Who are you and how do you assert yourself in your profession?
Where are your strengths?
Are you sharing them?
Are you telling others about them?
Are you sitting only in your strengths?
Where are your weaknesses?
Are you sharing them?
Are you telling others about them?
Are you working on making them strengths?
Are you surrounding yourself with colleagues that value you?
How can you make your circle more supportive of your career goals?
Why do you offer discounted treatment?
Why don't you value your education, time and experience?
Why do you feel guilty to charge what you are worth, or to ask for payment for your time?
Do you feel like you are struggling financially?
Are you part of the problem?
Why do you allow others to use you as a marketing tool?
Why don't you require payment for your time and effort?
Do you even recognize that this may be happening?
Do you rely on another healthcare practitioner to tell you what to do?
Why are you not confident enough in your skills to do this?
Why are you not searching out ways to get better?
Do you work with another practitioner that “directs” your care? What to do in sessions, how often to re-book, what tools to use, etc?
Do you allow this to happen? Why? Why not?
Why do people keep complaining of the same problems?
Why don't they ever get better?
What responsibility do you have in this?
Are you doing enough to stay current?
If not, why? If you are, how?
Why are you staying in your current situation if you are not happy?
What prevents you from leaving, making a change?
What is your worth? What are you worth?
What is missing?
What needs to change?
How can your circle of supportive colleagues help?
How can I help?
There has been a lot of discussion regarding many manual therapy interventions and efficacy. Forever. As of late, these questions have come from insurers, which has made many therapists worried about their ability to continue to nurture practices that allow them to make a living. Whether insurers will or will not drop massage therapy, or any other “paramedical” expense, is not the focus of this piece, but rather HOW manual therapists can position themselves so that they are valued.
What's the deal with the money bits of all this?
Here are my thoughts...
It's expensive for insurers to pay out when you use up all your healthcare spending
When they notice a trend of high spending in one paramedical category they start to look into why (read: bottomline management stuff)
When there isn't sufficient, scientific data to support the why their assumption is “because people like it” and that is not a good enough reason to fund it. (I like pedicures but sunlife hasn't paid out a single pedicure I have submitted)
This is the scary part. Now because they don't have a good enough why, they start to introduce negotiations for less coverage upon renewal or hike up premiums to deter said paramedical expense from being kept on plans. Uh oh! Enter some pretty upset therapists
To help build their case, insurers have been taking to smear campaigns, like the recent GreenShield attack on massage therapy, which included guilt trips for those who decided to use massage identifying them as villains taking medicine from babies. Seriously, this actually happened. This is when therapists unite to rise up against this bad press and urge the insured to stand up for the right to preventative care. OORAH!
So insurers bad, therapists good. Right?
#disagree and here's why...
When therapists aren't rallying together because of some outside force threatening their livelihood, some are using garbage “facts” to promote their businesses like, “getting a massage is like sleeping for 8 hours” or “it will flush out toxins” or one of my faves “your muscle isn't aligned properly so this will put it in better alignment.” Eeek! 😳
So do you see the problem here? Not yet? How about these? I have seen massage packaged with tarot card readings, therapists offering up their opinions about vaccination within the context of their clinical practices, and some offering treatment for emotional and physical trauma waaaaaay outside scope. Just the tip of the very unprofessional iceberg, unfortunately.
What do insurers see? A whole pile of BS that they are having to pay for.
What is the solution?
Not completely sure, but here are some.
Manual therapists are strategically placed in a position that can greatly influence peoples lives in so many ways. Well informed, honest, ethical practitioners are able to not only address the obvious physical concerns (biological) but by doing this, and the manner in which they do it, influence the psychological and social concerns of the individual and within a community.
In an article written for Massage Therapy Canada, Donald Quinn Dillon RMT says that,
Massage therapy should position hard in the bio-psycho-social model, linking to benefits in mental health, sleep quality and returning injured workers to work. Our profession should look for strategic alliances and pool resources to campaign against the image of profit-focussed, insurance-exploiting practitioners to contributors in public health and economic accountability.
