Perspectives…on manual therapy

“Our understanding of the body is about to go through a radical shift.  Everything we ‘know’ about how our (bio)mechanics work—that we have 600 muscles that work via tendons over separate ligaments that limit our joint movement—has been to date the best model we have had, but it has become outdated, obsolete, and woefully inadequate.  These are all elements of one integrated system—the BARS (biomechanical auto-regulatory system), otherwise known as the ‘fascial system’.  Our old vectors-and-levers understanding of how that system works is about to go out the window.  We can now see how our fascia reaches into and affects all our cellular physiology and even our genetic expression.  Our children will understand the mechanics of movement in a totally different way from how we learned it.  What will replace our familiar and reassuring (but wrong) Newtonian biomechanics is a much more Einsteinian relativistic and uncertain world.

Touch is food, and we live in a starving culture.  We are going to need all our skill in touch and movement, all our understanding of the neural and chemical system, and yes, the fascial system (BARS) as well, to answer the unique challenge of the 21st century: keeping ourselves and our children embodied in a virtual world.” (Meyers, 2016)

In patients with chronic pain, the source of the pain is rarely the cause of the pain.  In fact, Czech physician Karel Lewitt often noted, “He who treats the site of pain is often lost.”  Lewit’s colleague Vladimir Janda conceptualized musculoskeletal pathology as a chain reaction.  He was a strong proponent of looking elsewhere for the source of pain syndromes, often finding causal dysfunction distant from the sight of the complaint.

“The manual therapy industry has evolved to a place where specializing in just one discipline/modality is no longer sufficient to treat complicated pain conditions and sports injuries. An ‘umbrella’ term, Integrated Manual Therapy, connotes the synergy of many modalities and disciplines integrated together, that allows the therapist to treat each client in a truly individualized manner.” (Waslaski, 2012)

“As the art and science of neuromusculoskeletal care evolve, it is becoming increasingly clear that manual techniques are essential in the management of patients with problems in this area.  What is less easily measured, however, is the impact of the degree of skill with which these techniques are applied, on the outcome of treatment.  Most clinicians who use manual techniques in the treatment of dysfunction in the locomotor system would agree, however, that the level of skill with which a practitioner applies a technique is of the utmost importance in the success of any treatment strategy.

Intuition would tell us that a clinician with limited skill and a limited variety of methods in his armamentarium, would be less effective, especially for a difficult case, than one who possesses wide-ranging knowledge and ability.  Muscle energy techniques (METs) are among the most valuable tools that any manual clinician can have in his or her toolbox.” (Murphy, D.R. in the forward to Chaitow, L., Advanced Soft Tissue Techniques, Muscle Energy Techniques, 2006)

The famous Dr. Ida P. Rolf (creator of ‘Structural Integration’) quote, “First, put everything back where it belongs, then introduce movement,” accurately describes a highly successful therapeutic sequence of manual therapy, which actually meets the criteria necessary for successfully treating painful functional lesions.

After 20 minutes of repetitive posture or repetitive movement, the viscoelastic component alters and your myofascia becomes biased (imbalanced) to that posture or movement pattern. Think of sitting at a desk, working on a computer, or a cyclist’s riding position.  It then requires approximately 60 minutes of continuous stretching to return this distorted myofascia to its correct neutral position.  This method for trying to return the myofascia to its neutral position, or ‘muscle balance’, will be ineffective unless you have several hours a day to devote to stretching.  A manual therapist can realign myofascia with a hands-on technique known as ‘creeping’ in minutes. Specific stretching/strengthening, which can also be accomplished in minutes (daily), is then introduced to maintain the realignment.

