RE: STRETCHING & NEURAL INFO

[Guest guest]

At 10:45 AM 9/15/00 -0400, you wrote:

>Would you elaborate on your views of myofascial release? I am being

>approached my a MFR Practitioner to work on my athletes.

>

> Boone

>

,

I’m happy to discuss the problems inherent to “myofascial release” (MFR) as

has taught it since the early 80s. Perhaps it would be best to

begin with some information from the research community.

f Threlkeld, PhD. P.T. studied the effect of manual care in the aptly

titled essay The Effects of Manual Therapy on Connective Tissue (Physical

Therapy Volume 72, Number 12/December 1992). Please note that this

reference is the Journal of the American Physical Therapy Association.

After a prolonged discussion of connective tissue (CT) properties

(including fascia, of course), Threlkeld concludes, “ If 100% of an

externally applied force could be transmitted to a selected portion of a

connective tissue structure, then it could be presumed that forces commonly

produced during manual therapy could produce permanent elongation…the

external forces, however, are not direct and are not completely transmitted

to a preselected segment of a CT structure.” He goes on to describe the

dispersal of manual force inherent to our body’s reaction to pressure.

Threlkeld points out that there is no evidence that manual force results in

connective tissue elongation that is prolonged or therapeutic. Of course,

this is really bad news for a lot of people in the massage therapy

community, and certainly those practicing MFR.

proposes (with sparse and highly questionable citations) that a

combination of “cellular consciousness” and “piezoelectric phenomenon”

forms the deep model of this work. If this were true, it would certainly

have revolutionized the entire field of medicine by now. It hasn’t, and it

remains a very confusing concept to me. often proposes that fascial

tissue possesses qualities I’ve never seen anywhere else. Questions like:

“Is fascia the physical basis for consciousness?” are asked but I can see

nothing in any literature to justify them. By any measure, the underlying

theory of MFR is, well, gobbledygook. Pinning the practitioners down on

this issue has been, in my experience, impossible. They retreat in silence

or carry on about results that are seemingly miraculous. After twenty years

there has not been even one outcome study that I’m aware of.

But there’s much more. I have had numerous conversations with therapists

involved with MFR and I’ve followed the listserv for a few months. There is

a great emphasis on the need for “emotional release” in conjunction with

this work. This is a prescription for false memory syndrome, in my opinion.

There are regular references to the “energy medicine” aspect of MFR. This

is often used when the mechanical explanations fall apart. In order to

support this, I guess, there is in ’ writing a laughable repudiation

of Newtonian physics and a complete misunderstanding of quantum mechanics.

I assume he hopes his readers don’t know much about this stuff. Anyway, the

strongest tendency among the practitioners on the listserv is to evoke the

“spirit” of various things in order to help them, including ’s spirit.

I don’t know about anybody else, but this creeps me out.

Well, I guess that’s enough for now. I’ve written a good deal more about

this elsewhere.

Barrett L. Dorko, P.T.

<http://barrettdorko.com>

[Guest guest]

Dear Barrett,

Would you include deep tissue massage in your definition of MFR? If so, what do

you use in your management of chronically shortened myofascial systems?

Regards,

Epsley.

-------------------

Boone:

>>Would you elaborate on your views of myofascial release? I am being

>>approached my a MFR Practitioner to work on my athletes.

Barrett Dorko:

>I'm happy to discuss the problems inherent to myofascial release (MFR) as

> has taught it since the early 80s. Perhaps it would be best to

>begin with some information from the research community.

>

>f Threlkeld, PhD. P.T. studied the effect of manual care in the aptly

>titled essay The Effects of Manual Therapy on Connective Tissue (Physical

>Therapy Volume 72, Number 12/December 1992). Please note that this

>reference is the Journal of the American Physical Therapy Association.

