I just read through all the comments on the orginal post regarding EBMT. I'm wondering if it might be a good idea for me to do a needs assessment of the ABMP members, in the form of a survey, regarding EBMT. One of the things I've learned in the public health program here at the U of A (MPH), is how important it is do have participatory inclusion of the community you're working with in doing research. The EBMT question posed has an active discussion forum with many good points brought up on either side of the debate. In my experience it pays to listen to the needs of the community and it would be very interesting to see where the majority is concerning EBMT. What do you all think?

Robin, I presume that by community you mean bodyworkers. I think that it will not help because of the move afoot to standardize all of bodywork. I believe that the big push for licensing is not to protect the public but to insure that everyone starts out with the same training and thinking. I also think that the people who support this feel that we need to look more like traditional medicine. So they fill the course with A & P that 99% of the MTs forget but in the process they instill a way of thinking that does not support EBMT. So polling the population will help because people who understand and use EBMT do so in spite of their basic training.
Jan, for me the obstacles were that I had to effectively unlearn my basic massage training. This is not to say that I don’t use A & P in my work. As a matter of fact I could teach it to most MTs. It is the fact that I don’t try of compete with medicine but rather use that knowledge to complement it. I start by listening to the client in was not are extra-rational and only then bring my knowledge into play.
I got into this work by taking a series of Lauren Berry courses. Each course covered one joint. One you completed the joint-by-joint training you moved on to a second level of training and an internship that consisted on working with your mentor and a series of workshops. It took me a lone time to realize that if I could not help people it was that I was trying too hard. I need to stop thinking of how to fix things and really listen.
It was only then that I started correlating the extra-rational perceptions with results.
I find that too often people in this business start feeling things that make no scientific sense and see that they correlate results, but instead of acknowledging that they are touching on things that cannot be scientifically explained and learn to work with is as a right-brained activity, they wrap it is some fanciful system just to get some type of explanation.

This link is to Guided Imagery study results carried out by Duke University Medical Center and the VA. Shows you can, in fact, measure the non-tangible, seemingly unscientific outcomes of body/mind/spirit relationship, based on particular scales.

My understanding of this group is to talk about how we can encourage the practice of evidence based massage therapy, not argue it's merit, which is what we did in the forum. Please correct me if I'm wrong in this assumption Bodhi.

Robin, I agree with Bodhi. I think a literacy/attitude survey comes first.

I understand that Jennifer. I was responding to another comment.

To move on, the biggest obstacle is education, in my opinion. If we don't at least teach research literacy in the schools so that students can begin to read and discern valid and reliable research, then we will not get massage therapists actually doing the research and collecting the data in our own field. There was a great study done several years ago on the effects of massage therapy on arthritis of the knee. It was published in the Journal of Internal Medicine. Fortunately the study was run by Adam Perlman, MD who insisted on using professional massage therapists, but he had a hard time finding therapists who wanted to be involved. Why? I think it's partly because research is not included in our education. The least we can do is introduce the word, use it in our classrooms, and tell students how we know massage is efficacious. That means teachers have to be trained. yadda, yadda, yadda.

Dodhi "We need to get therapists at least to start questioning theories and approaches." I agree 100%. I also think we need to teach people to use both halves of their brain. I tell people that one can easily recognize a face but if one analyzes it they are less able to recognize the face because they remember the analysis. Evidence based work that relies on right brain activity is just as valid. It is just that it is more difficult to tie to outcomes.
My last client today had a migraine. I find that I have use bodywork to help people with migraines. Understanding the nature of migraines only helps a bit. For example I can tell with better than 90% accuracy which side the headache is on. I don’t know how it works but I have the evidence to support my feeling and use science to insure that if I am wrong that I do no damage.
Intuition by itself is nothing but when you can start combining it with a monitoring of objective evidence it can be powerful but you must always keep a skeptical eye on the whole process.
I decided at one time to major in psychology. However in school something was missing. If I wanted to work in a rat lab or be a pure behaviorist then the schooling was fine but there was something major missing. I did not know exactly what it was unit I read “Blink” which explains right-brained evidence based thinking. I think this book is a must for all bodyworkers.

