MAYBE

 

MAYBE

I was privileged to assist Dr. Leon Chaitow at a workshop recently.  It was gratifying to spend time with my teacher, mentor and friend for the past 27 years.  We had time to talk about the past, present and future and the changes that have occurred and what we anticipate for the near future.  There were shared satisfactions, recollections, concerns and frustrations on a professional level and deep respect and connection on a personal level. I consider myself very fortunate to have this ongoing relationship with Dr. Chaitow.  We don’t always agree and his professional world of osteopathy and mine of massage therapy are similar but not the same.  Massage therapy continues to struggle with it’s identity, entry level education let alone advanced practices. Manual therapy is the term that is usually used for the rest of the professions that manipulate soft tissue as the avenue to interphase with physiology. Of course I can make a case for most manual therapy being adaptation of massage application and others can make the case for massage being some sort of manual therapy.  Evidence based practices, now modified to the more forgiving evidence informed practice, challenges us to evaluate our belief systems (BS) about what we think we are doing and why it works (if it does or doesn’t). Some of our belief systems related to mechanisms of benefit are pretty silly actually. Some make more sense but overall it is all theory and not fact. This was clear at the recent workshop where I assisted Dr. Chaitow with the concept of muscle energy technique. He spent sufficient time with the evidence –past and present- and identified what concepts have persisted and what has changed.  Finally after talking in a circle as one must when presenting research studies and then extrapolating clinical practice significance concluded with the profound statement (a least for me) MAYBE this is what is going on or not. It does not necessary alter what we do but challenges what we think we are doing.

It is no secret that I do not like gimmicks and abstract method naming. I do not like claims some educators make for results. I fuss and get my fascia in a twist and my neuromatrix in a wad when people make claims without qualification or provide answers when we are more working with educated guesses.  I really get a fascial wedgie and a neuromatrix snag with someone trademarks a style , claims they have found something new and puts a weird name on it or says they are able to target a specific tissue or nerve receptor.  Grief.  We are physiologically too interconnected for this type of specify.  There is just no way to isolate function or application like some would claim. 

 I have been being treated for glaucoma for many years.  I have used every combination of medication drops and oral medication there is. Some actually bring the eye pressure down BUT also have other effects.  We may call this a side effect but what is occurring is that we are too interconnected in structure and function to be target specific with treatment.  I have had a laser burn little holes in my eyes so the fluid can leak out.  I have had a laser burn a big hole in my eyes so the fluid can leak out.  I just had a canoplasty which is essentially a rotorooter procedure on the clogged drain.  I am fortunate to have as a Dr. an international glaucoma expert and I watch her experimenting and making educated guesses just like I do when I provide massage.  She knows the outcome-less pressure inside the eye from accumulating aqueous humor and she knows the reason is because the drain does not work right but the rest of the process is based on experience, clinical reasoning, and evidence both scientific and experiential. She is involved in multiple research projects of the hard science type and in fact my sister and I are participating in a genetic study trying to figure out glaucoma heredity.  You would think there would be better treatment then making holes in the eye but right now there isn’t.  Now there is some important factors with you are making eye holes that relate to this blog topic-MAYBE.  Anatomy, physiology, pathology, sanitation, procedures and equipment.  She has used lasers, knives, needles and probes. I use my hands, arms and sometimes feet as tools but I am not trying to make holes in the tissue. I use my tools to fool around with the anatomy and physiology in an attempt to achieve outcomes. When I push and pull on soft tissue I can have some level of specificity to target somatic and autonomic nervous system-indirectly the endocrines system and since we are a fascia based, fluidy, slimy and slippery being I cannot avoid any of it let alone only target a specific part.  The methods used by myself and my Dr. are attempting to help the body function normally. Sometimes it works especially if there is little concurrent harm.  I tried a medication for the glaucoma and not only did I have a bad side effect reaction it may have made the situation worse.  Even if the medication had lowered the eye pressure I couldn’t use it because of the side effects. This is kind of like using deep transverse friction of tendinosis when the person is frail and on blood thinners. Evidence is mixed as to if friction as a soft tissue method even works on tendinosis and even if it does it may cause more harm than benefit.

The finial message of this blog is MAYBE we can make logical justification for what we are doing-MAYBE.  What we do using manual therapy / massage is way to general- a push or a pull on complex interconnected tissue and physiology to make specific claims .  We should have discussion about procedure, process and possibilities.  And consider this as the foundation regardless what you call It.:

The four main outcomes for massage:

•             Relaxation/pleasure

•             Stress management

•             Pain management

•             Functional movement support.

Also remember the three main approaches to care:

•             Palliative

•             Condition  Management

•             Therapeutic Change.

Consider the nine primary methods

•             Static methods/ holding

•             Compression

•             Gliding

•             Torsion Twisting (Kneading)

•             Shearing (friction)

•             Elongation

•             Oscillation

•             Percussion

•             Movement

Methods are used to generate a mechanical force by:

•             Pushing

•             Pulling

Methods adjusted and adapted by the following 12 modifiers :

•             Pressure

•             Point of Application (location and broadness of contact)

•             Magnitude (intensity)

•             Direction

•             Drag

•             Speed

•             Pacing

•             Rhythm

•             Sequencing and transitioning

•             Frequency

•             Duration

•             Intention for outcome.

Adjusted methods generate appropriate force to load the body tissue to create the following five stresses to which the physiology must adapt:

•             compression stress,

•             tension stress,

•             shear stress

•             torsion stress

•             bending stress.

And hopefully a good thing occurs.