All kinds of yes to that. 🙌🏽
(Link to the Massage Therapy Canada article: https://www.massagetherapycanada.com/insurance/insurers-question-value-of-massage-therapy-–-a-signal-of-changes-to-come-4778)
They look lovely during a shirtless pull up. They keep you warm when its snowy outside. They help your blood get back to your heart.They coordinate to allow us to execute a killer down dog. Muscles are amazing.
Here are 7 super cool muscle facts that will knock your unicorn-print deadlift socks off!
1. The smallest muscles in the body can be found in the ear - stapedius and tensor tympani. These muscles act to dampen sounds from our external environment (like that noisy neighbor) and from our internal environment (like the sound of chewing organic kale chips).
2. A muscle cell contracts because of specialized structures within the cells called sarcomeres. Remember grade 9 science class? Of course you do. Remember when you were taught what a cell looked like, and it was filled with all these squiggly lines and shapes? Well some of those squiggly things include sarcomeres, and that's where you'll find protein filaments that slide along each other to either shorten a muscle, or return it to its resting length.
3. Palmaris longus is a muscle found in the forearm BUT is absent in an estimated 10-15% of the population, and that can be on both sides or just one. Weird. Wanna know if you have it? DO THIS TEST
4. The longest muscle in the body is sartorius, a muscle of the thigh. This muscle crosses the hip and the knee, and its name means "tailor" in Latin which was given to this muscle since its action is to allow us to sit cross-legged like a tailor would when working.
5. The muscles that attach to our skeleton tug at their bony attachments and stimulate bone growth. As a muscle gets larger, its tendon tugs on the bone with more force requiring the bone to get bigger to support the growing muscle. Take a look at the clavicles (collarbones) of males and females. Generally, males have larger clavicles because their pectoral muscles (found in the chest) are also larger. This is how muscles contribute to making our bones stronger, and preventing conditions like osteoporosis.
6. One of the muscles that lots of people know by name is iliopsoas. It makes me a little sick to type that cuz IT'S NOT AN ACTUAL MUSCLE! In the 1950's a medical guy said that the iliacus and psoas muscles did the same thing because they share a common lower attachment site, and started this whole iliopsoas business. That couldn't be farther from the truth. These muscles do very different things, and need to be assessed and treated separately. Iliacus is a short, one joint crossing, beautiful and powerful hip flexor (brings the front of your thigh closer to your chest). Psoas is an enchanting stabilizer of the lumbar spine and pelvis that crosses many joints, including vertebral segments and the hip. They are two muscles, so call them by their real names and know that they are very different but like to come together for a second in one spot.
7. The word muscle comes form the Latin musculus which means "little mouse." This term came about because, upon contraction of the bicep, the muscle shortening resembled a mouse crawling under a rug (a skin rug). Kinda gross.
Muscles are such amazing structures, in fact, our bodies are filled with amazing wonders. We are beautiful skin sacs full of miracles, mysteries and marvels.
Photo by Alora Griffiths on Unsplash
Please learn your worth.
Please do not discount your care by offering deals, coupons, or "packaged rates." While this may be acceptable in other industries, this is not acceptable of a healthcare professional. Charge what you are worth. You are worth more than you think.
Please trust that your education has prepared you to succeed and that you have what you need to provide great care.
Just because you are new, does not mean you are inadequate or "less than." The desire to provide compassionate care is more powerful than you will ever know (right now).
Please hold close the importance of lifelong learning, and continuing to explore, experiment and question.
Do not allow your education to end; make it instead part of your journey to challenge your assumptions, opinions and process always.
Please educate, share and collaborate without judgement.
Understand that there are many methods, and all can have value. There is no better way. There are many ways. Learn the difference between passion in your beliefs, judgement and ego.
Please know your scope and stay within it.
This allows your colleagues to feel proud to be a part of a whole, and allows the public to know what to expect and what is not appropriate in their care. It keeps people safe.