Carl:
It sounds as if you are misunderstanding what evidence-based practice is actually about. The diagram that Bodhi has used for this group’s icon on the site is a great example of what EBP encompasses. When you speak of evidence, it sounds as if you are just relying on the observations of what you have found from your own clinical work and from the results you have produced. This perspective is represented by the circle down below and labeled “own expertise and experience”. That is certainly a component of EBP, but this is not research evidence unless you have specific research studies that back up the claims you are making. What seems to be missing from what you describe is research evidence (represented by the upper right hand circle).

Whitney, I think that if we limit evidence to scientifically obtained research evidence we are limiting our observations to that which can be measured using tools that are analytical in nature. By doing so we are limiting the scope of what we do and the ways we can help others. On the other hand to work totally without structure is not right.
Expanding EBT from the atomistic to holistic is a serious challenge. I think is can be done I am not sure how. Are there forms of research that go beyond the limits of science? This was the problem I had with psychology. What was taught was limited to science but it left one unable to be fully effective unless you acquired your skills outside of school.

Thanks for reminding us of this group's purpose so we can get back on track!

I may be missing something, but can we post things in the articles section or is that only something that you (the group founder) can do? I don't immediately see how to post things in this section.

“This group was set up to advance and encourage EBP, not debate its merits or the merits of science.” Before you advance and encourage you need to establish a clear concept of what EBP is. I have searched the web and cannot find any such clear explanation. If example I think people understand what medical massage is. But how does EBP differ? What do you mean by “Research Evidence” this will imply scientific studies. Is EBT limited to what can be scientifically proven? Are other forms of evidence acceptable and if so what are they?

Paul we all rub shoulders with people who believe and practice real quackery. It makes me shiver but the other extreme is just as bad. Maybe EBM is not what I am looking for if it precludes non-research based work but SBM is denies people real alternatives. For example if a person comes to me with carpal tunnel I can often fix the problem by getting the carpal bones to articulate allowing the retinaculum to reform the tunnel taking pressure off the median nerve. The alternatives are steroid injections or surgery. The steroids are at best temporary and the surgery is not always successful so what not try a less invasive procedure which works most times but if it doesn’t there are no negative drawbacks?
I also find that that most of us experience things that fall outside of what can be explained scientifically. We need to use good science it insure that we do no harm but beyond that we need guidelines to handle things that repeatedly show positive result even though we don’t fully understand them.
BTW Thanks Jennifer for the wiki link.

Bodhi the Sicily statement was excellent. It provided a different perspective that it is primarily an attitude of positive skepticism that leads to a pursuit of knowledge and skills. It also teaches us to accept and work with uncertainty. I think that is where it deferrers from science based therapy in that you can actually provide a more beneficial results with less potential downside. I see that all the time in my hospice work where the focus is on the patient and what is best for them rather than the exact pursuit of the best medicine. It is not about ego. It is about questioning your sources as well as your past experience. It is knowing that you have limitations and that sometimes your strengths are also your weaknesses.
Thanks for being patient with me. Entering the bodywork field really upset my faith that everything could be explained by science. That does not mean that I accept things on blind faith, but instead I question everything. I think that many other MTs have had similar experience but have instead embraced fanciful explanations and superstitions. I think EBP training could do wonders for the entire professions because these ideas are so far out that they reflect on the credibility of the profession.

I am looking for clinical trials about corporate chair massage effects on workers.
Can anyone steer me in the right direction??
Thanks,
Rene.

Hi Rene.

Can you be any more specific about your interest? It will help us direct you to the information you seek.

There are only likely to be a few clinical trials of workplace chair massage, and they might not assess the specific outcomes you are interested in. Are you interested in productivity? Satisfaction? Anxiety? Absenteeism? Pain reduction?

