Myofascial Release
A Patient-Directed Model By Walt FrITZ , PT
Ware the experts . Be it myofascial release , manual therapy , massage , or any of the countless other terms used to describe what we do , we are trained to call ourselves the soft tissue experts . Patients seek us out due to our experience and expertise with pain and movement dysfunction . The longer you ’ ve been in practice the higher your regard may be . Folks come to see us because they believe we will help them and , as a result , will often gives us a fair amount of latitude in terms of what we say and what we do , often with them offering little feedback or input , under the assumption that they need to let us do our job .
You may agree with some or all of what I just wrote , but I am moving farther away from those thoughts every day I practice and teach . Over the past few years my work , in both my physical therapy practice and Foundations in Myofascial Release Seminars , has become more patient-centered . Patient-centered sounds like what we should all strive for , but I hold to a stricter meaning . For many years I have taught that my patient should completely understand why I am doing in the area I am working at all times , or I quite possibly am not doing my job well enough . Not understanding it because I coached them , but understanding it because they feel it .
While I understand that many forms of manual therapy work from a method that necessitates building-block work , or working in areas thought to be the sources of the problem , even if they are far-removed from where issues are felt . Or , that work must be done to balance a person ’ s body / system and , as such , work is done in areas that the patient may not realize there were issues . While I understand some of those methods ( I was trained in a model of myofascial release that stressed , “ find the pain , look elsewhere for the cause ”, which sounded nice but ended up being a coercive method of convincing the patient of things that they may not believe ), I think our patients deserve more . I use a very simple model of evaluation that requires patient validation when seem to locate an area that may be implicated in their issues , one driven by a simple to learn feedback loop .
As manual therapists , we tend to be fairly good at palpating problems / pathologies , whether real or metaphoric , but what do those palpatory findings indicate ? We may cite the things we feel , be they myofascial restrictions , trigger points , knots , spasms , energy cysts , joint subluxations , inhibited muscles , etc ., but I think that we need to circle the wagons back to the patient . The keen observer may note that two therapists may palpate the exact same area but cite two totally different problems or pathologies , hence the probable inaccuracy of palpatory findings . Given the lack of reliable knowledge of just what we are feeling , I think it makes sense not to sell our patients but yet another pathology ; rather we should locate areas of sensitivity to mechanical pressure ( that ’ s what all palpation intends , right ?) and then determine if that area reproduces a sensation that is relevant and familiar to the patient . If it is , stick around and treat . If what we have located is in no way relevant / familiar to the patient , we should not try to sell them on its importance . There are enough pathology-peddlers in our shared professions ; I think we should base our treatment on what is important to the patient , not selling pathologies .
Each time I teach one of my Foundations in Myofascial Release Seminars , the lesson of assuring that treatment is only done when fully validated as relevant by the patient is emphasized . I truly feel that if we are supplied with a simple means of determining patient-centered and patient-valued evaluation findings , no matter what the modality is called , we will increase efficacy and allow the patient more input into the work . We need to move away from being perceived as the expert who should be listened to , just because they are experienced . I know nothing if I am not providing work that my patient understands and agrees with . Some of this may sound rather vague , but if you choose to take my class , it will become quite clear .
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