Articles Of The Week December 31, 2017

December 30, 2017/1 Comment/in Article, Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

We have to be careful when loading certain injuries like a fracture or complete tendon tears. However, with muscle and tendon injuries the evidence is showing that loading early is beneficial, and a little bit of pain isn’t a reason to back off.

“Starting Rehab Early Can Speed Recovery From Muscle Injuries: Study” – The Globe And Mail

This is a great article (however I think I connect with it because I used to be that guy!). Manual therapy is great, but we don’t need to crush tissues or use heavy weighted force to ‘release’ tissue. We need a more logical way to work, and this article helps us understand that.

“Should We Crush Tissue?” – Mitch Hauschildt

This one is actually a video from David Butler on assessment of the upper and lower limb. It’s great information and can be implemented in your clinical setting right away.

“NOI Neurodynamics” – David Butler

We are all business people, so it’s just as important to learn about business as it is therapy. This article shows how recognizing a pattern and reacting to it differently can change a bad habit and create new positive ones.

“How Your Patterns Can Kill Your Business – The Solution Is Not So Simple” – Alley Jean

I’m sure we’ve all helped a patient in our practice who has dealt with a concussion. Whether from a car accident, a fall, or from playing sports, concussions can be difficult to deal with. For this reason, some parents are pulling their kids from sports because they’re afraid of them getting a concussion. But what about all of the other things sports do for kids? Here are 5 reasons why they should still be in sports:

“5 Reasons Kids Should Play Sports” – Complete Concussion Management

Change is hard, change within an entire industry is even harder! However, this post goes on to discuss why manual therapy needs to change, and why the change is important.

“Embrace Change” – Eric Purves

Articles Of The Week December 24, 2017

December 23, 2017/in Article, Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

We all know how important movement is, but what about the quality of movement? Well, there are a few things to look at in this regard, and Greg Lehman has some arguments around pain, movement and quality of movement.

“Why I Put Strength On Dysfunction” – Greg Lehman

How good are you at listening to your patients? There are times where a patients recovery could be held up because they are blaming the scenario that put them in pain. But if a person feels they have been heard, they may have less of a reason to hang on to that blame.

“The Blame Game” – Alison Sim

As humans, we have many different behaviours. Did you know we also have pain behaviours? These behaviours can influence your patients response to pain, so there may be a way for us to help them if we understand this better.

“One Way Of Using A Biopshychosocial Framework In Pain Management – II” – Bronnie Thompson

I’m sure we’ve all heard (and some of us have preached) about not letting your knee go past your toes with certain exercises, in an effort to have great form. But what about when the intent of any given exercise changes? Here’s a great article looking at the mechanics of a split squat and how its intent and thus form can change.

“The Split Squat And The Knee Over Toe Conundrum” – Michael Gouldon

This one is important, not just for our loved ones, but also for our patients. There may be cues you pick up on with your patients, where their loved ones may not. Its important for all of us to be able to recognize warning signs of dementia, so this article should help.

“5 Early Signs Of Dementia (And Why Everyone Should Know Them)” – Jamie Wiles

Treatment Tips: An Easy Way To Achieve Posterior Pelvic Tilt

December 18, 2017/in Article, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Walt Fritz

As I teach, there are certain concepts/techniques which are self-explanatory, while others have nuances which make them harder to convey, both in the classroom as well as once the therapist is back in their clinic. In the past, I’ve sent out Treatment Tips, but the printed word and still photos only go so far. Recently I had another photo shoot to provide updated content for the new Upper Body and Lower Body Foundations in Myofascial Release Seminars as well as the renamed Myofascial Release for Neck, Voice, and Swallowing Disorders Seminar and we shot a dozen or so short sequence videos. Here is the first one and excuse the first-time-editor-mistakes.

Though not a mandatory aspect of lower back/abdominal/pelvis manual therapy/myofascial release, increasing posterior pelvic rotation and applying light lumbosacral traction often changes the dynamics while treating.

My preference, and what I teach, is manual sacral traction applied in supine with the opposite hand on the lower abdominal region.

I beg and plead with therapists to try this method, but I know that placing a hand under their sacral area by placing the arm between the legs is too much of a boundary issue. I get it. So over the past few years, I devised a “cheater’s” method of accomplishing sacral traction/posterior pelvic tilting without the need to place a hand under the sacrum. Watch the video to see what I mean:

Pretty easy, right? If you add a piece of Dycem under the sacrum beforehand, you have an even better-felt sense for the patient. You can find more treatment tips over at Foundations in Myofascial Release Seminars.

Articles Of The Week December 17, 2017

December 17, 2017/in Article, Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

If I’ve heard this once in life, I’ve heard it a thousand times, (Work Smarter, Not Harder!) however, this is the first time I’ve heard it from a fellow therapist. And what’s cool, is that it’s from one of my heroes in this profession. She’s one of the few who will tell it like it is (and honestly, when I first started following her, she pissed me off but I realized she’s pretty amazing), which is rare for us. So take her words to heart!

