind, if you treat patients you must deal in a subjective world that forces the scientific model to change because when you deal with patients you will never have true objective data to work from."

The scientific knowledge of the functioning of the human nervous system does not change one bit when we ask a patient about their experience of pain. How can asking a patient about their experience suddenly cause the transduction of nociceptive impulses in irritated tissue, conduction into the CNS, processing in the brain and descending response to all cease and somehow this entire process to be transferred into a tissue that simply does not have these capabilities? I am just a surprised at your statemant as Barrett. It is incorrect.

I can see quite clearly that you are "not up in (your) research of the brain". You should take a look. Neuroscience is a fascinating place where all kinds of archaic myths are dispelled.

Luke

[Jon Newman]

Walt,

Giving someone verbal encouragement is standard practice in human relations. There is scientific explanation behind why it might be good to do this but most understand it intuitively. This is a far cry from pinning someone to a plinth table and then telling them after they've escaped 'good job, your safe now'. To contend that the need to escape was, a priori, stored in the fascia (somehow causing neural irritation) and you simply released this pre-existing emotion is unsound.

Dave,

Pain is a subjective experience but to contend that because of this that science has to change is not logical. There a clearly objective reasons why we come to experience pain. If you set down the article about guns and pick up an article about pain physiology you'll see why it is unnecessary to attribute pain reduction to dolphins, pre-newtonian physics or the special memory capacity of fascia.

[Dave Vollmers]

Nari -

As far as I know you can't get pain measurements from an EMG but I figured anyone who can get objective data from a subjective report might be able to

[Dave Vollmers]

Luke and Jon -

You are missing the point. Each person's perception of pain is different based on their life experiance. Yes the nerves conduct the same way but the persception the person has is based on their life experiance. If this is what you and Barrett truly accept or believe? The more I read your post the more it appears to me that you are negating the value of a person's life experiance in the interpretation of their pain.

Please explain to me what your thoughts are on a person's life experiance and how it releates to how they percieve pain. As of your last post it appears that you don't think it matters and therefore I can understand why you think that when you ask a patient to rate their pain it would be objective data and void of their personal bias.

Of course after reading your post one last time I have to wonder if you are still stuck on the comment that the fascia "holds emotion". If so please rejoin the conversation - it changed to defining what fascia is, it's relationship to the nervous system and how it can influence the transmission of impulses to the brain. The comment I made to Barrett was in reference to his belief that you can get objective data from asking a patient to rate their pain and the fact that because of this when you study concepts in therapy it is not possible to truly have an objective research project because you are always dealing with how patients percieve their pain, life experiance, therapeutic relationship with the therapist as well as their current situation in life. Therefore scientific study of therapeutic techniques must adapt/change inorder to aknowldge this fact and move more to subjective research (otherwise known as case studies). This is why the therapy world is changing to evidence based practices.

[Luke Rickards]

Dave,

The comment I made to Barrett was in reference to his belief that you can get objective data from asking a patient to rate their pain

Please point out where Barrett said that. I maintain, you have misunderstood the point.

I can understand why you think that when you ask a patient to rate their pain it would be objective data and void of their personal bias.

Please point out where I said this.

your last post it appears that you don't think (personal experience) matters

Neuroscience clearly explains the effect of personal experience on the perception of pain (please read about Melzac's Neuromatrix) and I have no problem with that, only with idea that this experience is generated in the fascia.

I have to wonder if you are still stuck on the comment that the fascia "holds emotion". If so please rejoin the conversation - it changed to defining what fascia is, it's relationship to the nervous system and how it can influence the transmission of impulses to the brain.

Well, now we are getting somewhere. What then is your definition of fascia and what is its function? What do you see as it's relationship to the nervous system? How does it influence transmission of impulses to the brain? What do you think the brain does with these impulses? (I take it we will not see any evidence that the fascia stores emotion then?) Please answer these questions!

Thanks,
Luke

[nari]

Dave

I still can't find anywhere that states Barrett or anyone else gains objective data from subjective questioning. It is just not logical. The VAS (which is the term for pain 'measurement') is unreliable anyway ; like blood pressure it varies from hour to hour and would need to be taken consistently over a period of time to have any real meaning. It simply shows a bit of a trend, up or down or unchanged over several weeks.

