I can count quite a few that I\u2019ve told and retold. But what do we base these statements on,, how many do you think are supportable by independent, outside examiners, and what if none of these statements is true?<\/p>\n
I used to think that my comments and conclusions on fascial restrictions were based on facts. I\u2019ve made a living as a physical therapist using a derivative of the myofascial release (MFR) I was taught 25 years ago. Over the past 10 years I\u2019ve also been teaching this work. But I have recently become pretty testy about therapists who pathologise their clients without even knowing they are doing it.<\/p>\n
The Modality Empire<\/strong><\/h6>\nWhen choosing which modality or the name of the teacher they will follow, therapists will be required to make decisions on what structure or pathology they wish to view as most important. Most will not realise this until they are entrenched within the umbrella of that modality and all that comes with it.<\/p>\n
Committing to a continuing education in most modality-based manual therapy training all but requires you to close your lens to see only the targets that the particular school of therapy sees as important. <\/em><\/p><\/blockquote>\nThe modality empire<\/a> that I was trained in saw everything as unresolved fascial restrictions and the emotional memories that are trapped within those restrictions. Your targets may be quite different, depending on the empire you\u2019re steeped within. No doubt you feel pretty certain of the existence of your targets and your ability to eradicate those targets from your client\u2019s body. That is the primary purpose of modalities, to rid\/reduce\/lessen\/eliminate, right?<\/p>\n\u201cMFR releases fascial restrictions, allowing you to live a more pain free lifestyle.\u201d \u2013 <\/em>I bet your modality makes similar claims?<\/p>\nWe buy into these claims more with every course we take. I have come to believe that taking more \u201cadvanced\u201d classes or repeating classes we\u2019ve already taken does little to make us more skilled or learned. It simply drums the stories that we are told into our head; reinforcing the narrative is an important aspect of selling the modality, both to you and to the general public.<\/p>\n
What is Pathologising?<\/strong><\/h6>\nTo pathologise is to claim that something is abnormal or unhealthy<\/em><\/a>. Pathologising is the practice of seeing a symptom as an indication of a disease or disorder<\/em><\/a>.<\/p>\nThe Problem with Pathologising<\/strong><\/h6>\n![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/01\/Die_Frau_als_Haus%C3%A4rztin_1911_139_Schlechte_Haltung.png?resize=126%2C576\")
In my case, I was taught rabbit-hole science, where liberties and exaggerations are made with existing science to form new so-called sciences that can\u2019t withstand critical thinking.<\/p>\n
I was quite guilty of succumbing to rabbit-hole science:<\/p>\n
\n- I picked apart bad posture<\/li>\n
- I looked at patterns of tightness that I thought were fascial restrictions<\/li>\n
- I encouraged patients to root out the emotional holding patterns keeping them back from true healing.<\/li>\n<\/ul>\n
And all in the name of diminishing pathologies of the dreaded fascial restrictions<\/em>.<\/p>\nThe problem was that the stuff I was doing was working<\/em><\/strong>.<\/p>\nMy guess is that most reading this article could substitute their modality-based beliefs. \u201cBut I get great results using (fill in the name of your modality)\u201d. No argument there, I am sure you do<\/em><\/strong> get great results. But what about all the other therapists? The ones who believe totally different stories and follow totally different recipes of evaluation and treatment; the ones who believe in totally different pathologies? They are also getting good results.<\/p>\nIf all of these problems existed for the reasons we thought; if all of those people are suffering pain due to the causes we find through the recipe of our modality; if our clients are improving due to the reasons we think, can all our claims be true?<\/p>\n
Maybe there are simpler reasons, simpler narratives to explain both the problems, as well as the solutions.<\/p>\n
Manual therapy is effective but it is quite probably due to reasons that are simpler than we make them out to be or, at least, not so specific that we can selectively and singularly target one tissue, pathology (real or metaphoric) or weakness\/inhibition.<\/p>\n