“How Massage Therapists Can Work Smarter, Instead Of Harder” – Alice Sanvito

I’m sure we all have patients who are dealing with fibromyalgia. For me, I sometimes wonder what advice to give as far as home care. This article comes straight from someone with the condition and gives some sound advice for this holiday season that you could share with your patients.

“Banish The Word Should For The Holidays” – Christine Lynch

Rajam Roose gives some quality advice on client retention and building relationships in this post. I promise if you even do one of the things she recommends you will see a return on your investment, because if we’ve said it once, we’ve said it 1,000 times, building relationships is crucial in this business.

“Retain Your Massage Clients” – Rajam Roose

This one is a conversation piece. A conversation with Lorimer Moseley so you can understand the difference between pain science education, and understanding pain science. And let’s be honest, anything with Lorimer in it is worth reading.

“Lorimer Moseley WOW Chat: Pain Science Education Vs. Understanding Pain. What’s The Difference?” – Shelly Prosko

This is a great post on pain and why it persists. Everything Rachel writes in this post, you could easily use as an explanation to your patients. Please give it a read and use the info she has shared, and talk to your patients about what meaningful touch is!

“Why Does Pain Persist?” – Rachael Scott

The Science Behind Why Assessing And Blaming Posture For Pain Is B.S.

December 11, 2017/in Article, Massage, Massage Clinic, Massage Therapist, Massage Therapy, Pain/by Ben Cormack

If I had a £ for everybody that mentioned posture on social media or when they had a pain problem…… well lets just say I would be a pretty rich guy.

POSTURE has literally become engrained in peoples thoughts when talking about back, shoulder or neck pain even though we have a shit ton of studies that compare the postures of pain-free people with those with back, shoulder or neck pain and find no real differences, this information gets regularly IGNORED.

NEVER let science get in the way of a good story, especially if it’s on the interwebs!

In fact, I have written about posture a few times before:

The definitive guide to posture and pain 3 minutes flat

Do you really need your joints to be centred?

But just to kick off with a bit of science, this paper HERE from 2016 found NO significant difference in lumbar lordosis (spinal curve) between people with back pain and those without.

This is super important. HOW can we blame something that we see in people WITHOUT pain as a cause of pain for those that do?

I will just let that sink in…

What Are You Measuring?

In this blog, we are going to explore a few questions related to how we assess posture and if they are actually scientifically VALID, because if you don’t have a good measure, to begin with then it is pretty tough to blame something for the problem.

The first piece of ACTUAL EVIDENCE, something often missing in the posture debate, looks at the measurement of STANDING LUMBAR LORDOSIS (the curve in the back often blamed for back pain) and this assessment is something that is performed in treatment rooms and gyms the world over.

The idea is that an increase (and sometimes decrease) in lumbar curve increases back pain and is often coupled with the idea that the tilt of the pelvis has an influence on the size of the lumbar curve, even though lumbar curves do not seem to be much of a factor in lower back pain anyway (see the SCIENCE above : )

Way back in 1990 this was explored by Heino et al HERE and they found that the angle of someones pelvic tilt and their lumbar curve do not simply correlate! So looking at the position of the pelvis tells us very little about what is occurring at the lumbar spine, which is much harder to measure. A very similar study HERE from before this in 1987 also threw up the same result but this BS is still being taught today.

Anyway, back to the standing measurement paper HERE. The authors explored the variability in standing posture of 400 people, 332 without pain and 83 with low back pain, and they found that each time we stand we do it in a slightly different way.

The authors in their words state “standing is highly individual and poorly reproducible”.

So why does this matter?

Well simply put, which posture are you ACTUALLY measuring with your postural assessment. One may show an increase in lordosis, another less so.

I have some questions related to how we interpret postural assessments in light of this information.

Which of these postures is related to the problem?
How many times do you measure and do you average?
What are you comparing against to determine if the curve is too much or not enough?

The authors highlight a good point that the lack of consistency in standing posture may actually lead to the “wrong diagnosis and possibly unnecessary treatment”.

If you focus on something that is not an issue you do not focus on something else that might be or be blinded to the fact that it is not working or only works transiently (potentially why so much back pain is persistent).

What people actually use in their everyday lives might also be different to what is measured in the clinic or gym. A clinic or gym measure could be described as a ‘snapshot’ and this study HERE compared this ‘snapshot’ to what was actually used on a daily basis by the study participants.

The authors found that on average whilst standing, as most postural assessments are, there was a 33.3° lumbar lordosis but the average used over a 24hr period was only 8°, a huge difference!

