Core strengthening is a popular treatment modality among physical therapists, as well as being popular in the mainstream of exercise. There have been a number of articles written critical of core strengthening (see The Myth of Core Stability). Based on my experience, one serious flaw has to do with tightness that most physical therapists pay little attention.
Tightness of the anterior (front) spinal and pelvic musculature can play a great role in back, sciatic, and pelvis pain. Shortness or tightness of the iliopsoas musculature can cause the lumbar spine to become drawn forward and downward. The psoas originates at the transverse process of L1-L5, with fascial slips into each of the lumbar discs. Tightness of one or both sides of the psoas and surrounding fascia can lead to commonly felt back pain and dysfunction. I find this a repeating theme among patients with back pain and one that I spend a great deal of time in education and treatment. Repeated exercise can lead to shortening of a muscle, if not properly stretched.
Some common symptoms that can result from shortness in this region are pain with prolonged standing, or standing while leaning forward (doing dishes), pain on rising to stand after sitting, especially when you are leaning forward (computer use or bleacher sitting), and lying flat on your back with the legs flat.
If the psoas and surrounding fascia is restricted, further strengthening these areas easily leads to further exacerbation of the back pain. This is what often results from core strengthening. The traditional medical model, including the traditional physical therapy model, pays little attention to these interplays. While your therapist may have put you on a general stretching program for your pain, the prescribed exercises seldom target the hip flexors. Strengthening the trunk and back to better support is a repeating theme among the patients I see who have not been helped (or have been hurt) by this approach to pain.
Myofascial release stresses identifying the restricted or shortened musculature and soft tissue that may be causing excessive strains on the body. In my Foundations in Myofascial Release Seminars™, I stress a unique deep model of evaluation as a part of Myofascial Release training. Without this proper type of evaluation, this tightness is often overlooked. Demand more of your therapist. Don’t settle for what each and every back pain patient receives. No two cases are alike, so why allow yourself to be treated by everyone else?
Walt Fritz, PT
www.MyofascialResource.com
August 25th, 2010
Time is running out to register for either upcoming Foundations I class. Early registration/reduced fee for the Rochester, NY seminar Sept. 17-19, 2010 end 9/1/10. For the Hershey, PA seminar Sept. 24-26, 2010, early registration/reduced fee runs out 9/10/10.
Please refer to my website, www.FoundationsinMFR.com for full details.
Walt Fritz, PT
www.MyofascialResource.com
August 14th, 2010
As a followup to my last post, “Miracles”, I’ve been thinking a lot about fear and how it effects us and our patients. The example I gave in this previous post should be obvious to all, but what about the more subtle suggestions that we give to our patients? Can these backfire and create fear?
Traditional physical therapy often links a patient’s success to their performing their home exercise program. If the patient fails to improve, blame is often placed on them, since they did not “follow through”. There are a great deal of assumptions made on the part of the therapist that allows them to deflect the blame onto the patient, first of which should be will strengthening exercise truly diminish pain. The evidence is rather scant on this. Failure to improve becomes a source of shame on the patient. Fear of not improving creates the desire to do what the therapist asks.
When I ask a patient if they have done the myofascial stretches that I have taught, a common response is one of embarrassment; that they did not do them as often as they felt that they should. (My home programs never consist of strengthening exercises). I tell them not to be ashamed, I am simply trying to check their response to all of what we’ve done, both in session and out of session.It is their choice whether they are going to do them or not. It is my responsibility to work with them in such a way that we make changes, whether or not they do the home myofascial stretches.
What about other things that we ask or tell our patients? How many of you have told them to drink a lot of water after a session to flush the toxins or to keep from being sore? The scientific research has shown this not to be true. But by telling a patient this, aren’t we potentially setting them up? I know, most of us were taught this in our various trainings, but they simply don’t hold water…
Drink at least eight glasses of water a day. Really?
Flushing out Myths
I know I have to stop somewhere, as anything that I tell a patient can induce an emotion. But why pass on our own beliefs if that is all they are?
