Protocols and Cookbooks

The use of protocols has gotten a bad rap in some areas of Myofascial Release. “Cookbook Therapy” it is often called. Certainly following a strictly defined treatment plan is out of line with most forms of MFR, but don’t we all follow certain protocols?

Each individual that comes into my treatment room is approached differently. That being said, there are certain trends that, in most cases, hold true. If a patient tells me that they have difficulty standing for any length of time, especially while performing an activity such as washing dishes, and, experiences difficulty coming to stand after working at the computer for a length of time, I immediately suspect hip flexor involvement. While I remain open to other possibilities, my experience has shown that I am often correct. This is a protocol, or recipe, that has proven to be valuable, in that releasing the hip flexors provides improvement, and I do not waste time treating the back.

Us this a recipe from my cookbook? It probably is, but it comes from years of experience. Have I narrowed my focus to soon, possibly missing some other cause? I do not believe so, as I always perform a complete assessment, head to toe, prior to coming to any conclusions. And, the assessment/evaluation is always a dynamic process. I am constantly re-assessing as I treat.

Peter Lelean’s Migratory Fascia Syndrome has a set protocol of areas to assess and treat. It does not preclude addressing other areas, but works from trends. I have seen great success using this protocol of evaluation and treatment. Cookbook therapy? Not in the least.

All myofascial release involves some sort of sequencing or protocol, though some would have you believe this is not so. The three step lumbosacral decompression is a perfect example. Perform the sequence in a certain order and results typically improve. Most therapist trained as I was follow these steps without feeling they are doing cookbook therapy.

Cookbooks are fine, as long as you write them.

What are your thoughts?