Real estate

[rkathryn]

I'm glad to see that Don has finally reached his ten posts. In a private correspondence he admitted (as I once did) to lurking around for years before making any posts. So now he'll get access to much more information than the bits & pieces he's been reading. And then he can make a more informed decision about what he's arguing against.

[zimney3pt]

Don, I'm not sure if you are still here trying to defend your thoughts and those that you copied from Leon Chaitow's Facebook posting.

I wanted to take a look at the studies that were listed and try to do due diligence to look at the research that apparently we are ignoring.

Diane may want to ignore such evidence, but I urge you (and her) to remove the blinkers, and add this dimension to whatever you do now, rather than pretending that because you get reasonable results, you don't need to know more. This is not a fundamentalist belief system "fascia is everything" but it is a strong assertion that without understanding fascia better your results will not be as effective as they can be

Let's look at this study in detail.

Fascia and stretching
Loose connective tissue responds to light tissue stretch, which “may be key to the therapeutic mechanism of treatments using mechanical stimulation of connective tissue”
•Langevin H et al 2010 Histochem. Cell Biol. 133(4):405-15

First lets realize that this is on mice cells taken out of the body and put on a microscope slide. This is a long stretch to get overly excited to be relevant with human tissue working in a living, breathing system with a nervous, endocrine, immune systems interacting along with all of our other systems. I don't try to get too excited over one sentence taken out of context of the entire research paper to justify a treatment approach.

Let's look at some of these results from that study:

There was no significant difference in cellular or nuclear cross sectional area between stretched
and non-stretched tissue after 2 minutes of stretch (Figure 5). In tissue that was stretched for
30 minutes and then either released for 2 or 10 minutes, or not released, significant differences
were observed between conditions for cell cross sectional area, but not nuclear cross sectional
area (F

2,6=18.9, p<.003) (Figure 5). Cell cross sectional area was significantly reduced after 2
minutes (p=.003) and 10 minutes (p=.001) of release (Fisher's LSD). Although there was a
trend toward decreased nuclear cross sectional area in released tissue, this did not reach
statistical significance (p=.42 for 2 minutes and p=.07 for 10 minutes). There were no
significant differences in nuclear orientation or eccentricity within the image plane in tissue

stretched vs. non-stretched for 2 or 30 minutes (data not shown).

I guess I want to hear how any of that is useful or explains the use of supposed fascial release? Yes, it maybe interesting and may lead to further study but currently useful in a therapy setting I need help understanding how.

a strong assertion that without understanding fascia better your results will not be as effective as they can be

Would Leon and others in the fascia community also state that without understanding "myosin and actin cross bridge cycle" (insert any physiological process) your results will not be as effective as they can be? With this form of reasoning probably so. I'm sure as we set up our exercise program the myosin and actin cross bridge cycle is the most important thing we are considering to make sure our results are as effective as they can be, right?

[Thoth]

An orthopedic surgeon wrote that normally when""On the other hand, when one opens a thigh that has been at rest, either in a cast or in a splint, or as a result of rest in bed, one finds that the fascial surfaces, as well as the surface of the underlying muscle, is dull and does not glide; often times many small adhesions have formed between the muscle and fascia."Ralph K. Gormley, 'The Abuse of Rest in Bed in Orthopedic Surgery', J.A.M.A., August 19, 1944

An orthopedic surgeon verifies what was contained in the Fuzz Speech. Rome was not built in a day, neither are these fascial adhesions. they grow slowly and veryify Gil Hedley's fuzz speech. Perhaps paul can backtrack a bit on this topic now?

http://mygeologypage.ucdavis.edu/joy...0al%202007.pdf

contained this.
"We demonstrated that, in most individuals, the biceps muscles are two independent muscle bellies of the two heads, with two separate tendon areas. The remaining individuals had several interdigitations between both muscle bellies
and again two easily defined tendons." Page 1048 right side of page

indicating fascial adhesions in 7 of 17 biceps studied.

Disks, joints, fascia, facet joints, nerves etc. these are all important, and the reason the chapter keeps getting rewritten is that there is consistently new information made available.