Please do not feel that you are in competition with your colleagues.
We all have our place, and we may need to come in and out of our patients lives at different times. Patient hoarding does not protect your practice, and it often prevents your patients from getting the care they truly need. Know your strengths and weaknesses, and find colleagues to help fill in the gaps for the good of your patients. Put your patients first not your finances, and the money will work itself out.
Please represent yourself with the integrity of a professional.
Whether we like it or not, in healthcare, we are in a profession that is held to a higher standard even outside our workplaces. Be mindful of your social media presence. Be mindful of your behavior in public. Be mindful. You represent us all.
Please ask for help and give it.
If you or a colleague is struggling, or needing support, ask for it or give it. Give it without ego, without ridicule. Just give it. Ask without worry or care about what others may think rather be proud that you are secure enough in yourself to recognize when you need help and ask for it. At some point, we all were in a place where we didn't know or know how. Remember that and be kind.
Yours in Unity,
The fitness and rehab world is full of toys, tools and techniques that promise to make people faster, stronger and get them out of pain. There is always a new __________ that every fitness pro or therapist NEEDS to have if they want the best for their clients.
*enter some great marketing skills*
Some of these supposed game-changers are the plethora of unstable training surfaces that promise to make your core stronger, improve your 'functional strength' and decrease recovery time from a multitude of injuries. You will recognize these tools as thick foam pads, wooden platforms attached to a rounded base, and the cousin of this wood tool made of plastic and resembling half a large exercise ball. There are many, many, many more variations of these rehab/exercise tools. What they all have in common, is that they are often used to treat conditions that just don't respond to these tools with the intended result. Do they have a place in some rehab and training goals? Absolutely, but it may not be what you think. In order to understand the role these tools CAN play in training and rehab, lets investigate the basics of balance and proprioception.
Balance & Proprioception: same same?
Balance relates to our ability to control our center of gravity. Proprioception involves "the central nervous system processing limb and trunk movements while balancing." 1 This delineation is important, but is often not made. Here is why it is important.
When you train on an unstable surface, you are training balance NOT proprioception. In order to train proprioception you must be on a surface that stimulates the receptors sensitive to vibration. Lets look at the abbreviated physiology of proprioception for a second. We will discuss the feet since we are bipedal, and most applications for proprioceptive training involve standing.
The feet are primarily innervated by the tibial nerve, and the tibial nerve has way more branches associated with sensory information than motor. Since proprioception relies on sensory feedback, this must mean that the feet are pretty darn important. Of these sensory nerves, there are way more small vs. large nerves. What are small and large nerves? Small nerves respond very rapidly to movement, and thus play an important role in both proprioception and balance, while large nerves have a relatively slower response time. The key here is that small nerves are sensitive to VIBRATION. "Many of the unstable surfaces we associate with proprioceptive training are actually examples of large nerve (or slower) proprioceptive training."2 This is usually because these tools dampen vibration, and therefore don't allow small nerve receptors to play a role in the intervention.
A Little Research
In 2007, a paper called "The effects of ten weeks of lower body unstable surface training on markers of athletic performance." was published in the Journal of Strength and Conditioning Research. This study compared the affect of unstable surface to stable surface training to improvements in jumping, and 40-yard sprint. The findings demonstrated that the unstable training group had no significant improvements in jumping, and actually got slower in the 40-yard run.3
In 2000, a study looking at elite soccer players found that balance board training did not reduce lower limb injuries, and was actually associated with increased incidence of major injuries, like ACL tears.4
What research has been able to demonstrate, is that training using unstable surfaces can improve performance in those who have had previous injuries related to balance and proprioception. BUT... and this is a BIG ONE... use of unstable surface training in HEALTHY athletes may actually have a negative effect on performance by training them to have slower response times. (Take a look at this article for some more info)5
What if I'm Not an Athlete?