There exists a tendency in some schools of therapy (physical therapy?) to encourage the strengthening of weakened muscles (exercise?) in order to normalize postural and functional problems as a priority, before attention is given (myofascial release) to short/tight antagonists of the inhibited, weak muscles .” (Chaitow, 2006)

The above approach is ‘putting the cart before the horse’. In pathogenesis as well as in treatment of muscle imbalance, short/tight muscles play a more important, and perhaps even a primary role in comparison to weak muscles.  Janda continues, “Clinical experience and especially therapeutic results, support the assumption that (according to Sherrington’s law of reciprocal innervation) tight muscles act in an inhibitory way on their antagonists.  Therefore it would seem quite incorrect to start with the strengthening of the weakened muscles, as most therapeutic exercise (physical therapy?) programs do.  It has been clinically proven that release of the short/tight muscles must take place first.  Otherwise, the weakened group cannot, and will not respond.  Once the short/tight agonists have been returned to their neutral position, the strength of the weakened antagonists improves spontaneously, sometimes immediately, and without any additional treatment.” Janda (1978)

“Working in the pain-management field is a challenging, yet exceptionally rewarding, experience. Clients suffering from chronic pain are confronted by a unique disorder—a personal experience unlike any other physical malady. While an X-ray can confirm a broken bone and an infection can be detected by a simple blood test, there are no universally reliable tests available to measure pain levels. Because of this, many common musculoskeletal complaints are incorrectly assessed and treated.

To achieve a noticeable reduction of increased excitability in the neuronal pool, the pain-generating stimulus must be interrupted until the memory burned into the nerve cells has been completely forgotten. For many chronic-pain cases, a serial-type deep-tissue therapy works best when clients are seen twice weekly until hyperexcited receptors feeding the CNS are quieted. This process helps inhibit the chemical activation of pain at the site of its peripheral stimulation and often allows the brain to downgrade the condition and relieve protective spasm.

Of course, successful management of chronic pain depends on much more than intellectual knowledge. It must be teamed with keen observation skills, patience, compassion, and a constant reminder that the healer is, ultimately, within each client. Therapists only serve as helpful facilitators in the brain’s ongoing journey toward optimum health, and we must learn to gratefully utilize the body’s innate self-regulatory system (see Meyer’s ‘biomechanical auto-regulatory system’, BARS) to help guide the therapeutic process.

Despite the variety of pain-management approaches available in today’s ever-expanding bodywork field, the therapeutic goal should remain the same: restoration of maximal pain-free movement within postural balance.(Dalton, 2016)

“The differential diagnosis of low back pain continues to be a dilemma for the examining physician.  Approximately 60-80% of cases of low back pain are still classified as idiopathic. After the exclusion of structural lesions (physical damage) and organic pathologies by orthodox orthopedic and neurological testing, the examiner is left with the difficulty of determining if any other treatable source for the back pain can be identified.  It is with these patients that the ability to identify and treat functional abnormalities of the musculoskeletal system has been found to be clinically effective.  Including a functional diagnosis of these patients significantly reduces the number that needs to be classified as idiopathic.”  (DeStefano, L. in Greenman’s Principles of Manual Medicine, 2011)

This site is all about:  Assessing and Treating Muscular and Movement Pain  (functional lesions) with Integrated Manual Therapy approaches, including; Advanced Myoskeletal Techniques, Orthopedic Massage, Muscle Energy Technique, Strain-Counter-Strain, Integrated Neuromuscular Inhibition Technique, Functional Movement, Arthrokinetic Technique, and more… How I practice:  The mentors, resources, thought processes, and techniques behind my practice of Integrated Manual Therapy.

THE PAIN-FREE MOVEMENT EXPERIENCE

I am passionate about promoting pain-free living and an active lifestyle, optimum sports performance and the prevention of injuries through a cross-disciplinary approach integrating the sciences of Anatomy, Physiology, Postural Biomechanics, Functional Movement, and a wide-range of proven Structural and Functional Bodywork techniques. I strongly believe there is a holistic connection between these fields that can be accessed through a cross-disciplinary approach that has previously been missed, misunderstood, ignored, or just plain rejected by traditional mainstream practitioners.

My intention is to both expand and integrate these fields into what can appropriately be termed a “Next Generation” configuration for physical wellness that is based on structural integration, functional movement, and the pain-free movement experience that leads to sleeping, eating, and feeling better, exercising more, training more efficiently and performing at a higher level!

Have fun, train well, live and move pain-free!

…Castle

2 thoughts on “Perspectives…on manual therapy

  1. Hi. I would like to speak with you re my case. I was wondering where you practise- if you are currently doing so? I’m in London. Would very much appreciate details re the best way to get in touch with you so i can give you some background and perhaps you may be able to help me? Thank you.

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