-CM

Thank you for your responses Chris and Bodhi.
Chris: I am looking for all studies that show improvement in any of the areas you mentioned, stress, absenteism, pain relief, productivity etc...I intend to market my services to offices in my area, but want to do it "evidence based".

Bodhi, your articles hit the right spot (ACHI like they say in China!). I will look for them. Thanks a lot! Do you know of anything published in the more mainline medical journals that you know of? Like Lancet, JAMA, New England J. M. etc..?
Rene.

Rene.

Rene -

To the best of my knowledge, you probably won't find any chair massage studies in the major medical journals, yet.

In addition to the citations Bodhi gave you, I seem to recall another study of chair massage for nurses at their workplace - let me see if I can find it....

Hmm, I didn't see the one I was looking for, but I did find a few others! Here:

http://www.ajan.com.au/Vol23/Vol23.4-4.pdf

Also:

Chair massage for carers in an acute cancer hospital
European Journal of Oncology Nursing, Volume 9, Issue 2, Pages 167-179
P.Mackereth, P.Sylt, A.Weinberg, G.Campbell

and

The effect of chair massage on stress perception of hospital bedside nurses
Journal of Bodywork and Movement Therapies, Volume 10, Issue 4, Pages 335-342
M. Brennan, R. DeBate

It used to be hard for people not currently at university to search for such articles, but no longer. Go to google.com, and at the top, from the "more" menu, select "Scholar". Then type in what you want, such as workplace chair massage.

One more suggestion - these papers are not chair-massage specific, but these may also be applicable for your purposes. I have co-authored two different review articles that attempt to summarize a range of massage therapy effects. You can view them here:

http://www.anatomyfacts.com/Research/Massage%20Journal%20Club/January07/Moyer.pdf

and

http://ecam.oxfordjournals.org/cgi/reprint/4/1/23

You will need Adobe Reader (a free program you might already have) to view those files.

-CM

Christopher: Thanks for letting us know about Google's Beta testing of the "Scholar" search option. While articles may be older, as someone who doesn't have an academic account, I get free access to articles via: http://www.pubmedcentral.nih.gov/

Thanks again Chris. I found the articles you mentions very useful and to the point. That was the kind of solid study I have been after.

Noel, thanks for the pubmed nih site hint. The NIH is a terrific resource for EB CAM studies.

I find it interesting that mostly guys are interested in EB studies. Is that because our female colleagues prefer the more intuitive path, rather? I have nothing against the use of intuition, and try to use it whenever it manifests itself. But I can not make a sales pitch to a corporation based on it, right?

Rene: Re making sales pitches to corporations, you might find it helpful to watch the hour ten minutes Columbia profession's presentation regarding how to best influence others: http://www.youtube.com/watch?v=1tyUQb9IUQw

Go back a couple of pages Rene--women have commented and contributed.
And will continue to do so, here and elsewhere, with regard to EBP and research.

By a quick count, women make up 40% of this forum.

Yes, indeed, women are well represented here as well, which is good to keep the balance. Sorry, I had not seen the previous pages because I just joined.

Actually I think that much of the intuitive difference is our cultural training. When I was born I was ambidextrous but not now. I feel that most of my learning in this business has been to relearn to use the right side of my brain. I have natural empathic abilities that I suppressed for a totally left-brained career. But even though I have this uncanny ability to feel things there are interpersonal clues that I miss all the time. I feel that it is largely due to my upbringing. Likewise I think women have been right brain focused by our society but fortunately I see that changing but men are still being stereotyped and are behind in attaining sexual equality.
I think the “prove it” attitude that is the bases of EBT is probably just as common among the sexes.

Thank you so much for creating this group. This is a great resource to stay current with massage related research and grant opportunities.