Fair enough. Not all of us are NBA hopefuls (well hopeful maybe, but likely no). This still tells us that if the regular fit fam gym goer and weekend athlete wants to improve their performance and make sure they can continue to do what they love then they are better off just putting the time into the basics of solid strength and conditioning. Us regular folk likely do not have the allotted training time that an elite athlete does so why spend time doing drills that actually won't give us gainz?
In the rehab world, we need to reconsider WHY we are using a tool. Do we want to improve balance or proprioception? If the answer is both, then we must also include drills that allow our small nerves to be more sensitive to vibration since that is the only way to amp up this physiological mechanism. How do we do this? Get your clients off the cushy pads and wobbly wood things and get their BARE feet on the ground.
GET YOUR SHOES OFF WHEN YOU TRAIN, at least for some of your training. It only makes sense, especially for older populations who lose sensitivity to vibration through degeneration of small nerves. NO MORE SHOES IN GYMS! I may have a specific preference surrounding the use of footwear. Can you guess what it is? ;)
3Cressey, E. et al. The effects of ten weeks of lower-body unstable surface training on markers of athletic performance. J Strength Cond Res. 21(2):561-7. 2007.
4Soderman, K. et al. Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthrosc. 8(6):356-63. 2000.
This muscle group certainly gets a bunch of attention; they get tugged, foam rolled, lacrosse balled and scraped. Many feel like they are in a constant battle to keep their hamstrings "loose". Well, there's a real good reason why most feel like they are fighting a losing battle with these muscles at the back of the thigh.... it's because they may not be the problem at all!
*Feel free to stretch your hamstrings while you read on*
The hamstrings are made up of three muscles(ish), that cross the knee and the hip - biceps femoris, semitendinosus and semimembranosus. The biceps femoris is located more laterally and has a short head that doesn't actually cross the hip but contributes to knee flexion (you could actually consider this a separate muscle since it doesn't fit the criteria of being a hamstring). The semi's are located more medial on the posterior aspect of the thigh. They all attach superiorly at the ischial tuberosity of the pelvis, thereby having an impact on position of the pelvis. The semi's then continue to attach at the inside of the tibia (large shin bone), and the biceps femoris at the fibula (small outer bone of the leg).
Note: the biceps femoris short head has different attachment and innervation, but for the purpose of this blog we will discuss the two heads of biceps femoris as one muscle, but they're not.
The action of the hamstrings group is extension of the hip and flexion of the knee. They also influence rotation of the lower leg internally and externally. Their attachment at the pelvis allows them to control anterior tilt, or encourage posterior tilt.
They are part of the Superficial Back Line (a Tom Meyers Anatomy Train), and the Deep Longitudinal Subsystem (a la Vleeming). As part of these fascial/movement slings, they are linked to many other structures, including the erector spinae, multifidi, peroneal muscles, suboccipitals and gastrocnemius. They are also dependent on the function of their antagonists outside these slings including rectus abdominus, quadriceps and transversus abdominus. With so many relationships there exists lots of potential for dysfunctional ones. We will talk about just ONE of those dysfunctional relationships here.
When Your Core F***s Up Your Hamstrings
So lets talk about how this might happen. While there are a few different combinations of muscle that could contribute, we will talk a little more generally about this common movement dysfunction. We will talk about how a lack of control in tilt of the pelvis can contribute to "tight" hamstrings.
Scenario #1: You are standing with your feet about hip distance apart, waiting in line for a
burrito. You have a surgical scar across your abdomen that has affected your ability to
generate good motor control of the deep core muscles so your pelvis tips forward and
your butt sticks out a bit. #bootypop but #nobueno This puts your hamstrings in a
lengthened position.(maybe, all just a thought experiment here cuz there are no one-
size fits all rules for movement dysfunction). This chronic lengthening causes the
hamstrings to eccentrically load (read: contract) and potentially become very very tired.
Then you get your burrito, wash it down with a Dos Equis and head home to stretch
your "tight" hamstrings. Sad day. Next day is groundhog day cuz the hamstrings go back
to feeling rock solid and you still can't touch your toes.