"Would Leon and others in the fascia community also state that without understanding "myosin and actin cross bridge cycle" (insert any physiological process) your results will not be as effective as they can be?" No, why would that be so? My can opener works, I don't understand why on a scientific level, would this mean it doesn't work? I don't know what type of metal it's made from. Does that matter?

[Thoth]

Originally Posted by Alice Sanvito

I don't mean to be rude, but gosh, I feel like I'm talking to 2 year olds sometimes. You probably do, too, Paul. I can't imagine your mail.

Alice, when you talk down to people you may feel as though you are talking to a 2 year old and may come off as condescending. 1. Acting in a way that betrays a feeling of patronizing superiority.

[Barrett Dorko]

Saying this to Alice is insulting. She has not "talked down" to anyone here.

[TexasOrtho]

From clinical findings during surgical fasciotomy to unwinding. I'll need to pull up a chair and sit a while for this explanation.

[Thoth]

If what we perceive is our perception than perceiving 2 year olds in conversation would be perception, which is insulting to those she perceives as 2 year olds. Agreed?

Uninformed, incorrect, biased, could have been used. 2 year olds was chosen.

[Fletch]

Originally Posted by Thoth

An orthopedic surgeon wrote that normally when""On the other hand, when one opens a thigh that has been at rest, either in a cast or in a splint, or as a result of rest in bed, one finds that the fascial surfaces, as well as the surface of the underlying muscle, is dull and does not glide; often times many small adhesions have formed between the muscle and fascia."Ralph K. Gormley, 'The Abuse of Rest in Bed in Orthopedic Surgery', J.A.M.A., August 19, 1944

But nothing as to how this affects ROM or pain, how we test it as manual therapists or how we change it as manual therapists. For all we know, if it is the case as above, removal of a cast and a few movements through range may change this.

I don't think this surgeons writings add anything new to the fascia debate.

[Thoth]

Originally Posted by TexasOrtho

From clinical findings during surgical fasciotomy to unwinding. I'll need to pull up a chair and sit a while for this explanation.

Would like to hear the explanations. If fascia is operated on and it can be treated via manual therapy than we should embrace different types of manual therapy including some form of MFR in order to best serve clients.

Unwinding...? I came up with ( I think ) and prefer the term rewinding.

[Alice Sanvito]

Originally Posted by Diane

We could well be. However, right now, we are somewhere far away from the rest of the human primate social grooming troop. Which is why we're all dead here.

Oh, great, I've been seduced into becoming one of the living dead. ;-)

I dunno, I feel very alive right now. I must be delusional.

This particular shift hasn't cost me anything so far and, in fact, I feel like I've gained so much. But then, no one has threatened to sue me. Yet. I've been out of synch with my colleagues since the beginning, so though my thinking may have shifted, my status hasn't really changed. Actually, it has changed for the better because I've finally found a community of manual therapists where I can learn, express myself, ask questions, and not be treated like a pariah.

[Thoth]

Originally Posted by Fletch

But nothing as to how this affects ROM or pain, how we test it as manual therapists or how we change it as manual therapists. For all we know, if it is the case as above, removal of a cast and a few movements through range may change this.

I don't think this surgeons writings add anything new to the fascia debate.

Paul stated that Gil's observations are invalid due to the fact Gil's observations are of 'dead tissue' this is an observation 100 percent accurate and reinforcing Gil's "fuzz speech" in living tissue. For this reason this is 100 percent relevant. Paul said he would correct himself. This is proof in living tissue.

Gil did not espouse any treatment in the fuzz speech, just that immobility would cause fascia to become dysfunctional. Explain how this does not contradict Paul's statement. Further explain what is better than a view of living tissue from a surgeon.
And "for all we know" isn't that scientific. What would change the fascia debate? Is it fixed? Can it not be changed?

[TexasOrtho]

Originally Posted by Thoth

If fascia is operated on and it can be treated via manual therapy than we should embrace different types of manual therapy including some form of MFR in order to best serve clients.

Point of clarification - the fascia is incised during a fasciotomy. The problem isn't fascia, but the circulatory surplus deep to it.

The second half of your statement regarding manual therapy influencing fascia and its connection to serving clients is a logical leap across a certain chasm you should be aware of.

Thoth...spend more time reading and less time defending. It worked for me.