>After a prolonged discussion of connective tissue (CT) properties

>(including fascia, of course), Threlkeld concludes, If 100% of an

>externally applied force could be transmitted to a selected portion of a

>connective tissue structure, then it could be presumed that forces commonly

>produced during manual therapy could produce permanent elongation the

>external forces, however, are not direct and are not completely transmitted

>to a preselected segment of a CT structure. He goes on to describe the

>dispersal of manual force inherent to our body's reaction to pressure.

>Threlkeld points out that there is no evidence that manual force results in

>connective tissue elongation that is prolonged or therapeutic. Of course,

>this is really bad news for a lot of people in the massage therapy

>community, and certainly those practicing MFR.

>

> proposes (with sparse and highly questionable citations) that a

>combination of cellular consciousness and piezoelectric phenomenon

>forms the deep model of this work. If this were true, it would certainly

>have revolutionized the entire field of medicine by now. It hasn't, and it

>remains a very confusing concept to me. often proposes that fascial

>tissue possesses qualities I've never seen anywhere else. Questions like:

>Is fascia the physical basis for consciousness? are asked but I can see

>nothing in any literature to justify them. By any measure, the underlying

>theory of MFR is, well, gobbledygook. Pinning the practitioners down on

>this issue has been, in my experience, impossible. They retreat in silence

>or carry on about results that are seemingly miraculous. After twenty years

>there has not been even one outcome study that I'm aware of.

>

>But there's much more. I have had numerous conversations with therapists

>involved with MFR and I've followed the listserv for a few months. There is

>a great emphasis on the need for emotional release in conjunction with

>this work. This is a prescription for false memory syndrome, in my opinion.

>There are regular references to the energy medicine aspect of MFR. This

>is often used when the mechanical explanations fall apart. In order to

>support this, I guess, there is in ' writing a laughable repudiation

>of Newtonian physics and a complete misunderstanding of quantum mechanics.

>I assume he hopes his readers don't know much about this stuff. Anyway, the

>strongest tendency among the practitioners on the listserv is to evoke the

>spirit of various things in order to help them, including 's spirit.

>I don't know about anybody else, but this creeps me out.

>

>Well, I guess that's enough for now. I€  ’²ve written a good deal more about

>this elsewhere.

[Guest guest]

At 03:37 AM 9/18/00 -0700, you wrote:

<Would you include deep tissue massage in your definition of MFR? If so, what

do you use in your management of chronically shortened myofascial systems? >

,

In '81 I spent four days with Moshe Feldenkrais. Well, me and a couple

hundred other people. What I saw accomplished without doing anything that

could possibly have elongated the connective tissue convinced me once and

for all that, as Feldenkrais said, 98% of the restriction is in the brain.

Twenty years later my opinion hasn't changed. This means movements designed

to enhance awareness and/or reduce neural tension will solve these problems

in the vast majority of cases.

I'm not suggesting that connective tissue will never be too short for a given

task, but no therapist is going to solve that problem manually. The

athlete/client/patient should be instructed in positioning and stretching

appropriately. That's the easy stuff, it's the restriction in the brain and the

neural tension that require a far more esoteric approach. Begin with the

presumption that the

system is self-corrective, then figure out how to amplify that.

This is what I've been teaching for years, and I would gladly give you a

protocol if I thought it appropriate, but I believe that's impossible.

Simply put, stop trying to stretch people with your hands (I presume this

is the " deep tissue " work to which you refer). It might feel good, but

there's no evidence it alters things in any profound or lasting way. It's a

pleasantry, not therapy. I'm sure you know that it can make many people

feel much worse, but that's not possible to predict.

Barrett L. Dorko, P.T.

<http://barrettdorko.com>

[Guest guest]

Barrett Dorko <bldorko@m...> wrote:

On 9/18/00 , you wrote:

< I'm not suggesting that connective tissue will never be too short

for a given task, but no therapist is going to solve that problem

manually. The athlete/client/patient should be instructed in

positioning and stretching appropriately. That's the easy stuff, it's

the restriction in the brain and the neural tension that require a

far more esoteric approach. Begin with the presumption that the

system is self-corrective, then figure out how to amplify that.>

Barrett,

I agree that our bodies are highly self-corrective systems but in

certain cases they do need a little " outside help " . As far as the

brain and neural tension I am presently learning more about

neurodynamics which is fascinating.