Given the uncertainty surrounding the basic tenets of our work, shouldn\u2019t we avoid telling our clients things that may not be accurate? And shouldn’t we avoid making direct references to the things – <\/em>the pathological states \u2013 that we believe our clients are suffering from, and focus on helping them to move and feel better?<\/p>\nAs our clients see more and more professionals, they are inoculated with more thoughts of pathologies. Each of us gives them new hope but we often do it by adding to the pile of pathologies they have been given. The load that this over-pathologising creates must be enormous.<\/em><\/p><\/blockquote>\nPathologising Avoidance<\/strong><\/h6>\nWhen I ask my clients what they\u2019ve previously been told by other practitioners, they can tick off a list of real pathologies: disc bulges, scar tissue and sprains, as well as metaphoric pathologies<\/em>: fascial restrictions, trigger points, knots and cranial lesions. I refer to these as metaphoric pathologies because it is difficult to prove or disprove their existence even though therapists view them as real.<\/p>\nThese clients are looking to me to figure them out, to help them improve. They\u2019re usually expecting yet another pathology to be pronounced. I don\u2019t aim to add more layers and burdens of pathologies upon them. As I move through my evaluation, my greatest goal is to get clients to relate the experience of their pain\/dysfunction with me but framed in their own experience, not mine. I try to avoid assigning my beliefs onto them but, if pressed, I will mirror the question back onto them \u2013 \u201cWhat have others told you? What do you think?\u201d<\/p>\n
If they grab me by the shirt and insist that I tell them what I think is the problem, my preference is to frame my reply from the context of pain science: that there may possibly be nothing wrong with them, that there may be no damage and no nefarious creatures under their skin that other professionals have named as the culprits. I frame my reply from a basic understanding of neurology, mechanoreceptor action and neurodynamic technique.<\/em><\/p><\/blockquote>\nI cannot rule out contextual factors, ones that may benefit the relationship since they came to see a pain specialist<\/em>. But I want them to feel heard. I might say, \u201cwell, it might be the trigger points that your last therapist said it was, or the fascial restrictions that the therapist before that told you, but all I know is that when I touch you in this way, you tell me I\u2019ve replicated a familiar aspect of that pain. Does this stretch\/pressure\/contact feel like it might be helpful? If so, let\u2019s just hold this engagement until you feel a change\u201d. Sound too simple?<\/p>\nI believe in patient-directed approaches to manual therapy, as opposed to pathology driven models.<\/p>\n
Avoid pathologising. Reducing your reliance on older proprietary models of manual care and moving into more plausible (but often less slick and specific) ones is not easy but it is worthwhile.<\/p>\n
About the Author<\/h6>\n
Committing to a continuing education in most modality-based manual therapy training all but requires you to close your lens to see only the targets that the particular school of therapy sees as important. <\/em><\/p><\/blockquote>\n The modality empire<\/a> that I was trained in saw everything as unresolved fascial restrictions and the emotional memories that are trapped within those restrictions. Your targets may be quite different, depending on the empire you\u2019re steeped within. No doubt you feel pretty certain of the existence of your targets and your ability to eradicate those targets from your client\u2019s body. That is the primary purpose of modalities, to rid\/reduce\/lessen\/eliminate, right?<\/p>\n \u201cMFR releases fascial restrictions, allowing you to live a more pain free lifestyle.\u201d \u2013 <\/em>I bet your modality makes similar claims?<\/p>\n We buy into these claims more with every course we take. I have come to believe that taking more \u201cadvanced\u201d classes or repeating classes we\u2019ve already taken does little to make us more skilled or learned. It simply drums the stories that we are told into our head; reinforcing the narrative is an important aspect of selling the modality, both to you and to the general public.<\/p>\n To pathologise is to claim that something is abnormal or unhealthy<\/em><\/a>. Pathologising is the practice of seeing a symptom as an indication of a disease or disorder<\/em><\/a>.<\/p>\n I was quite guilty of succumbing to rabbit-hole science:<\/p>\n And all in the name of diminishing pathologies of the dreaded fascial restrictions<\/em>.<\/p>\n The problem was that the stuff I was doing was working<\/em><\/strong>.