Walt Fritz, PT
www.MyofascialResource.com
August 14th, 2010
Miracles. I recently had an experience with a client that I wish to share. This client had been seeing a NUCCA chiropractor for approximately 15 years. For those who may not be familiar with NUCCA chiropractic, I would refer you to the NUCCA.org website. NUCCA emphasizes and focuses on C1 as the cause of issues throughout the body. Treatment is focused only on C1. My client felt that the NUCCA chiropractor had really helped him over the years, but with some reservations.
One thing that seems universal among NUCCA is that no one, beside the NUCCA chiropractor, should be allowed to touch the person’s neck, for fear of knocking the precise adjustments out. Additionally, this client had been warned to avoid hitting potholes with the car or jarring the neck or back in any manner. My client had developed a deep sense of fear that the alignment of C1 would be knocked out of place with the slightest incident.
This client, after numerous return visits to the chiropractor for check ups and re-adjustments after minor jarring, finally asked me to look at his neck. Tightness of the upper neck was evident and we proceeded with a few sessions of simple cervical lifts to release the sub-occipital region. He was doing quite well for a long period of time until a few weeks ago. He bumped his head and called to schedule a session. At the session he voiced his fear that this would send him into a few months of problems, as it had in the past. Prior occurances such as this required frequent re-visits to the chiropractor and much caution and guarding of the neck. At that session I simply performed a cervical lift to loosen the upper posterior cervical region and sent him on his way. He returned two weeks later calling me a miracle worker. While I appreciate the praise (and asked him to repeat it a few times!), I educated him further about the environment surrounding C1 and the need to keep things loose.After the previous session he had no symptoms at all, nor had any returned.
I tell this tale to ask why some health practitioners build so much fear into a client? I might be that they really believe that the precautions that they convey to the client are real. The cynic in me feels that it is a guaranteed method of maintaining repeat business. Make the client so fearful of any type of re-injury that they keep coming back, if nothing but for reassurance that they are OK. That’s what I love about the work that I do and teach. Get them moving again and get them out the door. Miracles.
Walt Fritz, PT
www.MyofascialResource.com
August 11th, 2010
I have some exciting news regarding the Myofascial Release Practitioner Directory on MyofascialResource.com. There is now no charge for a listing on this nationwide Myofascial Release and Bodywork Practitioner Listing. Therapists have had very good luck being found by potential patients and now is the time to add your practice. Simply go to the Sign Up page of my website, complete the form, and email it back to me. You can also send along a photo and/or logo for inclusion into the listing.
You can sign up here.
Walt Fritz, PT
www.MyofascialResource.com
August 9th, 2010
In my training as a physical therapist, pharmacology was required study. Traditional physical therapy comes in contact with many different medications for pain, inflammation, etc. As I began my Myofascial Release training, medications were viewed as maskers of symptoms and frowned upon.
Research published earlier this year shed light on a promising new treatment partner for fibromyalgia sufferers. Low-dose naltrexone has shown to be effective in reducing the symptoms (pain) of fibromyalgia. Published in 2009 by the scientific journal Pain Medicine, low-dose naltrexone produced a 30% reduction in symptoms vs use of a placebo. Given the very low side effects of this compounded medication, it merits inclusion into the treatment choices of fibromyalgia sufferers. Low-dose naltrexone is not a pain medication. It affects the body in different ways. You can read the full text versioin of this research paper on my website (#229).
Walt Fritz, PT
www.MyofascialResource.com
August 5th, 2010
Marketing your Myofascial Release (MFR) practice, or any type of practice, is about building a brand around you. I wrote an article a number of years ago that I cannot locate (after a number of computer changes) that talked to this fact. You, as an MT, PT, OT or whatever T you are, must decide what it is that you do and do well.
When I started my Myofascial Release practice, I pushed the words MYOFASCIAL RELEASE in all types of print advertising, as well as in verbal discussions about my work. I was going to convert every doctor and potential patient in my area of what Myofascial Release could do for them. But after a few years in practice, as my name and reputation spread, it was what I did that mattered more, not what modality I used.