<Simply put, stop trying to stretch people with your hands (I

presume this is the " deep tissue " work to which you refer). It might feel good,

but there's no evidence it alters things in any profound or lasting

way. It's a pleasantry, not therapy. I'm sure you know that it can make many

people feel much worse, but that's not possible to predict.>

So are you saying that therapies such as neuromuscular therapy and

any other form of soft tissue therapy is nothing more than a short

term fix for the sake of a better term?

Boone

[Guest guest]

Hi I think Barrett's point by saying

<<no therapist is going to solve that problem manually>>

is that neuromuscular therapy is more of a gymmick than anything else (it

maybe nothing more than a massage). However, neuromuscular training can be

very beneficial by providing lasting change because the neuromuscular

system has been trained or retrained which takes longer than a 5 or 10

minute (ever heard of someone else training for a 10k and you get the

benefit?). To prove the point check the so-called improvement (in ROM for

example) from a patient after a therapist does some release or neuromuscular

therapy. Check that same improvement 1 hour later, 4 hours later, the next

day, the next week, etc. and check it's lasting effect. Neuromuscular

training on the other hand, after whatever period of days, weeks, etc. has

been deemed appropriate) maybe more likely to produce lasting change as the

mind and muscles have been trained or retrained as to how to function.

Is this not on the right track Barrett?

All the best,

Heppe, M.A.

Biomechanical Solutions

http://www.biosolutions.net

-----Original Message-----

From: Boone [mailto:Javen92@...]

Barrett Dorko <bldorko@m...> wrote:

On 9/18/00 , you wrote:

< I'm not suggesting that connective tissue will never be too short

for a given task, but no therapist is going to solve that problem

manually. The athlete/client/patient should be instructed in

positioning and stretching appropriately. That's the easy stuff, it's

the restriction in the brain and the neural tension that require a

far more esoteric approach. Begin with the presumption that the

system is self-corrective, then figure out how to amplify that.>

Barrett,

I agree that our bodies are highly self-corrective systems but in

certain cases they do need a little " outside help " . As far as the

brain and neural tension I am presently learning more about

neurodynamics which is fascinating.

<Simply put, stop trying to stretch people with your hands (I

presume this is the " deep tissue " work to which you refer). It might feel

good, but there's no evidence it alters things in any profound or lasting

way. It's a pleasantry, not therapy. I'm sure you know that it can make many

people feel much worse, but that's not possible to predict.>

So are you saying that therapies such as neuromuscular therapy and

any other form of soft tissue therapy is nothing more than a short

term fix for the sake of a better term?

Boone

[Guest guest]

At 01:42 PM 9/19/00 -0700, you wrote:

>neuromuscular therapy is more of a gymmick than anything else (it

>maybe nothing more than a massage).

,

I like how you worked the word " gym " into this description.

I agree. The phrase " neuromuscular " itself bears no relation to what is

done or accomplished, though the inventor would like us to believe

otherwise. Why does the massage therapy community continue to insist that

rubbing the skin that overlies (in many cases, approximately) a muscle

belly has some kind of profound, prolonged or, for that matter. healthful

effect. It can be pleasant, and the massagee (I just made up that word)

might choose to " relax " in response, but that's their choice. Aside from

large fiber stimulation that is known to reduce pain, I really don't think

it does much more, and its growth as a profession is largely a sociological

phenomenon that a justifiably scientific one.

Barrett L. Dorko, P.T.

[Guest guest]

At 12:26 PM 9/19/00 +0000, you wrote:

>in certain cases they do need a little " outside help " .