Dear colleagues,

I am happy to invite you to join my group:” Medical and Sports Massage” including FREE Medical and Sports massage lessons. Not alot of practitioners in the US are familiar with Russian Medical and Sports massage as it was proposed by a Russian physician professor of medicine Anatoly Sherback . I'm happy to offer you information about this methodology as well as some additional information about me. I hope that our friendship will be pleasant and mutual beneficial. I believe in sharing knowledge. In such a case you will be able to learn from me as well as I can learn from you . If after reading information about medical and sports massage, or viewing lessons you will have any question I'm encouraging you to make comments or initiate discussion topic . In such a case my replies will be available for many to read, as well as your replies. Looking forward for great relationship.

Best wishes.
Boris

An interesting (short) clip on personal bias and public opinion in science by Neil deGrasse Tyson.

Jan- excellent resource-it looks as if the entire series would be valuable

Jan/Sandy; you might also find this interesting: http://www.sciencedaily.com/releases/2009/08/090821135020.htm

Thanks for sharing this, Noel. There were longish articles in the Chronicle of Higher Education a couple of weeks ago on anger and rage in the U.S. and most of those articles support what the researchers say in the Science Daily article. Tough to do objective research when there is so much emotion involved.

Sounds like Fox news.

Jan: Indeed, we appear to be living in interesting times. :~)

I can understand the feeling that one has to justify the fact that they we already at war but the article misses the fact that simple logic would have prevented the war to begin with. Even if Saddam had WMDs does anyone believe that he would try to wage war directly with the US? I don’t think anyone thought he was that stupid. He is also on record for using his power to stop any and religious competition to his secular power. He was already on Osama’s hit list for how he treated the clerics. I also don’t think he would have given then WMDs either.

Bush and his cronies were just looking for an excuse the invade Iraq since the Nixon days. I can’t believe that out legislators were so stupid. Reason would have prevented to war in the first place.

Carl: When one's foundational beliefs (premises) are false/invalid, one's reasoning process may be logically consistent, but one will still come to a wrong conclusion. To accurately, efficiently and effectively resolve a problem, one must first find/know the truth. Self delusion is both common and comforting until one is confronted with cataclysmic events and sociopathic individuals.

I should have tied this into massage better. The dots that need connecting have to do with biases. Many massage therapists "just know" that massage works and so even reading and analyzing the research becomes challenging because of that bias/opinion, particularly if it doesn't prove the bias/opinion.

Sandy is right, the entire series of deGrasse Tyson's short videos are helpful in understanding the phenomenon of bias as well as other issues in research. He's a scientist but doesn't overwhelm you with technical stuff. He is a really good and entertaining presenter that way.

Very true to quote Jan"Many massage therapists "just know" that massage works and so even reading and analyzing the research becomes challenging because of that bias/opinion, particularly if it doesn't prove the bias/opinion." As a profession we really need to move beyond our beliefs. There will always be that intangible mystery of the energy exchange between two human beings. That being said, there are just so many myths about massage and as massage therapists we often don't want to know about the information that is not supporting of massage. Only reporting one side of an issue- typically yours and my opinions can be backed up by only selecting some of the research and avoiding or ignoring the rest. I have done this- I am human. However, if I am doing something like writing a textbook it is necessary to be very disciplined about looking for this kind of bias.I can be opinionated-and many of my peers agree with that statement. The first step in objectivity is knowing that I can believe and present my opinions as facts.That's why textbooks have reviewers or more objective journals are peer reviewed. Hopefully this type of process will catch the problem. We need as teachers to teach students to be critical thinkers and to question intelligently. When they accurately do this it can be quite an ego slam if you let it- or you can learn something.

Well said, Sandy.

Jan, one of the problems is that parts of massage and bodywork can be explained scientifically and other parts cannot. What I find very discouraging is the parts that don’t fit into science are stuffed into some pseudoscientific drivel as accepted without proof.

Science is all about usefulness. If I have a steel beam of specific dimensions I can tell it breaking strength without actually breaking it. The disadvantage if science it that one has to take observations and fit them into a model. In the process, one loses information that does not fit. If we shift all of our thinking into the left brain we are operating half crippled.