Scenario #2: You head out for a nice little jog cuz it's sunny and you feel like gettin' your
fitness on. You had a little low back pain a few years ago, and were told you had a disc
herniation but no biggie, it got better in a couple months. Your work position is seated at
a computer all day, and you admittedly could do better with your posture. Your back is
often stiff and sore, but that will be a thing of the past once you can retire and move to
Arizona to bask in the desert warmth all day, every day. After your run, you feel pain in
your SI joints (you learned that word from your chiro) and you get a cramp in one of your
What do these two very familiar scenarios have in common? In both situations, the hamstrings may have taken on the role of some of the core muscles and got "tight" because they were super tired and overworked. In scenario #1, it could be transversus abodominus and/or rectus abdominus that were inhibited by scar tissue. Since both of these muscles influence position of the pelvis, when they don't work, the hamstrings may have been unfairly loaded. In scenario #2, the hamstrings, unsupported by some of the deep spinal muscles (and maybe glutes) had to take on the role of primary mover-forward of the body. This isn't fair. There should be a more equal division of labor. How can we get frustrated by the hamstrings when we give them too much to do? And stuff to do that's not even their job?
Okay, so lets stop blaming the hamstrings for a CORE PROBLEM. Instead, lets fix the core problem. If the muscles of the core are not functioning well then the hamstrings, no matter how often you stretch them or beat them with rollers, will always "get tight".
STOP THE INSANITY!!! How? Well, if the problem is inhibited core then you gotta change the core. Improve core function and those hamstrings will be permitted to relax. That tight feeling and restricted movement will change when you give the body what it needs.... STABILITY not mobility. Stop releasing the hamstrings if you don't know why they feel tight. You may be taking away the only stability you, or your clients, have in the pelvis. Not only will this not achieve your goal of "looser" hamstrings, but it can potentially lead to further dysfunction. #reallynobueno
Here's a video showing you an option for combining core stability with hamstring mobility. Try it out and see if those hamstrings start to change.
Have you been told that all your problems could be solved by "releasing your fascia?"
Does your trainer say that you have to do foam rolling to loosen your fascia?
Do you tirelessly and painfully roll your foot on a golf ball to treat your plantar fasciitis?
So many healthcare practitioners, gym goers, yoga aficionados are OBSESSED by FASCIA. If you think you may be suffering from fascia obsession, this article may be the cure you need for just this sort of ailment.
The truth is, there isn't a ton of research that links what we know about fascia to the indications and methodology related to treatment of it. Heck, there's not a ton we know about even the biology of fascia. If we don't completely understand how it works, how can we possibly understand how to treat it? What does exist is a lot of anecdotal and downright wrong "evidence" to justify painful, a bit silly-looking and sometimes harmful interventions aimed at fixing the problems of your fascia.
The reasoning and explanations for why fascia is so important has a dirty little secret....marketing and money! Of course. There is a sh**load of money to be made by selling you the story that your fascia is the key to unlocking your pain and movement dysfunctions. That being said, some people swear that by painfully, tearfully rolling out their IT band with a foam roller, they cured their knee pain. Well that's great. Truth is, though, the research doesn't support that "releasing" the IT band had anything to do with their experience. And that's okay. We just need to own up to the fact that there isn't solid evidence and we don't fully understand how all interventions work. What's important is that we, as therapists, stop spreading this false information using warped science to fit our agendas, and perpetuate misunderstanding. It's okay to not be able to explain fully why something works.
Here are some of the FASCIA MYTHS that have been and continue to be immortalized in a wide variety of therapeutic approaches, movement-based practices and fitness.
This word is pretty damn fancy. I think that's why it's thrown around so often.
MOMENT OF TRUTH ALERT: I admit that I have used the following explanation with my clients (or some derivative of it) and even taught it to my students. I officially apologize to any one I have misinformed using ignorance and garbage science.
