"Because It Works" is Not Enough.

“I don’t see how knowing the science behind my work will improve what I do…”

“I don’t care about the science behind it, as long as it works…”

“The evidence does not matter, it is results that matter…”

“Stop talking about things I don’t care about…”

“Shut up…”

Do any of these statements sound familiar? Have you said any of them yourself? It may be the places I frequent on the internet, but these are hot topics of discussion/argument. I’ve spoken a bit about this over the past few months, but I wish to elaborate further, especially when it comes to myofascial release. To put things very simply, when I place my hands on a patient and gently direct pressures in a certain fashion, pain fades or goes away. If life was simple, there would be no need to say anything more and continuing education seminars would be over before they started. “Just place your hands on your patient, gently direct the pressure in a certain way, and the pain will lessen or go away”. Heck, college or professional education training programs would be a lot quicker as well. Learning a methodology of treatment is not quite that easy, though it need not be difficult. Learning what to “look” for, in order to determine where to treat, takes a bit of teaching, but the process is really quite simple. At its core, myofascial release is simple. That is, if you believe what they tell you about what is happening under your hands. Here is where the “who cares, as long as it works” often will be voiced. Who cares if it is the fascia we are intervening upon, or the muscle/joint/bone/nerve/ether/spirits/energy, as long as it works!!! YOU should care.

Time for a confession; I used to say the same things. I believed what I was told in my myofascial release training and collected “research” that proved it so. Why did I place quotation marks around the word research, you might ask? Because all of what I collected (and there was a lot of it, you can still see it all here…but closer to the bottom now) showed that myofascial release has been used successfully in a wide range of studies. These showed that what the tester did with their hands helped to achieve the intended effect. It did NOT, however, prove the WHY’S of what was happening, which is the bone of contention with many disbelievers in MFR and many other modalities. And now I understand why.

Anyone can design a case study, perform it, and send it in for submission to a journal. Well, OK, maybe it takes understanding of the basics of research to do it correctly, but we all have that capability. But read through the dozens of studies on the research page of my website. Let’s use this study as an example: Effectiveness of Myofascial Release in Treatment of Plantar Fasciitis: A RCT. (#76 on my research page). What the researchers did was to take two groups of people who suffered from plantar fasciitis. One group was given ultrasound, strengthening exercise, standard stretching, and contrast baths, while with the second group a standardized myofascial release treatment was added to the other treatments. Pain and function improved more with the myofascial release group. So what does this prove? To me, it proves that what the testers performed with their hands made the difference. It does nothing to prove the basic tenats upon which myofascial release is based, specifically, “By myofascial release there is a change in the viscosity of the ground substance to a more fluid state which eliminates the fascia’s excessive pressure on the pain sensitive structure and restores proper alignment.” It does give a reference, but it is simply relying on previous OLD science to move the study forward.

So, we have established that most of the research on myofascial release does nothing to prove that it works the way people say it does. So what to do? Start looking at the current trend in pain science, for starters. In previous posts I have pointed to many places where the reader can go to begin to learn. On my Research Page, I have also given a number of examples where the reader may begin to read through some really intelligent and PLAUSIBLE explanations for pain and its remediation. The research from all fronts (even the fascia research), is pointing to a neuroscience-based model to explain the changes we feel under our hands.

So, why is “because it works” not enough? With every new discovery comes change. As we become more accurate in explaining how our therapeutic interventions elicit change, we will discover newer ways to be more focused and accurate with our results. For me, saying “because it works” was due to laziness. I had doubts, but it was a lot of work to begin to even scratch the surface of plausibility. I’m less lazy now.

Anoop T. Balachandran wrote a blog post recently entitled “All I care about are results, not evidence or science“. Give it a read.

As an aside, a few months ago I was asked to answer a questionnaire for a national massage magazine, regarding myofascial release and fascial therapy. It was quite extensive and I took my time, using much of my recent acquired knowledge to dispel a few myths. Unfortunately what came to press today was a far cry from what I wrote. You decide for yourself.

The article: Fascial Therapy

What I actually wrote

For now,

Walt Fritz, PT