It is easy to see how we can evidence based testing to validate rational thinking and the scientific hypothesis. But I believe that we can use that rational mind to establish objective tests for intuitive perceptions that cannot be rationally understood.

To start we need to acknowledge that science does not apply and setting of a predictive system is a false approach. However to throw out intuition just because it does not fit is limiting. Intuition, however can lead to false assumptions because it is untestable.

So what does one do? Firstly one has to use science to determine if the intuition is wrong what are the consequences. Will it cause harm? If not one can proceed. Ideally third party verification would be ideal but impractible with concepts that don’t communicate well.

When I feel problems like pinched nerves deep in the body and I release them and to problem goes away. I know in is scientifically impossible for me the physically fit the nerve but what am I to believe? What happens when I do something medically impossible but x-rays confirm what I have done?

Bodyworkers often see things that can not be explained by science and often adopt woo-woo explanations rather that try to develop objective evidence based testing to guide them to produce the best results. This is a far more difficult are to apply evidence based practices than scientifically proven areas.

Hi to one and all,
wow its great to see this site as an option and looking forward to getting to partake in some sound evidence based outcomes with this very worthy group of practitioners.
Cheers
Paula Nutting

For those interested in orthopedic massage, Pam Latterell, one of James Waslaski's top pupils and TAs, is teaching a (free!) 2-hour workshop on Sunday, November 14, from 10am to 12pm. Participants will be eligible for exclusive discounts on a Waslaski orthopedic massage seminar and related products.

No CE hours will be ...granted, but it's FREE. Full details are available here: http://cstminnesota.com/8.html

Listening to Leon Chaitow at the Massage Therapy Foundation research conference I was disappointed with how the straight leg test to determine if the patient had a structural or muscular problem was first created. But I was a further disappointed in how more research was built on the first assumptions. When we use the models from physicians, osteopaths, physical therapists, sports trainers, our results can only be as good as their model. So I hope massage therapy can continue to be the one modality that can approach a patient's body differently. To listen and watch how the body responds instead of imposing the intellectual knowledge of what and how we think the body should respond. Is the evidence in a research project or is the evidence in the decreased pain and increased function of our patients? I raise money for the MTF but I don't want our profession to become like physical therapy where I see every person with the same diagnosis is given the same exact treatment without any concern for the outcome of the patient. It is late maybe you have had this comment before. But what has happen over my 33+ years of experience is my patient's symptoms lead me to do something I have never done before and the results are amazing. Then I try this with a few more of my patients to see what results I get. If it is working, then I have to figure out why it is working because it doesn't fit the educational models we been taught. So my patients are my teachers and experience has shown me that just when we think we know how the body works, it shows us that there is so much more for us to learn.

Tanya
I can relate to every word you say especially when we are taught to regard osteo'schiro's physio's as "senior therapists" "research literate" "EBP"......then we find their evidence was flawed. But this goes all the way up the health chain eg surgeons are removing neck muscles and ribs in an attempt to resolve thoracic outlet syndrome but only 7 in 10 ops are sucessfull !!!

Like Sandy says my journey into research was a hell of an ego slam but having got over that, I've realized their are golden egg research articles that have empowered my work and thought process beyond anything I could have imagined. The best of which "Eyal Ledermans the fall of the postural biomechanical model in low back pain" explains why I work the way I do.
http://www.massageprofessionals.com/profiles/blogs/chronic-pain-you...