The piezoelectric effect is believed to be an electric charge released from crystalline structures that occurs when they bend. From here, the story goes that these electric charges represent tissues "releasing" and that this happens in fascia to change it's shape and make it healthier. So here's the problem, the piezoelectric effect on its own is poorly understood, but most believe that these electrical charges do occur. The idea that this is the mechanism behind tissue release is plain ol' false. Dr. Robert Schleip, and others, have done a lot of research related to the changes that do occur in fascia. None of that research shows that manual pressure applied for a short duration, like massage, can influence the construct of fascia in this way. That's just not how it all works. Further, in Schleip's "Fascial plasticity: a new neurobiological explanation", he states that the "life cycles [of collagen and ground substance] appear too slow to account for immediate tissue changes that are significant enough to be palpated by the working practitioner."
So when your therapist tells you they felt your fascia"release", well there's just no science that implies that is at all true, and it certainly isn't the piezoelectric effect that made it happen.
I was introduced to this concept only a couple years ago. It sounded odd to me and I also hate flowery language and silly words used to describe scientific concepts. Big pet peeve. Here's a link to the fuzz speech.
The fuzz is described as this network of tendrils that permeates all tissues and cells. It webs around organs and through them, encapsulates muscles and creates the framework for many tissues. According to Gil Hedley, who proposed the fuzz concept, when we are at rest or in a position for a length of time, the fuzz hardens up and that explains why we experience stiffness. Every morning we must overcome the strength of the fuzz, breaking free of its hold on our tissues by moving and stretching.
One of the problems with the fuzz is that Hedley was using cadavers as reference to observe it. The fascia in living tissues is very different than that of tissues in a cadaver. The fuzz concept has been well loved by many manual therapists, as are the implications that fascia can be "released", and this is just not true.
The article “Three-dimensional mathematical model for deformation of human fasciae in manual therapy” by Chaudhry et al, published in the Journal of the American Osteopathic Association in 2008 demonstrated that fascia was just too strong to mechanically be changed. The study concluded that "very large forces, outside the normal physiologic range, are required to produce even 1% compression and 1% shear in fascia lata and plantar fascia." Researchers also remarked that "the palpable sensations of tissue release that are often reported by osteopathic physicians and other manual therapists cannot be due to deformations."
Another very prominent researcher in the field of fascia, Schleip, in Fascial plasticity: a new neurobiological explanation, found that slow soft tissue manipulations were not strong enough to elicit deformation in fascia. Based on the research, and on the claims manual therapists make about being able to "release" fascia, Schleip proposed a thought experiment that goes like this:
In everyday life the body is often exposed to pressure similar to the application of manual pressure in a myofascial treatment session. While the body naturally adapts structurally to long-term furniture use, it is impossible to conceive that adaptations could occur so rapidly that any uneven load distribution in sitting (e.g. while reading this article) would permanently alter the shape of your pelvis within a minute.
Back to the fuzz...
When met with some criticism, Hedley retracted/altered his position a little, admitting that he took some creative license to paint a picture of an idea he had about how fascia MAY behave. Too late! The damage had been done, and tribes of manual therapists and fitness professionals had already grabbed hold of the fuzz, unwilling to let go of this pseudo-science.
Oooooo another fancy word. This skewed concept came from Ida Rolf.
Did she just say Ida Rolf? Yes she did.
The Ida Rolf, founder of Rolfing Ida Rolf? Yep. That's the one.
Mind Blown? Read on!
Rolf has influenced virtually all myofascial treatment approaches with her ideas rooted in thixotropic effects. She explained that fascia was arranged in sheets that need deep manual pressure to change from a more dense to fluid state. This is the property of a thixotropic substance, the ability of certain gels to become less viscous when shaken or subjected to shearing forces.
ANOTHER CONFESSION: I have taught this. Shame on me, and apologies to my hoards of students that I have mislead. *hangs head in disgrace*
Here's the TRUTH.... Ida didn't have any basis for claiming this. It was just a thought, an idea. She admitted that it was not based on any sound science or evidence. Her musings became dogma and that dogma continues.