So the ‘snapshot’ postural assessment would not really inform us very well about how much lordosis was REALLY being used and we could overestimate the extent of the imaginary problem.

We also have to remember these were radiological measurements and this is the clinical ‘gold standard’. Often a lordosis is measured in a much more rudimentary fashion by looking at the relationship of landmarks at the pelvis indicating a pelvic tilt and therefore change in the lumbar curve, which we have already discussed as not being well related to lumbar curve! This in itself is a problem as demonstrated by Preece in 2008 HERE as pelvic morphology is also VARIABLE leading to incorrect measures.

“These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry”

Here is the distribution of side to side difference of the ASIS-PSIS relationship (used to assess pelvic tilt), we can see it is skewed to the right side meaning it is more anteriorly tilted at a BONY level.

So it might be that we are really bad at measuring something that doesn’t matter that much. OUCH

Are You Biased?

Another important question for those that assess posture is…are you MORE inclined to see an ‘abnormality’ in posture when you know pain is present?

This paper HERE would suggest so. Here the authors looked at scapular dyskinesis or abnormal posture and movement of the shoulder blade, which is often proposed as a CAUSE of shoulder pain.

They compared 67 people with shoulder pain and 68 without and firstly found that there was no difference in shoulder posture or motion between those with pain and those without.

Fascinatingly though when the assessors were aware that they were assessing someone IN PAIN, they reported a greater prevalence of a postural or movement problem. This shows a bias towards finding an ‘abnormality’ to blame when there is pain, even though there was NO MORE ‘abnormality’ in those with pain than without.

The authors also suggest that scapular dyskinesis actually represents normal variability between humans! Perhaps if they assessed it multiple times it would throw up different measures each time?! It is important to remember we have no scientifically defined ‘good posture’ to base deviations from in the first place.

How Do Healthy People Sit?

Another question is how do people without back pain actually behave? They must have great daily posture, right? Well actually NO.

This paper HERE shows that asymptomatic folk, 50 of them, when seating actually SLUMP. In 10-min sitting, spinal angles flexed 24 deg at lumbar and 12 deg at thoracolumbar regions relative to a standing posture. But this slumping does not seem to cause them problems.

So changes in our spinal curves seem to be fairly unrelated to pain as we can see below.

So If Posture Does Not Really Correlate With Pain, What Does It Correlate With?

Well, this paper HERE shows that cervical spine alignment changes actually correlate with age. This study split the participants into 4 groups determined by age. They found that the measures of the angles of the neck all correlated with the increasing age range of the 4 groups.

The key point to remember here is that all the participants, 120 of them, had no pain. In fact, the exclusion criteria here was pretty rigorous and the authors actually excluded 64 people, so 1/3 of the original sample, for having current or previous pain.

So simply put, as we get older our posture becomes ‘worse’ or perhaps better put our posture increases….BUT and a this a big BUT, this does not seem to cause MORE pain.

To sum up it does not seem as simple as ‘bad’ posture = pain whatever you read or are told in a bar, gym or clinic room.

Key Take Homes

People IN pain DON’T have different postures to those that don’t have pain
Posture displays variability just like movement
This means your assessment may not tell you what you think it does
Your assessment could be biased to finding a postural ‘problem’
Postures used throughout the day are probably different to those being assessed
As we get older our posture change and this happens to people NOT in pain too

Articles Of The Week December 10, 2017

December 9, 2017/1 Comment/in Article, Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

Great article about pain and why we experience it. One of the great things about this article is that while we are becoming more aware of pain science in massage therapy, not all industries are as aware of the new research. So Elie Somers is bringing it to the strength training industry.

“What Is Pain And Why Do We Experience It” – Elie Somers

As we all heard about the Massage Envy stuff last week, there were blogs everywhere writing about it. But I found this one especially interesting. Is it possible that the Massage Envy debacle is our fault?

“An Open Letter To The Massage Therapy Profession: Massage Envy Is Our Fault” – Lauren Cates

There are many facets to our massage therapy and business. One facet is our massage schools and education. Apparently, some organizations expect schools to show up and have their students provide free work. But is this right, or should everyone have to pay for students to provide massage?

“Free Student Chair Massage? Nope!” – Jill Berkana

I liked this one because there is a lot we can liken to being massage therapists. While our scope is different, there is a lot Paul is saying in this post we could look at as well. There is so much massage therapy can do to be part of healthcare, but WE have to evolve and develop in order to be looked at that way.

“Physiotherapy, Come Forward! (It’s Time To Step Out From Behind The Curtain)” – Paul Lagerman

How is the culture in your clinic? Is it an open and psychologically safe place where comments and new ideas are easily presented? While it’s intended for companies with employees, this is something that could be applied in our clinics as well to create a culture of psychological safety.

“How To Create A Culture of Psychological Safety” – Jake Herway

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