,

I agree that the presence of another can make a big difference when it

comes to altering behavior, and I'm sure you'd agree. The issue then is the

characteristics of the person present. I'm working on an essay regarding

all of this entitled " Can I get a witness? " and it will appear on my web

site soon. This issue is already covered in something called " PT In

Service " on the site presently. It begins with a quote from Hermann Hesse

about what it means to be a " servant, " defined in a very specific way here.

Barrett L. Dorko, P.T.

<http://barrettdorko.com>

[Guest guest]

Guys,

Why not " produce a short lasting lengthening " as you suggest, followed up with

re-education. Then the patient has the benefit of immediate relief (you may

dispute that with your research - but I can tell you clinically it happens) and

a re-education program. It was also suggested that DTM can exacerbate symptoms

and there is no way of telling who may be affected. If you use it incorrectly

(ie there is a long weak muscle - and shortness is not the problem) this may

occur. But that is the therapists poor use of the technique, not the technique.

I'm sorry, but you seem to be just as closed minded about the use of muscle /

brain re-education as the proponents of MFR about their techniques. Shirly

Sahrmann's ideas are good but not the be all and end all. I'd rather have a

variety and combination of tools in my tool box.

Epsley

Physiotherapist

Brisbane, Australia.

--

On Tue, 19 Sep 2000 13:42:59

Heppe wrote:

>

>Hi I think Barrett's point by saying

>

><<no therapist is going to solve that problem manually>>

>

>is that neuromuscular therapy is more of a gymmick than anything else (it

>maybe nothing more than a massage). However, neuromuscular training can be

>very beneficial by providing lasting change because the neuromuscular

>system has been trained or retrained which takes longer than a 5 or 10

>minute (ever heard of someone else training for a 10k and you get the

>benefit?). To prove the point check the so-called improvement (in ROM for

>example) from a patient after a therapist does some release or neuromuscular

>therapy. Check that same improvement 1 hour later, 4 hours later, the next

>day, the next week, etc. and check it's lasting effect. Neuromuscular

>training on the other hand, after whatever period of days, weeks, etc. has

>been deemed appropriate) maybe more likely to produce lasting change as the

>mind and muscles have been trained or retrained as to how to function.

>

>Is this not on the right track Barrett?

>

>All the best,

> Heppe, M.A.

>Biomechanical Solutions

>http://www.biosolutions.net

>

>-----Original Message-----

>

>From: Boone [mailto:Javen92@...]

>

>Barrett Dorko <bldorko@m...> wrote:

>

>On 9/18/00 , you wrote:

>

>< I'm not suggesting that connective tissue will never be too short

>for a given task, but no therapist is going to solve that problem

>manually. The athlete/client/patient should be instructed in

>positioning and stretching appropriately. That's the easy stuff, it's

>the restriction in the brain and the neural tension that require a

>far more esoteric approach. Begin with the presumption that the

>system is self-corrective, then figure out how to amplify that.>

>

>Barrett,

>

>I agree that our bodies are highly self-corrective systems but in

>certain cases they do need a little " outside help " . As far as the

>brain and neural tension I am presently learning more about

>neurodynamics which is fascinating.

>

>

><Simply put, stop trying to stretch people with your hands (I

>presume this is the " deep tissue " work to which you refer). It might feel

>good, but there's no evidence it alters things in any profound or lasting

>way. It's a pleasantry, not therapy. I'm sure you know that it can make many

>people feel much worse, but that's not possible to predict.>

>

>So are you saying that therapies such as neuromuscular therapy and

>any other form of soft tissue therapy is nothing more than a short

>term fix for the sake of a better term?

>

> Boone

>

>

>

>

>

>

>

[Guest guest]

,

I might be inclined to agree with you that some kind of immediate relief

(chirpratic or P.T.) followed immediately by re-education or neuromuscular

training over a period of time maybe beneficial in some situations, maybe

even more than neuromuscular training by itself. However, the therapist and

chiropractors that i've seen and dealt with in the U.S. think that after the

immediate relief they are finished and seemed threatened when questioned

about re-education or neuromuscular training.