[Thoth]

Originally Posted by TexasOrtho

Point of clarification - the fascia is incised during a fasciotomy. The problem isn't fascia, but the circulatory surplus deep to it.

The second half of your statement regarding manual therapy influencing fascia and its connection to serving clients is a logical leap across a certain chasm you should be aware of.

Thoth...spend more time reading and less time defending. It worked for me.

Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure (and treat the resulting loss of circulation to an area of tissue or muscle). Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome. It is also sometimes used to treat chronic compartment stress syndrome. The procedure has a very high rate of success, with the most common problem being accidental damage to a nearby nerve.

Actually it's lack of flow, not surplus. This is due to tight fascia. Could this surgery have been prevented if the fascia had been released? I get the sense fascia is frowned upon in this forum, I don't understand the bias thus far. I am aware this chasm exists, but seemingly only on SS.

As far as defending I was merely providing the research Paul said he needed to retract his statment, for as he said if there was a weakness in his article it was that he didn't research it thoroughly, (as though it were relevant?) Skepticism is fine, I'm skeptical of skeptics.

[zimney3pt]

Originally Posted by Thoth

Disks, joints, fascia, facet joints, nerves etc. these are all important, and the reason the chapter keeps getting rewritten is that there is consistently new information made available.

Thoth, if you rewrite a chapter with new information does not mean it creates a new meaning.

"Living adaptable force transducers, bone to bone articulations, zygapophysial joints, peripheral nerve etc. these are all critical and the capacity to make sense of the main divisions in these pieces of writing keeps getting rewritten is that there is systematically new information being published in various formats and spoken by individuals."

I think I just rewrote what you said, but I don't think the meaning of it changed any.

[TexasOrtho]

Thank you for the lecture Thoth, but most of us took that class during entry-level training. I get the impression you are spending more time typing than thinking.

You obviously attended special training most of us are unfamiliar with. Fascia doesn't spontaneously tighten. It relies upon trauma in acute cases or persistent increases in exertion pressure in chronic cases. The issue in acute or chronic compartment syndrome is not fascia, the underlying circulatory pressure is. It is a fasciotomy because that's what the surgeon gets out of the way to address the real problem below.

I'm still trying to figure out what this has to do with MFR.

[Thoth]

Originally Posted by zimney3pt

Thoth, if you rewrite a chapter with new information does not mean it creates a new meaning.

"Living adaptable force transducers, bone to bone articulations, zygapophysial joints, peripheral nerve etc. these are all critical and the capacity to make sense of the main divisions in these pieces of writing keeps getting rewritten is that there is systematically new information being published in various formats and spoken by individuals."

I think I just rewrote what you said, but I don't think the meaning of it changed any.

You didn't add any new information, so the meaning didn't change, though you did provide the term "living adaptable force transducers" So you enhanced the conversation. Though if you did add new information it would have changed the meaning, clearly, which was in fact my point.

[Fletch]

Originally Posted by Thoth

Paul stated that Gil's observations are invalid due to the fact Gil's observations are of 'dead tissue' this is an observation 100 percent accurate and reinforcing Gil's "fuzz speech" in living tissue. For this reason this is 100 percent relevant. Paul said he would correct himself. This is proof in living tissue.

Gil did not espouse any treatment in the fuzz speech, just that immobility would cause fascia to become dysfunctional. Explain how this does not contradict Paul's statement. Further explain what is better than a view of living tissue from a surgeon.
And "for all we know" isn't that scientific. What would change the fascia debate? Is it fixed? Can it not be changed?

I haven't read the article you cited, however on the face of the year I would have to question how long people were immobilized/bed ridden back in 1944, and if those 'findings' would be there today. I don't see any writings from surgeons now about 'fuzz'. Is fuzz the same as what the surgeon was talking about anyway?

I'm back in the office tomorrow where I work along side a ortho/spinal surgeon. I'll ask his view on 'fuzz'!

[Jason Silvernail]

Regarding the assertion that a central role of the nervous system in pain and therapy is solely the idea of a couple of commenters on the forum "SomaSimple".....

Note the most current explanatory models published in our scientific literature here: Mechanisms of Manual Therapy..
And the the BodyInMind team.

These are all well-published, well respected researchers who, like many of us here, are just following the science where it leads.