The Pain Relief Center is the name of my practice in Rochester, NY. That pretty much explained to 99% of interested people what it was that I did. 1% would ask for Myofascial Release by name, and 1/10th of those 1% would ask who I was trained by. So my 2 minute elevator speech revolved around how I am very efficient at relieving pain. My 10 minute speech would talk about Myofascial Release a bit, but eyes tended to glaze over by that point. Once you are involved in the process of evaluating and treating, more attention is given to the specifics of MFR.
Brand yourself at what you do well. And what you do well should be patient directed. You may do MFR well, but to most people that message will not be heard. If it is pain relief you do well, create your brand around this fact. Know your market and know yourself. Promoting MFR, especially when you are promoting your teacher, may be wasted time and money on your part. It is YOU who needs to be in the forefront of your market.
Walt Fritz, PT
www.MyofascialResource.com
August 2nd, 2010
I’ll be in Hershey, PA for a Foundations in Myofascial Release I Seminar September 24-26, 2010. Details to be posted soon on my website.
July 21st, 2010
As a follow up to a previous post that I made, I want to present an analogy for scapular region pain. A situation presented itself again today that brought this to mind.
“Knots” in the rhomboid and scapular region seem to get all sorts of interventions. Massage, trigger point therapy, injections, stretching, heat, ice, etc are all common. My least favorite thing to hear is that a patient’s physical therapist is trying to strengthen this area, as if weakness is the cause of pain. With any of these interventions, the pain will lessen or go away, but usually not for long.
What happens when you get a pebble in your shoe? The answer should be pretty obvious; remove the pebble or the pain will continue. What happens if something under the shoulder blade rises to irritate the soft tissue? Spasm and pain will result. That something is usually a rib(s). Cause of such an occurrence can vary, and can be acute or chronic in nature. In my experience, unless you intervene to change the landscape of the ribcage/spine, the pebble will continue to irritate.
In my Foundations in Myofascial Release I Seminar, I introduce techniques to “Level the Landscape” of the ribcage. Myofascial Release holds a wealth of potential for making permanent changes to the thorax and beyond. Check out my upcoming Foundations I Seminar in Rochester, NY on my website.
July 9th, 2010
A new study has been published by the journal Footwear Science, which reports that going barefoot, or with only socks or slippers, in the home contributes to falls in the elderly. Their recommendation was for the elderly to wear shoes at all times to reduce the risk of falling. Sounds pretty wise, doesn’t it?
In the past, I posted another research article to my website:
Improving Physical Function and Blood Pressure in Older AdultsThrough Cobblestone Mat Walking: A Randomized Trial (#28).
Here is an article written about the above research paper.
This article looks at the influence that providing a test population with walking and exercising on an uneven, or cobblestone surface, improves both balance and cardiovascular fitness in the test subjects. They based their hypothesis that walking and exercising on cobblestones would simulate a group of people in Asia, where cobblestones make up the bulk of their walkways and streets. They found that these people had remarkable balance and fitness, even those into their 80′s and 90′s. The researchers then set up a trail to simulate this setting.
I spent many years as a home care physical therapist, and geriatrics were the bulk of my case load. Diminished balance was a common trait among my clients and it was often my duty to try to improve their situation. Intuitively, I often had them move outdoors onto the grass or other uneven surfaces and begin to walk, even if they needed to use a walker for assistance. As people age, our culture tends to move people into more supportive footwear and caution them from leaving very level surfaces, for fear of falling. What becomes of this is a loss of the physical and neurological stimuli that can maintain and even build balance and strength.
The results and recommendations of these two studies seem in absolute contrast. If a community sees crime on the rise, many will buy (or sell) stronger locks, while others will try to find the change the source of the larger problem. I believe that the first study is the “safety” model of medicine, the one that encourages “stronger locks”. It ignores the potential for change in all of us. I think that we are capable of more. There are many ways to build and maintain strength and balance as we age.
June 30th, 2010
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