Now, given all this evidence, there will still be people that refute the ACTUAL science. I always find this amazing. For some reason, the fact that therapists and their clients see benefit to a particular intervention is not good enough. For some reason, the perpetuation of the LIES told to "prove" the need for a therapy do not stop. Why is this? Why is it not enough to say "There really isn't a lot of evidence to explain what is happening but this is what we think may be happening...." Why will some of you, after having read this, and perhaps looking at some of the sited research, still go into your clinics and remark "Ah. I just felt your fascia release" or tell someone that their fascia is tight and needs to be stretched or foam rolled to get it looser?
(Note: The idea that loose connective tissue is healthy and better is completely outdated. Connective tissue is strong and tough for a reason, and there are not many situations were you would want it to be loose)
If you don't believe me, would you believe Tom Meyers, author of Anatomy Trains? Here is what he had to say about the topic:
I am so over the word 'fascia' I have touted it for 40 years — I was even called the ‘Father of Fascia’ the other day in New York (it was meant kindly, but…) — now that ‘fascia’ has become a buzzword and is being used for everything and anything, I am pulling back from it in top-speed reverse. Fascia is important, of course, and folks need to understand its implications for biomechanics, but it is not a panacea, the answer to all questions, and it doesn’t do half the things even some of my friends say it does.
The few links below will take you to many other pieces of research and articles written about more current ideas about fascia, manual and movement therapy.
Jump down the rabbit hole if you are willing to drop the dogma. What pill will you choose?
Further Reading & References:
Chaudhry H, Schleip R, Ji Z, Bukiet B, Maney M, Findley T. Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy. J Am Osteopath Assoc 2008;108(8):379-390.
If We Cannot Stretch Fascia, What Are We Doing? http://www.massage-stlouis.com/if-we-cannot-stretch-fascia-what-are-we-doing
Ingraham, Paul. Does Fascia Matter? https://www.painscience.com/articles/does-fascia-matter.php ****This is the article that lead me to create this blog. It made me jump down that rabbit hole myself and explore the literature related to fascia. I used this article to create this blog. Ingraham, in his article, explores this topic much deeper)****
Schleip, R. Facial Plasticity: a new neurobiological explanation. http://www.somatics.de/schleip2003.pdf
Who needs a liver, when you can get a massage?
Sounds ridiculous, right? That's because it is.
I created this meme as a joke after having read a post from, unfortunately, a colleague about a downright false massage claim (aka miracle) on a social media site. The habit of re-posting these fluffy facts about massage, fitness and diet has hit epidemic proportions. The problem is that it is not just the general public posting them, its chiropractors, personal trainers, massage therapists, nutritionists. There needs to be some recognition that as a healthcare professional, you need to be more responsible than just hitting "share" every time you see some interesting picture with a quote you think will increase your business. It has to be TRUE.
As a healthcare professional, I feel that it's my responsibility to make sure that the information I provide is valuable, accurate and within my scope of practice. And guess what? Some of that has changed over my career. You know why? Because the evidence changes, research is done and a new "accurate" is established. And THAT'S OKAY. I used to tell every one and his brother to apply ice to an acute injury, but emerging research has changed my perspective on how to treat some of these types of injuries. So, I CHANGED MY MIND. And guess what? None of my clients thought I was an idiot, a bad therapist or untrustworthy. Guess what they thought? They thought I was well informed, stayed up-to-date with current research and was genuinely concerned about their recovery.
My fellow colleagues, STOP SPREADING GARBAGE. You are in a position to educate and empower people. Do it. If it seems unreasonable, or too good to be true? Then do some digging and find out if it is. If it's not, then post it. If it is, post it and tell people why it's not true or just ditch it and move on.
THINK BEFORE YOU POST.
Here are a couple of my fave miracles/"facts". If you have posted these, not to worry, just realize the error of your ways and next time think before you post. :)
Don't bother sleeping. Get a massage instead and then you can just work 23 hours a day, make more money and get more done. Sleep is for the weak people who don't get massages.