[John W]

If fascia is operated on and it can be treated via manual therapy than we should embrace different types of manual therapy including some form of MFR in order to best serve clients.

A. Your initial factual premise that fascia is operated on doesn't have any relationship or relevance to the conclusion of the syllogism you present. The fact that a surgeon may cut through or separate layers of fascia with a very sharp instrument has no bearing on the application of manual therapy techniques to the skin of a living, breathing human being.
B. I don't accept your premise that fascia can be "treated" via manual therapy, and this is a very weak premise since it is highly arguable in and of itself.
C. This argument could be readily dismantled by a group of 6th graders with a basic understanding of logical fallies, of which several are demonstrated here.


OK, now I'll brace myself for using a bad "tone".

I should thank you for this. I'm going to use it in a clinical reasoning section of a course so my students can practice identifying faulty reasoning and logical fallacies within a manual therapy context. I'll tell them to try to ignore the poor grammar.

[Ref in Rehab]

Jason,
Thanks for the link to those articles....those are being shared with my staff ASAP

Sean

[Thoth]

Originally Posted by Jason Silvernail

Note the most current explanatory models published in our scientific literature here: Mechanisms of Manual Therapy..
And the the BodyInMind team.

These are all well-published, well respected researchers who, like many of us here, are just following the science where it leads.

Jason, What treatment methods do you use in your practice as far as Manual Therapy/Manual physical therapy? What should other therapists be doing that is verified by science. Thus far to my knowledge there are no scientifically verified treatments for chronic pain. What form of Manual Therapy do you use most? Looking foward to hearing more.

[Thoth]

Originally Posted by TexasOrtho

It is a fasciotomy because that's what the surgeon gets out of the way to address the real problem below.

I'm still trying to figure out what this has to do with MFR.

Is the fascia being tight and suppressing fluid flow not what is causing the lack of fluid flow beneath? Was that not taught to you in your entry level class as well?

If the fascia being tight is ever the problem, than releasing pressure on the deeper structure by releasing the fascia.

You can show them this thread as an example of how to talk down to someone (6th graders) and how to give a back handed compliment as well. I'm sure they will appreciate that.

Surgeons can address the problem, the tight fascia and muscle, the hardening and the adhesion are the problem often. Feel free to do nothing about it, the surgeon will appreciate the business.

[Thoth]

Originally Posted by Fletch

I haven't read the article you cited, however on the face of the year I would have to question how long people were immobilized/bed ridden back in 1944, and if those 'findings' would be there today. I don't see any writings from surgeons now about 'fuzz'. Is fuzz the same as what the surgeon was talking about anyway?

I'm back in the office tomorrow where I work along side a ortho/spinal surgeon. I'll ask his view on 'fuzz'!

Immobilized with a broken leg was the context, after removal of a cast this surgeon commonly saw these adhesions. The term fuzz wasn't used by the surgeon either. Clearly you didn't read the article, but good for you for commenting on it anyway!

Maybe ask his view of myofascial adhesions instead, and you may get a sincere answer instead of what you are looking for, which sounds like him scoffing along with you.

[Fletch]

Originally Posted by Thoth

Immobilized with a broken leg was the context. Clearly you didn't read the article

Maybe ask his view of myofascial adhesions instead, and you may get a sincere answer instead of what you are looking for, which sounds like him scoffing along with you.

As I said.... I didn't read it. I tend to limit articles to the last 10 years (unless it is something that is no longer studied or groundbreaking).

As you requested I will use the term myofascial adhesions, but knowing his views on many PTs beliefs like yours I cannot rule out him "scoffing along with me".

As you've read it, how long were they immobilized, how many patients did he see this in. Please divulge the importance.

[Fletch]

Thoth

I forgot to say; when you give some more info from the article that's shows its relevance, can you demonstrate some form of critical appraisal or do you just quote a section that you feel supports your POV.

[Thoth]

Originally Posted by Fletch

As I said.... I didn't read it. I tend to limit articles to the last 10 years (unless it is something that is no longer studied or groundbreaking).

As you requested I will use the term myofascial adhesions, but knowing his views on many PTs beliefs like yours I cannot rule out him "scoffing along with me".

