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When is it time to alter your beliefs?
An article came to my attention within the past few days, one that
really challenges what I have been taught and practice. Titled "The fall
of the postural-structural-biomechanical model in manual and physical
therapies: Exemplified by lower back pain". I've posted the link on my
website Research
page, #210. I am aware that there always have been, and probably
always will be, challenges and changes to therapeutic paradigms, but
this one is a big one for me. It also challenges much of the information
that I was taught about the foundations of Myofascial Release.
A reasons that I often hear (and occasionally give) as to why research findings are ignored is that "why should I care, what I am doing seems to work so well?". I cannot argue with this statement too much, except to ask; "if you knew more about the information that challenges your beliefs, might it not allow you to improve what you do?"
Postural observation and assessment has always played a role in my evaluation and treatment. I am fully aware that bad posture does not equate to present or future pain. The research is clear on this. My own observations of people confirms this as well, as I have seen people with perfect posture suffering the types of pains that I attribute to the soft tissue tightness that leads to pain syndromes. And, I have seen folks with terrible posture with no history of the type of pain that I would expect they would suffer.
Posture plays only a part of what I look at and for. I doubt that my practice will change much as a result of this study. But, my mindset might. It may cause me to search deeper into the body before I move into treatment.
I'd love others to read through the article and share your thoughts.
really challenges what I have been taught and practice. Titled "The fall
of the postural-structural-biomechanical model in manual and physical
therapies: Exemplified by lower back pain". I've posted the link on my
website Research
page, #210. I am aware that there always have been, and probably
always will be, challenges and changes to therapeutic paradigms, but
this one is a big one for me. It also challenges much of the information
that I was taught about the foundations of Myofascial Release.
A reasons that I often hear (and occasionally give) as to why research findings are ignored is that "why should I care, what I am doing seems to work so well?". I cannot argue with this statement too much, except to ask; "if you knew more about the information that challenges your beliefs, might it not allow you to improve what you do?"
Postural observation and assessment has always played a role in my evaluation and treatment. I am fully aware that bad posture does not equate to present or future pain. The research is clear on this. My own observations of people confirms this as well, as I have seen people with perfect posture suffering the types of pains that I attribute to the soft tissue tightness that leads to pain syndromes. And, I have seen folks with terrible posture with no history of the type of pain that I would expect they would suffer.
Posture plays only a part of what I look at and for. I doubt that my practice will change much as a result of this study. But, my mindset might. It may cause me to search deeper into the body before I move into treatment.
I'd love others to read through the article and share your thoughts.
Views: 262
Replies to This Discussion
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Permalink Reply by Robin Byler Thomas on
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Hi Walt,
Thanks for posting the link; I just finished reading it.
As much as I love research I take it with a grain of salt as a practitioner. Too much back and forth over the years has made me not get too attached to any one method, theory, or way of thinking.
Research has really evolved too; so when reading these reviews I keep in mind research done in the '80's didn't have the standards we do today. The author cited a wide range of dates, true, but I'd have to go back and look at the foundational research referred to from the '80s to see how their designs were set up. For example, Grundy was cited on a leg length discreprency study back in '84. Any chance you checked out the study to see what you thought compared to the author's conclusion? I'm too lazy.
Your approach to evaluation is similiar to mine and I realize many things effect LBP; with stress contributing to a HUGE degree. That's why subjective information is so important in research and clinical practice. Postural evaluation is just another great tool.
What did you think of the author's suggested approach to clinical evaluation?
Also, I've got to tell you, I'm always a little relieved when another field challenges long held believes, because it happens frequently in massage therapy research. Challenges can be somewhat unnerving, but useful in that we review our practices and fine tune once again.
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Permalink Reply by Julie Onofrio on
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Wow! what a great resource your site is! I am going to add a link to it from one of my websites ( I just have to figure out where! I think I will add it to my types of massage section at http://www.massage-career-guides.com/types-of-massage.html Feel free to also write an article on myofascial release and put a link to your site in it!)
I didn't read the article but know that from my work in structural integration that working to correct posture does get relief from back pain but I have also seen so many people who should be in more pain because their bodies are so out of alignment. I have a client right now who has really minimal posture aberrations and is in the most pain I have ever seen in my whole career so go figure!. My motto is "if it isn't broke, don't try to fix it" meaning if they have bad posture but no pain I don't try to change their posture.
Actually though the years I have also stopped doing session work on people and just use what I know about posture for when people are in pain.
It is just one study though and I am not a big believer in research because I have a friend who does it and she is always telling me how the people doing the research skew the results and throw out data depending on who is paying etc. I see research as just food for thought- not a golden rule.
Julie
www.massage-career-guides.com
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Permalink Reply by Laura Allen on
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As many of the scientists on here and on the evidence-based practice website will point out, research studies are made to be replicated. One study does not mean something is a fact.
