Canadian RMT Spring 2018 Canadian RMT Spring 2018 | Page 17

from a self-selection of patients who seek
us out. If a prospective patient believes
that a manual therapy form of interven-
tion will help them with their pain, they
in turn will seek us out for our expertise.
Conversely, if I, a believer in the benefits
of manual therapy, was forced to see an
exercise specialist, my pre-existing biases
and preferences would probably have
doomed that relationship from the start.
The patient who steps in our door may
have further self-selected by reading our
website (you have a website, right?) and
reading about our approach. How well
we tell the story of our modality often
dictates outcomes as well, at least that
is what evidence on the placebo effect
has shown. There is no stipulation that
our story needs to be accurate; we just
need to tell a good story. (See a blog post
I wrote on this topic, around a conversa-
tion with Brian Fulton, RMT, here.)
As a student of myofascial release
for the past 26 years, I’ve heard a lot
of good stories. Many of those stories
revolve around the superiority of myo-
fascial release as the best modality for
all sorts of ills. I was sold on MFR and
bought the whole story. I then sold it
to others; first to prospective patients,
then to therapists as I began teaching
my own workshops. I had great results
and since MFR utilized slow, prolonged,
stationary holds on the fascia (skin) and
worked in a dry manner (no lubricant), I
became annoyingly certain that this sort
of engagement was obviously superior
to all other forms of manual therapy.
After all, those other modalities did not
address the fascial component like I did,
so of course their results were less-than
or temporary. I was a pretty annoying
guy back then, though confidence in
yourself and your abilities can be seen in
our world as a real positive. I was stuck
headfirst down that fascial/MFR rabbit
hole, seeing no need to ever come up/
out. But I finally did, though it was not
until I had left the MFR camp in which I
was trained. Once removed, I started pok-
ing my head up to look around. It started
as I began to question many of the fascia
stories I was taught, seeing how much of
the published evidence on manual ther-
apy posed some conflicting information.
When I pulled myself completely out of
the hole, I allowed myself to jump down
a few other holes of competing narra-
tives. The neurological narrative seemed
especially interesting to me, as the folks
who introduced me to it had some pretty
Our education,
continuing education,
and personal experience
in the clinic will often
lead us down similar
rabbit holes of bias.
compelling points and was more accept-
able to those in the general medical com-
munity. But what became evident is that
nearly every rabbit hole, every modality,
seemed to have a ripping good story to
explain and validate the effects and supe-
riority of their modality. Deconstructing
the individual claims of each is beyond
the scope of this article. But if one thinks
for a bit about the claims made by each
modality or type/style of training you’ve
undertaken, you can easily see how the
claims made conflict with each other. Can
we really be impacting all of the various
structure, anatomy, and pathology that
we were taught, all while standing on the
outside of a patient and touching them
through their skin? And, are there univer-
sal aspects of our work that can improve
efficacy and outcomes?
I would venture a guess that even
though each modality makes ownership
claims to their ability to singularly and
selectively impact one and only one tis-
sue/pathology to the exclusion of all
else, there is massive overstatement
(exaggeration). For example, there are
forms of manual therapy/bodywork that
claim that pain is due, at least in part, to
inhibited muscle groups. The narrative
states that unless one reduces inhibi-
tion, pain/dysfunction will continue. MFR
states that pain is due to unresolved
fasci al restrictions and/or emotional
past stuck in the fascia and that unless
those fascial restrictions are properly
released, pain/dysfunction will continue.
Trigger point therapy states that pain is
due to unresolved trigger points and that
unless those trigger points are properly
extinguished, pain/dysfunction will con-
tinue. The various postural approaches
to manual therapy pin pain on poor pos-
ture and that unless postural deficits are
reduced/eliminated, pain/dysfunction will
continue. Upper cervical therapists feel
that all dysfunction stems from C1 being
misaligned and that unless C1 is put back
into proper alignment, pain/dysfunction
will continue. Craniosacral therapists
believe that pain and dysfunction stems
from cranial lesions and/or interruptions
in craniosacral fluid dynamics and that
unless these issues are resolved, pain /
dysfunction will continue. Those trained
from a foot alignment perspective feel

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