As you've read it, how long were they immobilized, how many patients did he see this in. Please divulge the importance.

The point of the article was that on a regular basis the surgeon would take the cast off and see myofascial adhesions between fascia and muscle. This is consistent with the "fuzz speech" by Gil Hedley that Paul Ingram had critized. I don't know how long people were kept in casts in 1949, i'd think about 2 months, though if anyone has info to the contrary that would be good.

Surgeons see these adhesions on a regular basis from what i understand. It's interesting to me that you would expect him to mock an honest question regarding this topic. Maybe fascial ahesion would be the term he would be familiar with. What type of surgery does he do? Was interesting earlier when someone said that a surgeons view would not be important. Who else sees inside the limbs to see myofascia and nerves in a living body? Anyone?

[amacs]

Originally Posted by Thoth

The point of the article was that on a regular basis the surgeon would take the cast off and see myofascial adhesions between fascia and muscle. This is consistent with the "fuzz speech" by Gil Hedley that Paul Ingram had critized. I don't know how long people were kept in casts in 1949, i'd think about 2 months, though if anyone has info to the contrary that would be good.

Surgeons see these adhesions on a regular basis from what i understand. It's interesting to me that you would expect him to mock an honest question regarding this topic. Maybe fascial ahesion would be the term he would be familiar with. What type of surgery does he do? Was interesting earlier when someone said that a surgeons view would not be important. Who else sees inside the limbs to see myofascia and nerves in a living body? Anyone?

I don't recall Hedley suggesting that the "fuzz" formed over weeks, I seem to recall he stated it formed over a much shorter time span. I am not sure that "fuzz" equates to fascial adhesions in general or surgically induced adhesions specifically.

regards
ANdy


ANdy

[zimney3pt]

Originally Posted by Thoth

You didn't add any new information, so the meaning didn't change, though you did provide the term "living adaptable force transducers" So you enhanced the conversation. Though if you did add new information it would have changed the meaning, clearly, which was in fact my point.

I guess I need help understanding what "new" information the fascial community has provided, which is my point. With injury tissues change, fascia being one of those tissues. This I hope isn't the new information that is being added, because that is not very new, so to me the story has not changed. Please direct me too what is "new" information.

Please go back to my post #52 , this is looking at one of those studies that is suppose to be new information that is ignored. When I read the study I don't see anything meaningful to change practice in this study. Please direct me to what I'm missing. Those not jumping on the fascia band wagon are direct to understand these studies and not ignore them. I did look at the study and read it critically, and there must be some hidden information that I am not getting from what I read, so please direct me further to the understanding you get from a study like that one (and not the one line taken out of context of the whole study as done by others using to defend fascia treatment).

[Thoth]

Originally Posted by amacs

I don't recall Hedley suggesting that the "fuzz" formed over weeks, I seem to recall he stated it formed over a much shorter time span. I am not sure that "fuzz" equates to fascial adhesions in general or surgically induced adhesions specifically.

regards
ANdy


ANdy

fuzz over time becomes adhesions, rome wasn't built in a day. dysfunction isn't either. Good point, really though Gil talked about 2 days worth of fuzz, he didn't have to say 3 4 5 and 2 weeks 2 months later and go on. the meaning was inferred. fuzz becomes adhesions over time. This is as observed, fact. i believe.... Regards. Maybe check out the fuzz speech again and see if it rings any more true after reading that brief observation by the surgeon. I'd appreciate that. A second chance for a worthy somanaut that is Gil?

[Jason Silvernail]

Thoth-
A fascia-based approach to these problems really depends on a chain of reasoning that doesn't seem to have much support in the literature to date:
-Fascial restrictions are present
-Fascial restrictions are commonly related to pain and movement problems in a direct way
-Fascial restrictions can be determined in a reliable and valid way with manual examination
-Fascial restrictions can be changed with manual therapy
-When manual therapy changes the restrictions, the pain and movement problems resolve

I don't think we're past "Step One - Fascial Restrictions Exist" here.

Regarding your questions about my manual therapy approach: this is a fair question. I'm happy to give you a quick rundown of the approach and a list of peer-reviewed articles (including randomized controlled trials showing good effect sizes) that help drive my practice, with what I consider to be the clinical implications of each. Feel free to start another thread and I'll respond there. Thanks for your question.