For many MT's researching the research will allways be a big challenge but the rewards are well worth it. :)

Taya, I agree 100%. Models by nature are limiting but when we go outside of the model we need EBP even more. We need to apply objective testing to guide us it insure that what we are doing is the right path. If we are truly going to complement traditional medicine by helping people who fall through the cracks we cannot work on faith based systems but need to apply objective testing even when we do not fully understand why what we do works.
When I started out in computers I learnd how the maching language instructions works from the circit diagrames, wrote my own operating system to run the programs and wrote my own code. Now softwre is so complicated that programmers have no idea of how the tools can pieces of code work that they use to create programs, yet they still test to results of what they create objectively. There is much of medicine that the doctors have no idea of how or why it works but they often lose sight of the fact that system only work when they are fairly simple. If I build a steel beam of certian dimentions I do not need to test is breaking point. But when things get more complex model based work starts to fall apart. Unfortunatly too many people throw out one model when it does not work and replace it with another. Western medicine does not work so tray Eastern medicine, etc.

Thanks for your comments. I have been wanting to express my feelings but was hesitant. So I find that by believing what we are told is the attachment of a muscle and/or the action we can only see the problem from this perspective. Tom Meyers is starting to challenge what we have been taught about attachments (Thanks Tom!) and I would like to challenge the actions. Piriformis is a great example. Did you know that the actions of muscles that we memorize came from the electrical probing of the muscle and watching it contract then applying the logic of, "The fibers attach here and here so the action must be...?" Why do all muscles have to be movers? Can't some of them be stabilizers? If we accept the piriformis as an internal rotator of the hip, then using scientific logic we have to intellectually guess the antagonist. But if we look at it as a stabilizer then we can look and feel the stabilizing antagonist. (I think in men the antagonist is the abductors of the same leg and for women the abductors of the opposite leg) I can prove this over and over. But how can you change the already accepted science? Research is not even close to doing any studies of this type.
I have read many studies by Physical Therapists that are great and many of them are about functional actions of the muscles. But PT's have not accepted or applied much of this information because they are still using isolated contraction of a muscle to determine muscle "weakness".
I guess I am asking, when do we question the already acceptable "standards of practice'? How do I convince a PhD to do a study to that challenges a system that people have paid good money to memorize, learn, and apply. AND what about all the products that make money by supporting that system such as braces, weight lifting equipment, etc?
Ok, I am ranting again... Carl, I do want to team with traditional medicine and when I worked at the Everett Providence Hospital Pain Control Center in the 1980's I worked with a team of traditional practitioners like a neurologist, PT, OT, biofeedback techs, psychologists, & nurses. The patients were treated with traditional medicine and now in constant pain and it was our job to help them cope with this pain. I was so naive that I kept thinking that there must be something we missed so I kept searching and trying. I have been very successful with treating chronic and complex conditions. The doctors in my area call and ask me to look at patients. Am I using magic to help these people? No, I have been using questions. I have come to question the traditional way we look at the body, what the patients symptoms are telling us, and even the diagnosis the physician has given them.
I have asked Diana Thompson to do a two weekend class for us in Washington to teach us how to do case reports and to have a case report ready to submit to the MTF. She has encouraged me to write some of my outcomes in this format so I will learn how and start sharing. This class is the first and my hope is to help her design one that can be the blueprint to be taught around the country. Thanks for listening.

"How do I convince a PhD to do a study to that challenges a system that people have paid good money to memorize, learn, and apply."

That's a good question. Researchers are generally interested in researching things that have a good chance of generating a finding, so if you can convince one that there is something to be discovered, they may be interested.

Do you currently work with or know any anatomy or physiology researchers?