<\/p>\n My guess is that most reading this article could substitute their modality-based beliefs. \u201cBut I get great results using (fill in the name of your modality)\u201d. No argument there, I am sure you do<\/em><\/strong> get great results. But what about all the other therapists? The ones who believe totally different stories and follow totally different recipes of evaluation and treatment; the ones who believe in totally different pathologies? They are also getting good results.<\/p>\n If all of these problems existed for the reasons we thought; if all of those people are suffering pain due to the causes we find through the recipe of our modality; if our clients are improving due to the reasons we think, can all our claims be true?<\/p>\n Maybe there are simpler reasons, simpler narratives to explain both the problems, as well as the solutions.<\/p>\n Manual therapy is effective but it is quite probably due to reasons that are simpler than we make them out to be or, at least, not so specific that we can selectively and singularly target one tissue, pathology (real or metaphoric) or weakness\/inhibition.<\/p>\n Given the uncertainty surrounding the basic tenets of our work, shouldn\u2019t we avoid telling our clients things that may not be accurate? And shouldn’t we avoid making direct references to the things – <\/em>the pathological states \u2013 that we believe our clients are suffering from, and focus on helping them to move and feel better?<\/p>\n As our clients see more and more professionals, they are inoculated with more thoughts of pathologies. Each of us gives them new hope but we often do it by adding to the pile of pathologies they have been given. The load that this over-pathologising creates must be enormous.<\/em><\/p><\/blockquote>\n When I ask my clients what they\u2019ve previously been told by other practitioners, they can tick off a list of real pathologies: disc bulges, scar tissue and sprains, as well as metaphoric pathologies<\/em>: fascial restrictions, trigger points, knots and cranial lesions. I refer to these as metaphoric pathologies because it is difficult to prove or disprove their existence even though therapists view them as real.<\/p>\n These clients are looking to me to figure them out, to help them improve. They\u2019re usually expecting yet another pathology to be pronounced. I don\u2019t aim to add more layers and burdens of pathologies upon them. As I move through my evaluation, my greatest goal is to get clients to relate the experience of their pain\/dysfunction with me but framed in their own experience, not mine. I try to avoid assigning my beliefs onto them but, if pressed, I will mirror the question back onto them \u2013 \u201cWhat have others told you? What do you think?\u201d<\/p>\n If they grab me by the shirt and insist that I tell them what I think is the problem, my preference is to frame my reply from the context of pain science: that there may possibly be nothing wrong with them, that there may be no damage and no nefarious creatures under their skin that other professionals have named as the culprits. I frame my reply from a basic understanding of neurology, mechanoreceptor action and neurodynamic technique.<\/em><\/p><\/blockquote>\n I cannot rule out contextual factors, ones that may benefit the relationship since they came to see a pain specialist<\/em>. But I want them to feel heard. I might say, \u201cwell, it might be the trigger points that your last therapist said it was, or the fascial restrictions that the therapist before that told you, but all I know is that when I touch you in this way, you tell me I\u2019ve replicated a familiar aspect of that pain. Does this stretch\/pressure\/contact feel like it might be helpful? If so, let\u2019s just hold this engagement until you feel a change\u201d. Sound too simple?<\/p>\n I believe in patient-directed approaches to manual therapy, as opposed to pathology driven models.<\/p>\n Avoid pathologising. Reducing your reliance on older proprietary models of manual care and moving into more plausible (but often less slick and specific) ones is not easy but it is worthwhile.<\/p>\nWhat is Pathologising?<\/strong><\/h6>\n
The Problem with Pathologising<\/strong><\/h6>\n
In my case, I was taught rabbit-hole science, where liberties and exaggerations are made with existing science to form new so-called sciences that can\u2019t withstand critical thinking.<\/p>\n\n
Pathologising Avoidance<\/strong><\/h6>\n
About the Author<\/h6>\n
![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/MG_0209-150x150.jpg?resize=150%2C150\")
Walt Fritz is a US-based physical therapist who teaches a simple, science-informed version of myofascial release. Walt will be presenting workshops in Sydney, Brisbane and Melbourne in February 2018. Full details on these workshops, and more information on Walt\u2019s treatment philosophy may be found on <\/em>