[amacs]

The update from Paul Ingraham's site, okay it is second hand and I cannot verify its accuracy although I am sure Paul can - interesting how lightly Hedley himself seems to take the matter of the video and focusses on - movement

'I have corresponded briefly with Gil Hedley about my criticisms of him below, which naturally concerned him. He explains that the video was “never meant to be anything but a light, goofy rant to inspire folks to move more.”

I am not aware of fuzz becoming adhesions over time, I don't think Gil Hedley makes that assertion either although it could be implied. It remains a jump to identify "fuzz" in a corpse with adhesions in vivo arising from irregular circumstances such as prolonged bed rest or immobilization and to then generalise that to the wider "normal" population.

regards

ANdy

[amacs]

Originally Posted by Jason Silvernail

Regarding your questions about my manual therapy approach: this is a fair question. I'm happy to give you a quick rundown of the approach and a list of peer-reviewed articles (including randomized controlled trials showing good effect sizes) that help drive my practice, with what I consider to be the clinical implications of each. Feel free to start another thread and I'll respond there. Thanks for your question.

Sometime (and not today) I would like to see that list, I am aware however that may reflect sheer laziness on my part (then again it may be a thirst that needs satisfied)

edit: maybe its just I recognise your smarter and further down the road from me and I can learn something.

regards

ANdy

[Fletch]

Originally Posted by Thoth

Surgeons see these adhesions on a regular basis from what i understand. It's interesting to me that you would expect him to mock an honest question regarding this topic. Maybe fascial ahesion would be the term he would be familiar with. What type of surgery does he do? Was interesting earlier when someone said that a surgeons view would not be important. Who else sees inside the limbs to see myofascia and nerves in a living body? Anyone?

I don't think anyone would say their view is not important, however opinions are low on the evidence level. Big difference!

The surgeon in question has done a variety of ortho surgery but specialized in trauma and spinal. Also has a fellowship in pain. I know he would mock because we chat about the misbeliefs PTs have. Sure he sends people for manual therapy and exercise to help with pain but he also knows that some of the explanations for their benefit is flawed and there are other more scienced based explanations.

For example we were discussing a patient of his who had LBP. On flex/ext xrays he had 1cm slippage. He sent him for 'core strengthening' knowing it wouldn't change the slippage but may change the pain. At 6 months, pain went but slippage on xray remained.

Many physios would have told the patient incorrectly that their core muscles must be stabilizing the spine, hence the reduction in pain. Clearly this wasn't the case!

But again, this is just one case study, important but not conclusive.

[Thoth]

Originally Posted by Fletch

I don't think anyone would say their view is not important, however opinions are low on the evidence level. Big difference!

The surgeon in question has done a variety of ortho surgery but specialized in trauma and spinal. Also has a fellowship in pain. I know he would mock because we chat about the misbeliefs PTs have. Sure he sends people for manual therapy and exercise to help with pain but he also knows that some of the explanations for their benefit is flawed and there are other more scienced based explanations.

For example we were discussing a patient of his who had LBP. On flex/ext xrays he had 1cm slippage. He sent him for 'core strengthening' knowing it wouldn't change the slippage but may change the pain. At 6 months, pain went but slippage on xray remained.

Many physios would have told the patient incorrectly that their core muscles must be stabilizing the spine, hence the reduction in pain. Clearly this wasn't the case!

But again, this is just one case study, important but not conclusive.

This case study of yours is important. Did he have physical therapy for 6 months, or do strengthening for that period of time? was the pain localized in the low back? The body may have needed more ab/core strength to truly stabilize that injured/slipped segment. Once that strengthening was over the body may have felt less in harms way and allowed the pain signal to cease as it was now stabilized. This makes sense to me. Am i missing the boat here? Some people have low back pain for years if they have no intervention. Something worked.

Fascial adhesions (sorry for the term...) from what I understand and hear from my Surgeon friend are fairly common to be seen when in an operation. I would just ask if during surgery on a part of the body that had been immobilized if he had seen any abnormal formations in the connective tissue or fascia or periosteum. He may (may not) be more receptive than you think.. .It's an honest question and will show an interest in what he sees and he does have a unique perspective.