*insert facepalm here*
I think I saw dihydrogen monoxide as an ingredient in my kombucha. Is nothing sacred? Everyone must know about this travesty. Spread the word. Tell everyone.
FYI: Dihydrogen monoxide is WATER
Corrective exercise should not be a rehearsal of outputs. Instead, it should represent challenging opportunities to manage mistakes on a functional level near the edge of ability.
(from one of Gray Cook’s 10 Movement Principles)
In my practice, I get to watch people move. I see how they are able to achieve movement well or as spectacular conglomeration of compensations. Both are beautiful. If they seek me out because they want to make those spectacular compensations spectacular movements, they are quickly made aware that they will have to be an active participant. Then they find out how challenging "easy" movements can be. They become intimately aware of that sweet spot at the edge of ability. When they accept it and sit in that place for a moment, they realize that this is where the magic happens.
This magic place builds links between sensory inputs and motor outputs so that movement becomes truly functional. This is because real movement is not simply an action born of repetition. Real movement is the outcome of sensory input, having been interpreted by the nervous system and expressed as motion. Hopefully spectacular movement. When it is not, for a multitude of reasons, a person needs to earn it again.
To earn this, one must be placed in positions or patterns that are at the edge of ability. They have to struggle and shake a little as valuable sensory input allows the nervous system the wonderful opportunity to learn. This is often perceived as failure, and met with frustration. Yet it truly is between this ease and challenge, that a person finds the opportunity to get better. Earning movement like this is not often a quick fix, in fact it's more like a really slow frustrating fix. One person may earn a movement quickly while another devotes days, weeks or months to the same task. What is the same is that both will have truly earned that beautiful exchange between sensory input and motor output that translates into a spectacular pattern of movement very difficult to unlearn.
A woman recently came to see me and, within moments of meeting, told me that I was her last hope. I both love and hate these moments. I love them because it tells me that I likely have someone in front of me committed to do what it takes to make some great improvements. I hate it because, while I'm confident in my abilities, I know that I am not always the person that can provide the solutions for everyone in every situation. In this situation, it seems, I could help.
After our first one-hour session, I had guided her to more range than she had ever thought possible. Two simple NKT corrections, and this woman was shocked at how differently she was able to move.
After receiving her homework, and putting in the work, two weeks later she was out of pain.
Just before our second session, this woman saw her doctor. After reviewing an MRI and ultrasound, she was told that she had damage to a joint surface and her symptoms would not get better. She was told that whatever therapies or interventions she was doing were not going to change the fact that she would need surgery. She sent me an email to tell my of this "bad news". I was infuriated. I was angry, not because of the findings, but because of the tendency of medicine to throw around absolutes. This woman had seen amazing improvements in both her mobility and pain, that no one else (including her doctor) was able to give her in the years she had been pursuing help. Despite this success, she was torn down by these comments by a poorly informed and irresponsible (in my opinion) healthcare professional.
Why do healthcare professionals ignore the research? The research that tells us that imaging tells us nothing about the experience of pain and does not determine how a person functions.
Why do they use words that induce fear?
Why do healthcare professionals think it is okay to casually say things like "Wow! Your back is a mess"?
When she delivered this news to me, she followed it by telling me that she didn't "buy it" and she wasn't going to accept that fate. She asked questions of her doctor based on research she had done. Her doctor was, to say the least, not receptive. She didn't let that bring her down. I couldn't have been more proud of her in that moment. The work she put in to gain movement, to improve strength and to decrease her pain was nothing in comparison to the courage it took for her to say "No. I will not accept that diagnosis"
If you receive a diagnosis, based on imaging alone, don't buy it. There are ways to achieve better function and less pain that do not involve scalpels, pins and plates.
Do not be made fearful by a healthcare practitioner, some of us believe that it is our job to instill hope not fear. Find one that will uplift you and guide you to finding yourself out of pain.
Do not be afraid to say NO.
Laurie Di Giulio
Aspiring Jedi therapist, lover of the art in human anatomy, reveler in the miraculousness of life.