Taya, many of models we have been using to try to understand anatomy and physiology today, are out dated. As is evidenced by the argument you brought forth about the muscular relationships in hip stabilzation. Granted you did mention Tom Myers's work. However, many others are working behind the scenes to rework and replace these models. One such group is Robert Schleip and his team at the University of Ulm, Germany Or Roberts's web site at Where, among other things tyhey are looking at the tremendously important roll superficial fascia plays in proprioception. In the past we have based our understanding of anatomy from the perspective of the anatomist working away with his or her scalpel. "ya cut through all of that nausty spiders web looking goop to get down to the good stuff beneath"!! . Or you tear away the skin of an animal and never stop to think what is this line of separation that makes skinning so easy?? Its the Fascia!!!!! Those wonderful pictures you see in Frank Netters books are fiction an artistic license! However, because of advances in technology (Imaging Ultrasound, MRI. RTF-MRI and CT scans) we are able to better appreciate fascias vital function. Checkout (a clip on youtube) and order a copy of Dr JC Guimberteau landmark film "Strolling under the Skin' to see this truly awesome tissue at work. A wonderful paper written by Jaap van der Wal and presented by him at the 2nd International Fascial Congress entitled "The Architecture of the Connective Tissue in the Musculoskeletal System–An Often Overlooked Functional Parameter as to Proprioception in the Locomotor Apparatus " blew the lid off our perception of how muscles worked. You can find it at

So the notion of kinesthetic muscular action as a function or origin and insertion is out dated. We need to look at the entire architecture and the mechanisms of force transfer through forced stabilization and force closure (Andry Vleeming, Diane Lee et al) to truly appreciate how the body reaches equilibrium. Please bare in mind that "all the forces are subjected to all the structural elements. With the result that the slightest increase in tension on any one of the elements, is transmittes to all the others, even those the furthest away" (Guimberteau 2009).
Yours,
Don Solomon, RMT (Vancouver, BC, Canada)

Grrr, I don't know why the hyper text did not post on this @#$%&* board
1) Robert Schleip http://www.fasciaresearch.de/ or http://www.somatics.de/
2) Jaap van der Wal article http://www.fasciacongress.org/2009/articles/IJTMB_vanderWal_62-436-...
3) Dr JC Guimberteau's Strolling Under The Skin http://www.youtube.com/watch?v=01jdrGrp4Fo
Don

One last note, If you have a chance check out Dr Lorimer Moseley's (et al) work on their blog at http://bodyinmind.com.au/ where they post their findings on the role of the brain and mind in chronic pain. Lorimer and a chap named David Butler co-wrote a brillaint book called "Explain Pain" about 8 years ago http://www.amazon.ca/Explain-Pain-David-S-Butler/dp/097509100X/ref=... In My opinion Explain Pain is a must read for anyone who works with people with chronic pain.
Yours,
Don Solomon, RMT (Vancouver, BC, Canada)

Taya, I have had the best luck working with hospice where to model shift from doing the right thing to quality of life. Focusing on the model can get obssesive and I found that if I stopping focusing on "doing the right thing", I started picking up on observations outside of the model. However, I kept the doubting Thomas hat on becasue if you step outside of the tested model you need to have an alternative methodology to determing not only the course of action but to test the effectivness of what you do. Becasue your observations may be subjective the tests must be objective. Where medicine fails is trying to make all observations abjective and in the process you lose vast amount of information in the process of codifying. Too often they assume that if the observations are objective they can rely on the model any not test the results at all. They also are unable to help people who don't fit the model. I believe that you must always test objectivly each time you work. Each person is different and if we could develop a model that was complete it would be too complex to use.

Hi Tanya, you make an excellent observation re piriformis indeed, but what about all the deep muscles of the hip ! !
I've spent the last year including this group for examination and treatment with excellent results, having previously ignored this group due to not developing a method that "gets around" the extreamly intimate nature of this work.
Surely there is a strong conection between hip rotator function and core stability issues?

http://www.ccptr.org/articles/rebalancing-hip-muscles/
http://www.movefreeblog.com/hip-mobility/why-to-strengthen-hip-rota...
http://www.massageprofessionals.com/profiles/blogs/hip-rotators-tre...

My appreciation of sensory feedback has been somewhat revolutionised by Robert Schleip.
I now veiw every muscle fiber, every fascial bag and network as fascial inteligence that feeds our ability to function with fluid efficiency.

The disproportianate amount of pain we feel from a paper cut to the finger, is not related to actual tissue damage, but the sectioning/disconnection of communication within the fascial network.