[Fletch]

Originally Posted by Thoth

This case study of yours is important. Did he have physical therapy for 6 months, or do strengthening for that period of time? was the pain localized in the low back? The body may have needed more ab/core strength to truly stabilize that injured/slipped segment. Once that strengthening was over the body may have felt less in harms way and allowed the pain signal to cease as it was now stabilized. This makes sense to me. Am i missing the boat here? Some people have low back pain for years if they have no intervention. Something worked.

I don't have answers to all your questions and yes you are missing the boat (as you say).

The point (boat) was that there was no change in the patients spinal stability as proven with f/u flex/ext xrays showing same degree of slippage. However there was a change in the patients LBP pain.

Hence, likely still a nocicetive signal from back but no pain experience. In this case, stability of spine does not correlate with the patients pain.

Exercise most likely gave the brain a reason to ignore the nociceptor signal (keep reading on SS) it DID NOT change the stability.

[Thoth]

Originally Posted by Jason Silvernail

Thoth-
A fascia-based approach to these problems really depends on a chain of reasoning that doesn't seem to have much support in the literature to date:
-Fascial restrictions are present
-Fascial restrictions are commonly related to pain and movement problems in a direct way
-Fascial restrictions can be determined in a reliable and valid way with manual examination
-Fascial restrictions can be changed with manual therapy
-When manual therapy changes the restrictions, the pain and movement problems resolve

I don't think we're past "Step One - Fascial Restrictions Exist" here.

Regarding your questions about my manual therapy approach: this is a fair question. I'm happy to give you a quick rundown of the approach and a list of peer-reviewed articles (including randomized controlled trials showing good effect sizes) that help drive my practice, with what I consider to be the clinical implications of each. Feel free to start another thread and I'll respond there. Thanks for your question.

Not having much support, and not having any support are two different things... But yes, I would like to have you send those articles and studies that drive your practice with some info on the clinical applications as you see them. Shall I message you my email?

[Diane]

Hi Thoth,

It looks like you are an enthusiastic poster. We have a welcome forum here where we would encourage you to start a thread about yourself, what your work is, what draws you here, what you hope to gain from being here, how you found your way here. We can engage with you on a more social level and welcome you properly. Meanwhile you can continue to post on whatever threads you find interesting.

[Jason Silvernail]

Originally Posted by Thoth

Not having much support, and not having any support are two different things... But yes, I would like to have you send those articles and studies that drive your practice with some info on the clinical applications as you see them. Shall I message you my email?

Yes I agree. But the standards of what is adequate support to consider a treatment approach and to make an argument along a chain of reasoning are well established in the scientific literature - many of those have been codified through the process of evidence-based medicine as well as the growing "science-based" movement. When the chain of reasoning is so weak and so much closer to "not any support" than so many other treatments and explanatory models, we have to wonder what the motivation is - and it clearly isn't "following the science."

Please ask me publicly here in the forum by starting a new thread and I'll be happy to respond. Recently I've pressed fascia advocates pretty hard for studies that underlie their practice with relevant clinical applicability - it only makes sense that I do that for my approach and that I'm ready to defend that approach in public. That's what we should require of each other.

[John W]

You can show them this thread as an example of how to talk down to someone (6th graders) and how to give a back handed compliment as well. I'm sure they will appreciate that.

You forgot to mention how to be sarcastic.

There it is- you attack my tone, but you don't address the fact that your argument was utterly meaningless.

I think I was being charitable stating that a 6th grader could dismantle that argument. I actually think my fairly bright 4th grader could dispose of it readily as well.

Toth, read it again and think about it. It makes no sense. Here, I'll quote it below so you don't have to go figure out what time it was you posted it:

If fascia is operated on and it can be treated via manual therapy than we should embrace different types of manual therapy including some form of MFR in order to best serve clients.

[Thoth]

Originally Posted by John W

You forgot to mention how to be sarcastic.

There it is- you attack my tone, but you don't address the fact that your argument was utterly meaningless.

I think I was being charitable stating that a 6th grader could dismantle that argument. I actually think my fairly bright 4th grader could dispose of it readily as well.

