Disclaimer: I teach continuing education seminars for a living.
When we touch patients in a therapeutic intervention, how many different “things” or actions can we really be accomplishing? How many different structures can we really make contact with or elicit change?
With higher levels of training come apparent deeper and more precise technique and expectation, while the beginner is viewed as less-than. If your practice is like my own, you receive referrals of people who have seen a multitude of manual therapists of all sorts. At the onset of the initial encounter, they invariably share what others have said about their problem as if all of that information is necessary to get to the bottom of things.
I patiently listen as they rattle off a list of claims made about their problems, with many trending into the catastrophizing mode (the WORST trigger points that therapist had ever seen!).
We are all touching the same body in much the same places, but most are believing we are feeling and finding vastly different structures and problems, both normal and aberrant.
To stay in the first person, my brain filters this information and tries to put it all into a framework of my evaluation findings and beliefs that I was taught and I will typically come up with a different language of what the problem might be. In the past I would have spoken in fascial-based language, calling palpated tightness a fascial restriction and telling a very compelling narrative on how these fascial restrictions, ignored by most in medicine, cause crushing pressures on pain-sensitive structures and only with the application of light, sustained pressures of myofascial release will they ever have a hope of resolving their issues. My language now is quite different, as are my beliefs, and I am much more circumspect about how I explain patient’s problems.
As I teach and travel I have a distinct privilege of meeting with and sharing beliefs with hundreds of therapists and professionals from a wide range of pressures. I am also active on hundreds (yes, hundreds) of niche’ manual therapy groups on Facebook and LinkedIn. Playing the fly-on-the-wall allows one to hear or read conversations that range widely from comparing and contrasting the effectiveness of various modalities to reading people’s suggestions for how to handle a problem case.
Well-meaning inquires regarding how to treat a difficult case are often met with a range of emotionally charged suggestions, most speaking to their favorite modality and citing the “inherited narrative” that goes along with this modality. (Thanks, Phil Greenfield!). As that fly-on-the-wall, I am struck with the hundreds of different modalities and narratives that therapists use in daily conversation.
It takes little effort to see that there really are hundreds of different modalities and sub-classes of modalities available to us as continuing education. But can we really be doing all of the things under the skin that those hundreds of seminar lines profess?
It is beyond the intent of this post to deconstruct any modality in this post. My point is to look at the commonality of our actions. Though our touch can often vary from light to deep, with holds that fluctuate from short duration to long, is there a simpler way to explain our touch rather than the often pained and convoluted models put forth by the various lines of teaching? Is it necessary to invent a new way the body works or a new way to describe how we impact the body in order to sell seats in classes? (A rhetorical question, as it apparently is.)
When we treat, we touch people in a manner that is intended to soothe, to improve the quality or ease of movement. This sounds too simple for many, especially those with advanced training. Many in our shared fields are working to simplify the explanatory model, rather than trying to make it more complex or secretive.
Join the Skeptical Massage Therapists group on Facebook, if you would like to see how this works. Read through the long list of threads and attached links to research and other reference materials. Take a side trip over to SomaSimple for a bit of mental flossing. These are very deep rabbit holes; ones that may cause you not to recognize yourself when you finally emerge. Don’t be surprised if you become defensive or angry as you read how others view your modality or its creator, but give it all time to sink in. How we affect someone when we touch cannot be as complex as many make it seem. Simple, well-meaning directed touch and presence may explain much of our outcomes. And this is not a bad thing
Pain Relief Center, Rochester, NY 1998-Present. Providing Myofascial Release treatment as a physical therapist to a wide variety of diagnoses and age groups. Practice consists entirely of Myofascial Release treatment. www.MyofascialResource.com. Founder of national based website for therapists practicing Myofascial Release and related types of bodywork. Extensive research collection for scientific publications of and around the field of Myofascial Release, as well as a treatment resource for therapists and patients. www.FoundationsinMFR.com. Information on quality continuing education seminars in myofascial release, with small group trainings and a high degree of individualized one-on-one instruction at www.waltfritzseminars.com