That being said, some of the things I have learned in the past few years have altered some of my beliefs significantly. When I was in massage school, I just kind of blindly accepted what the teacher said. Now that I've been at it for over a decade, and had the opportunity to meet people from all over who practice different modalities and some of whom either conduct research or make it their task to constantly review the research of others, I've come to believe that a lot of what I learned in school was false...taught by good-intentioned people, but still false.
You are totally right about posture and pain...sometimes there's a correlation, sometimes not. I'm not a believer that one modality or technique will "fix" anything and everything....I like the eclectic approach, and what works for one person isn't necessarily what's going to work on the next one.
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Permalink Reply by Walt Fritz, PT on
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Thanks for all of your thoughtful responses thus far. The question as to what I think of the proposed model to address low back pain remains a fuzzy one. In online conversation with proponents of a neurobiological rational to pain, the "whys" as to how pain occurs differs greatly. But when I view their treatment methods, they often closely resemble the ones that I use. It is the explanation of what one is effecting that differs.
This leads me to a point that I made in the original post. If there is growth to be made in understanding the rationale for pain mechanisms, then treatment may improve as well. I see no need to throw up my hands and state that my paradigm of explanation has no merit, when the outcomes are positive. Research will always provide conflicting information, depending on the researcher's interest. Learn from what was "proven" and keep moving.
There was one portion of the article that caught my attention:
"Within a biological dimension the structure (spine) is capable of self-repair and is able to adapt and change according to needs and demands (Fig. 2). But crucially, being a human with a highly evolved nervous system means that the structure is within the awareness. It is also under the influence of our emotions as well as the will and the actions taken. There- fore a person’s cognitions and behaviour will have important implications to their recovery from LBP" (from page 7 of the above cited article).
The emotional component of pain and injury will always remain the elusive component; the one that eludes all clinical research and reasoning, no matter the explanation.
Walt Fritz, PT
www.myofascialresource.com
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Permalink Reply by Stephen Jeffrey on
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Hi Walt
I have had to read the article a few times over and recently re read again. I relate to this article so much its rung all kinds of bells for me. Its is truely a revelation and should really shake things up for those whose practices are far too mechanical assesment based. When a client comes to me with chronic LBP or any other chronic condition, most times they have already seen a chiro, or osteopath or physio for "diagnosis" but not got a satisfactory level of relief. So for me to begin mechananistic assesment/tests is pointless as they already had this from previous therapists. It may be, a more organic approach, listening to their whole story and getting on with some treatment that also helps assess their condition is much more effective. I've come to think the more chronic the condition, the more value of this approach. See my blog.
http://www.massageprofessionals.com/profiles/blogs/chronic-pain-you...
So over the years my treatments have evolved organically into more listening and treating. Those therapists that want to do postural assesment, muscle testing diagnosing, etc should take note of this article.
At last I have an article that says "my way" may be best! thanks so much for posting this :)
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Permalink Reply by Daniel Cohen on
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Yes I would agree the organic approach as a holistic method is the way I also explore assess and work on relief. Even with this research I think postural evaluation and activity evaluation are valid as parts of the process towards resolving LBP. The key is it is a part of the process to unravel root cause. If it was the controlling factor we wouldn't find people with postural problems with no back pain. Julie already mentioned this.
Any research that helps us unravel the cause of back pain is worthwhile but I believe it varies from individual to individual and requires a variety of analysis both physical and emotional. If posture was the main reason then every music video model whose got back would have LBP.
From a holistic stand point I always evaluate, work from, and discuss all aspects I can exploring mind, body, spirit and environment. That would make a complex research study.
Stephen Jeffrey said:Hi Walt
I have had to read the article a few times over and recently re read again. I relate to this article so much its rung all kinds of bells for me. Its is truely a revelation and should really shake things up for those whose practices are far too mechanical assesment based. When a client comes to me with chronic LBP or any other chronic condition, most times they have already seen a chiro, or osteopath or physio for "diagnosis" but not got a satisfactory level of relief. So for me to begin mechananistic assesment/tests is pointless as they already had this from previous therapists. It may be, a more organic approach, listening to their whole story and getting on with some treatment that also helps assess their condition is much more effective. I've come to think the more chronic the condition, the more value of this approach. See my blog.
http://www.massageprofessionals.com/profiles/blogs/chronic-pain-you...
So over the years my treatments have evolved organically into more listening and treating. Those therapists that want to do postural assesment, muscle testing diagnosing, etc should take note of this article.