Toth, read it again and think about it. It makes no sense. Here, I'll quote it below so you don't have to go figure out what time it was you posted it:

Dohn, It wasn't just the tone. If myofascial release, or any form of manual therapy can treat the tight fascia and prevent a surgery it should be tried. No reason not too. Do you not try manual therapy to treat conditions, just leave it to the knife? What is the point of being a manual therapist if that's the case? Just because you don't understand something doesn't make it meaningless. You guys should think about that. You say you can't trust your eyes because you know you have bias dripping off of you and you see what you want to see because it is convenient for you, that which you don't want to see becomes invisible to you. Funny this is the only forum that discusses "not trusting eyes" and the only one i've been too that only sees what it wants too, and coincidentally seems to agree with itself. This is groupthink.

[Jason Silvernail]

Groupthink?
Surely you're kidding.
We challenge each other and we force each other to defend what we do.

You're the one here telling us we can treat fascial restrictions, without supporting your position with any kind of chain of reasoning or logical arguments.
What support is there for this concept of yours: "manual therapy can treat the tight fascia?"
I've provided proof upthread that major research groups in the manual therapy community support a primary neurophysiological mechanism. If its "groupthink", it's the group of people using scientific reasoning.
You're embarrassing your namesake here.

[Jackson]

Originally Posted by Thoth

This is groupthink.

As much as this group likes to argue and scrutinize everything, there is no way this is the case.

Nick

[joebrence9]

Thoth,
Have you introduced yourself in the welcome forum??? Start a thread with your name, field of practice and your interests??? Let us know who you are and what brought you here...

I would argue that this is not groupthink. It is simply "think".

[Fletch]

Originally Posted by Thoth

you know you have bias dripping off of you and you see what you want to see because it is convenient for you,

I would politely suggest you look in the mirror.

I also don't understand why you keep going on about the eyes. It's clear they can't be trusted. In my post-grad ortho training they even suggested closing the eyes and going by touch. Not that thats any better; what we think we feel is not always correct either.

[John W]

Do you not try manual therapy to treat conditions, just leave it to the knife? What is the point of being a manual therapist if that's the case?

You're in "Thothville" again. Or maybe it's the "Thoth Dimension". Or perhaps the "Thoth Zone". Whatever gave you the impression that I don't use manual therapy, and why is your conceptualization of its effects the only one that exists?

Just because you don't understand something doesn't make it meaningless.

No. It's meaningless because it violates the principles of logic.

I'd like to take credit for those, but I'll have to get approval from the Groupthink Grand Wizard first.

[bernard]

Originally Posted by Thoth

Immobilized with a broken leg was the context, after removal of a cast this surgeon commonly saw these adhesions.

By his own eyes or did he just saw that the patient was unable to move the way he (the surgeon) hoped.

[Diane]

That whole story has the ring of a "just so" story told by some fascial guru or other in order to persuade/gain the undying conceptual loyalty of his disciples into the (oops-better-not-use-the-word cult) tribe or human social grooming troop.

[Barrett Dorko]

Many appropriate comments in the last few posts.

I think it's time we quit asking if Thoth is kidding. This would include me. After all, why would anyone choosing that name (Description: Thoth is an unusual god. Though some stories place him as a son of Ra, others say that Thoth created himself through the power of language. He is the creator of magic, the inventor of writing, teacher of man, the messenger of the gods (and thus identified by the Greeks with Hermes) and the divine record-keeper and mediator. From here) kid around?

I'll be honest. When I offer help in the form of information and that is essentially ignored I find it difficult to continue the conversation. Maybe that's just me.

[Jackson]

Originally Posted by Barrett Dorko

I'll be honest. When I offer help in the form of information and that is essentially ignored I find it difficult to continue the conversation. Maybe that's just me.

It's not. Thoth has been given multiple links to multiple threads and articles, but still does not accept this advice to learn, think, then speak. Speaking first is causing "embarassment" as Jason said, and when embarassed the human psyche tries everything it can to rectify this in a manner similar to the road Thoth is travling down.

Nick

[Jason Silvernail]

Also I reiterate my offer to post explanations and a rationale for my approach with supporting literature if Thoth or anyone else will start a new thread elsewhere and ask me. Making an argument for why I do what I do and supporting it with literature is part of my responsibility and I'm happy to do it when asked.