I, in fact, presented this very approach to a Workers Compensation

Commission a couple years ago. After my presentation they turned to a

chiropractor (who had also watch my presentaion) and ask him about this

combination of treatments and if he would refer his patients to the clinic I

was working with. His response was that before he did anything else with

another type of treatment (except the P.T. clinic he was part owner of) that

he'd want to get a second chiropractic opinion. Talk about closed minded.

All the best,

Heppe, M.A.

Biomechanical Solutions

http://www.biosolutions.net

-----Original Message-----

From: Epsley [mailto:physio@...]

Guys,

Why not " produce a short lasting lengthening " as you suggest, followed up

with re-education. Then the patient has the benefit of immediate relief

(you may dispute that with your research - but I can tell you clinically it

happens) and a re-education program. It was also suggested that DTM can

exacerbate symptoms and there is no way of telling who may be affected. If

you use it incorrectly (ie there is a long weak muscle - and shortness is

not the problem) this may occur. But that is the therapists poor use of the

technique, not the technique. I'm sorry, but you seem to be just as closed

minded about the use of muscle / brain re-education as the proponents of MFR

about their techniques. Shirly Sahrmann's ideas are good but not the be all

and end all. I'd rather have a variety and combination of tools in my tool

box.

Epsley

Physiotherapist

Brisbane, Australia.

--

On Tue, 19 Sep 2000 13:42:59

Heppe wrote:

>

>Hi I think Barrett's point by saying

>

><<no therapist is going to solve that problem manually>>

>

>is that neuromuscular therapy is more of a gymmick than anything else (it

>maybe nothing more than a massage). However, neuromuscular training can be

>very beneficial by providing lasting change because the neuromuscular

>system has been trained or retrained which takes longer than a 5 or 10

>minute (ever heard of someone else training for a 10k and you get the

>benefit?). To prove the point check the so-called improvement (in ROM for

>example) from a patient after a therapist does some release or

neuromuscular

>therapy. Check that same improvement 1 hour later, 4 hours later, the next

>day, the next week, etc. and check it's lasting effect. Neuromuscular

>training on the other hand, after whatever period of days, weeks, etc. has

>been deemed appropriate) maybe more likely to produce lasting change as the

>mind and muscles have been trained or retrained as to how to function.

>

>Is this not on the right track Barrett?

>

>All the best,

> Heppe, M.A.

>Biomechanical Solutions

>http://www.biosolutions.net

>

>-----Original Message-----

>

>From: Boone [mailto:Javen92@...]

>

>Barrett Dorko <bldorko@m...> wrote:

>

>On 9/18/00 , you wrote:

>

>< I'm not suggesting that connective tissue will never be too short

>for a given task, but no therapist is going to solve that problem

>manually. The athlete/client/patient should be instructed in

>positioning and stretching appropriately. That's the easy stuff, it's

>the restriction in the brain and the neural tension that require a

>far more esoteric approach. Begin with the presumption that the

>system is self-corrective, then figure out how to amplify that.>

>

>Barrett,

>

>I agree that our bodies are highly self-corrective systems but in

>certain cases they do need a little " outside help " . As far as the

>brain and neural tension I am presently learning more about

>neurodynamics which is fascinating.

>

>

><Simply put, stop trying to stretch people with your hands (I

>presume this is the " deep tissue " work to which you refer). It might feel

>good, but there's no evidence it alters things in any profound or lasting

>way. It's a pleasantry, not therapy. I'm sure you know that it can make

> many people feel much worse, but that's not possible to predict.>

>

>So are you saying that therapies such as neuromuscular therapy and

>any other form of soft tissue therapy is nothing more than a short

>term fix for the sake of a better term?

>

> Boone