At last I have an article that says "my way" may be best! thanks so much for posting this :)
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Permalink Reply by Jimmy Gialelis on
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Mr. Fritz, isn't it strange that we are a pecularly fickle society? All it takes is a couple research articles to sway our perspectives on standards and procedures that have proven successful over time. Maybe everyone needs to take a statistics course to understand how one can formulate a study to create a desired result. And the question I always ask is who funded the research? The true answer to why change occurs lies here! Follow the money trail and let's see who profits from this change!
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Jimmy,
Are you speaking in the first or third person? If you read through what I wrote, I stated that this study made me stop and think. But my conclusion was that I will continue to practice as I do, "But, my mindset might. It may cause me to search deeper into the body before I move into treatment.".
Of course one must question research and follow the money. But do you exclude something simply because it states something you don't like or agree with?
The study I referred to may have a bias, but who of us doesn't? Any person who runs even a perfectly formulated study will be attempting to prove or disprove something. This too is an agenda.
I am teaching one of my myofascial release seminars this weekend and I do teach postural assessment as a part of that training. But, I tell my students that this is only one part of a much larger view that they must take in order to come up with an assessment of the problem. Posture can be a guide, but don't be ruled by it.
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Hi Jimmy,
the way I work has evolved over the last 12 yrs! and in no way an alteration of perspectives because of " a couple of articles" but because of results with my clients. Please allow me a brief period of celebration in connection with this article as its perspective (for me) has been a long time coming.
I understand your suspicions re research and funding and if you have something solid lets hear it. For me the author has gained my respect as he must have known putting this into print was inevativatably going to challenge/upset a large body of professionals, why do that? .....unless their are things we can all learn from this article?
As Daniel points out, the perfect marriage is within our grasp = organic and specific ? how good is your marriage ?
Jimmy Gialelis said:Mr. Fritz, isn't it strange that we are a pecularly fickle society? All it takes is a couple research articles to sway our perspectives on standards and procedures that have proven successful over time. Maybe everyone needs to take a statistics course to understand how one can formulate a study to create a desired result. And the question I always ask is who funded the research? The true answer to why change occurs lies here! Follow the money trail and let's see who profits from this change!
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Discussed here also
http://www.somasimple.com/forums/showthread.php?t=8313
Stephen Jeffrey said:Hi Jimmy,
the way I work has evolved over the last 12 yrs! and in no way an alteration of perspectives because of " a couple of articles" but because of results with my clients. Please allow me a brief period of celebration in connection with this article as its perspective (for me) has been a long time coming.
I understand your suspicions re research and funding and if you have something solid lets hear it. For me the author has gained my respect as he must have known putting this into print was inevativatably going to challenge/upset a large body of professionals, why do that? .....unless their are things we can all learn from this article?
As Daniel points out, the perfect marriage is within our grasp = organic and specific ? how good is your marriage ?
Jimmy Gialelis said:Mr. Fritz, isn't it strange that we are a pecularly fickle society? All it takes is a couple research articles to sway our perspectives on standards and procedures that have proven successful over time. Maybe everyone needs to take a statistics course to understand how one can formulate a study to create a desired result. And the question I always ask is who funded the research? The true answer to why change occurs lies here! Follow the money trail and let's see who profits from this change!
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Permalink Reply by Boris Prilutsky on
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Hi Walt.
Actually biomechanics as well postural assessments is an important issue in our fields too. Probably for a reason people who wrote article specifically addressing physical therapists. To the best of my knowledge physical therapists do not spending procedure time on mobilizing soft tissue in order to eliminate tensions within muscles and fascia,addressing trigger points, est.Most of biomechanical disturbances that can produce painful symptoms is a results of soft tissue dysfunctions (Myofascial pains)that cannot be detected by radiological means but only by diagnostic examinations of our fingers. I remember one of my clinical professors used to place x-rays and asked us to describe clinical symptoms of patients. Of course each of us described painful symptoms where we saw more severe degenerative changes est.
when patients used to be brought to classroom, to our surprise we learn that " good x-rays" patient suffering terrible, and
" bad x-rays" patient was plus/ minus OK.the message of this teaching was that we have to be directed in our decision
by clinical phenomenons as well by examinations of soft tissues and eliminations of pathological changes within soft tissues. massage therapy also is a one of methods for nerve/muscular reeducation that contributing to biomechanical corrections.as you said:"I have seen folks with terrible posture with no history of the type of pain that I would expect they would suffer. "I believe that your post is extremely important for us to have more definitions of what is our methodology about and to realize that in many ways it is different than other physical methods of treatment,and we shouldn't accept some theories that have little or none to do with our methodology.in my opinion article like this should be approached as a general information. Thanks.
Best wishes.
Boris
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Boris, I'd agree with all that you said except:
To the best of my knowledge physical therapists do not spending procedure time on mobilizing soft tissue in order to eliminate tensions within muscles and fascia,addressing trigger points, est.
Walt Fritz, PT (physical therapist :)
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