I read recently that some people refer to the 'second brain' - viz, the base of the spinal cord. That's a bit mysterious to me, but it occurs to me that you seem to see the fascia as a kind of second brain in the system. Is this a reasonable assumption to make from what has been said so far?

We would like our questions answered, Dave, as this is a discussion. You have mentioned several excerpts and references, but they don't seem relevant to the topic. I still invite answers from yourself or Walt and wonder why there are not more MFRers responding....

Nari

[Jon Newman]

Hi Dave,

You state:

The more I read your post the more it appears to me that you are negating the value of a person's life experiance in the interpretation of their pain.

Please highlight the part of what I wrote that led you to believe this.

I would also like some clarification of the above. When you state "...in the interpretation of their pain", who is the interpreter in this instance?

[Jon Newman]

Walt, Dave:

I was wondering if you are under the impression that current neuroscience would require you to change your practice significantly from what you are currently doing? I ask this because it sounds like much of your clinical practice is worth holding onto. I think what most here are arguing about is your explanation of what you observe clinically, not what you are doing clinically (not including my already noted objections).

[Diane]

Walt, about your example:

I performed 25 minutes of cross-handed myofascial release to the wrist extensors, lateral epi to wrist. After 25 minutes, mom asked her to extend her wrist and she did it on the first try. Weak, but full active ROM. It has maintained itself over the 3 weeks since this treatment, via active encouragement and therapy by all involved.

All this tells me is that skin stretching done in a careful manner works quite well to restore lost movement function. (Can you spell, n-e-u-r-o-m-o-d-u-l-a-t-i-o-n?).

Did I take the pressure off of the nerve? Maybe.

I doubt it. "Pressure" may have come off "the nerve", but I seriously doubt it was you. I expect if anything like that did in fact happen it was your patient's brain that did all the heavy lifting.

Was there so little extensibility of the neuromuscular complex that active motion was unavailable? Maybe.

Again, doubt it. Faulty movement pattern, yes. Inhibited, likely. Probably not much wrong with any tissue at all.

Was the strength actually present, but the compressive forces of the fascial system were too great for her to overcome? Maybe.

Again, doubt it. The brain perceived a peripheral nerve in some kind of trouble (i.e., not enough oxygen), message relayed to it by nervi nervorum, it shut down movement until it could figure out the "problem" then couldn't get movement going again properly. Happens all the time.

Take your foot off of the garden hose and the whole system can work. Hope this helps.

Actually, getting the brain to take its own 'foot off the garden hose' is the big trick, the rest is child's play.

[Dave Vollmers]

Diane -

Before we continue our discussion I think I would like to break free alittle bit from the past few posts because I have begun to see a trend here that is starting to sound like we are not on the same page and I think it was the last exchange I had with Luke that helped me to see that.

I'm going to ask for everyones patience for a moment (no I'm not avoiding any questions or trying to change the subject, just slow down the ride a little so that everyone is on at the same time) while I step back and let everyone know my intent and see if that helps the discussion.

In talking with Diane it has been made clear to me that many of us are utilizing different words to mean the same thing and the definitions that John Barnes utilizes are different than others that are out there. This was made clear to me when Diane was able to accept my point that maybe the skin ligaments were what John describes/terms as fascia.

One last thing I want to make perfectly clear to everyone: I have left the comment that "emotions are trapped in the fascial system" for now because it appears that people are misunderstanding what we mean. Luke asked when that happened and he has a good point. Please read Walt's posts 42 & 46.

Therefore I would like to concentrate and continue my discusion with Diane regarding what is the fascial system, its importance and how it is influenced as taught by John Barnes. These are the basics of MFR and what should be looked at. One quick note regarding comments about power animals, spirit guides and post life experiances as it pertains to the methods taugh by John. These are concepts that have been discussed on the MFR Chat line and not at any seminars that I've been at. Understand that when you train over 50,000 therapists not all of them come from a scientific mind such as some of the people on this chat but rather an eclectic view of life - this in no way should have any bearing on this discussion because we are talkin science not cultural belief systems. For examples of John's writtings I would like to encourage any and all of you to visits John's web site at www.myofascialrelease.com and click the link for articles and take a look at some of these, it may help your understanding as to the frame of reference MFR therapists come from.

Now on with the show :teeth:

[nari]

OK, Dave, I will leave it to you and Diane. But we won't wander off very far....

Nari