Since December, I’ve scheduled a run of Continuing Education courses that have me very, very excited. It’s just a group of topics that are serving to accumulate information as a PT to run in my use of the SFMA. I choose my words intentionally as I think there is a big difference between accumulating information and learning. My learning over the last 2-3 years has been as a coach in physiology, monitoring, and leadership as well as running my businesses. As a PT, I made a conscious decision to seek out courses that “fit” into the System I use in terms of methods that fit the options of changing pain, increasing mobility, acquiring motor skills, and fitness.
One of the primary searches I have made is for methods intended to change pain via a map of sorts. In using the approach of One Shot, 1 Kill that I learned from Gray Cook and that I talked about briefly on on my 2nd DVD, Lateralizations & Regressions, we are trying to find target tissues that simultaneously change pain and contribute to mobility or motor control if possible.
Now of course nothing can be proven in terms of why pain changes with any kind of neuroceptive approach, including manual therapy. I think what we can prove is what the intent of the therapy was on the part of the therapist and if the desired result was achieved. At this end, I’m not sure it matters why it happened, as long as it did happen, and the result is honest and realized.
But if we believe in some of the models that offer an intent of changing pain via a distant area from the pain AND potentiate a change in proprioception of that tissue for a different movement intent, we have something very exciting. Some of these models may include the Vertebral model using HVLA or TDN, a peripheral nerve distribution, a Trigger Point model, the Rib referral model, Structural Integration, Rolfing, others I’m sure, and in the case here, Fascial Manipulation.
In a simplified example of One Shot, One Kill using the SFMA, if an FP is anterior R anterior shoulder pain, and any cervical pattern is DN, we can use the Vertebral Model to thrust or needle C5 with the intent that C5 COULD be limiting at the neck AND COULD be referring pain to the shoulder. The 10 seconds it takes for this treatment is a high reward, low risk. We’re simply looking to change the pain and motion at the same time.
I was exposed to the Fascial Manipulation model in 2010 I believe in seeing Luigi Stecco present in NYC. It was at this event where I met Dr. Warren Hammer, and I have since spent time with him reviewing the model as well. Many horsemen of the fascial world were at this event where I recall Dr. Antonio Stecco, who taught my course in Queens and Dr. Thomas Findlay.
Fascial Manipulation as it is now in America is 12 days of study broken up into 2 levels of 3 days each. It appears thus far to be a method to change pain, yet it also appears that with a normalization of the fascia, there is a suggestion that motor patterns resolve. This is highly spurious and not something that I believe, but I’m also unclear that this is a claim they make. This is a question I have for the next installment next month. In fact, it appears different instructors of this model claim no exercise is needed along with the type of exercise is not significant.
Again, I’m not at all on board with this approach, but rather we need something that changes pain that allows us to establish new motor skill acquisition. Methods that fit that definition would be a Reset in the SFMA 3 R’s. I suggest it falls into the Zero Box as an approach to explain a 5th strata to following the Dynamic Systems Model – Subconscious Non-Purposeful, Conscious Non-Purposeful, Conscious Purposeful, Subconscious Purposeful. Sometimes we need a method to allow us to get into exercise that allows for motor skill acquisition or change. Sometimes exercise alone, properly chosen exercise, is not useful when the body’s nervous system is under such neural lock or fibrosis.
I mentioned before that I like maps. Fascial Manipulation is a combination of a map of points when stiff referring pain to a set area, a model of prioritization of treating points with aggressive cross-friction mainly with knuckles and elbows, and exploiting the neuroscience of fascia. It’s really quite solid.
What I found interesting is the evaluation they are using now was quite different from what I saw in 2010. Antonio, Luigi’s son, suggested the evaluation system has been changed and perfected over time. This is fine, but this also suggests in my mind a couple of things: 1) maybe the evaluation model can change again and be better, and 2) maybe I can make up my own or use my own evaluation.
That evaluation is the SFMA where we also review all three planes as the Fascial Manipulation movement verifications do, but also separate where interventions of pain, mobility, motor control, and fitness can fit in. The beauty of the SFMA is that after patterns are bucketed, any model of treatment can work if it is intended properly.
What I am trying to crack here is using Fascial Manipulation when changing pain is required. And I’m trying to fit it into One Shot, One Kill that I learned from Gray. I think once we correlate the location of pain to the Centers of Perception (locations of where non-specific pain are reported) and test the stiffness of Centers of Coordination (the “points”), we treat what is stiff and retest the SFMA. It’s really simple, but using their prioritization of points seems arduous and long given my rookie understanding.
I’m wondering if the plane of motion that leads to pain in the SFMA could be the indicator of which plane of points to treat using Fascial Manipulation. Their clinical model suggests treating 1 plane per session.
Towards the end of the weekend, I asked Antonio which came first, the evaluation or the points. He quickly said the points.
What doesn’t fit how I think is making up an evaluation to lead you to the techniques or exercises you like doing. You only get led to your favorite stuff, and nothing is going to work for everybody. I don’t know any commercial model other than the SFMA that buckets patterns into Pain, where you can do pretty much anything, Mobility leading you to joint, soft tissue (fascial, muscular, neural), or Neuro-Locked, Motor or Fitness where particular special exercises are the ticket.
How about when SFMA tells us pain, we use Fascial Manipulation?
Or hen it tells us Neuro-Locked, which it does tell you if you do it right, you use DNS or PRI?
Or hen it tells us go hard, you start teaching big lifts and/or aerobic fitness which have powerful humoral and hormonal effects that support the rehabilitation process?
Your eval not called the SFMA can’t do that. And no matter how hard you beat your chest or make claims, until you see notes on napkins and white boards and late night conversations, the SFMA will make you better because it takes you to what you need, not what you like. You’ll use your favorite stuff when indicated and limit the times it doesn’t work. Because again, nothing always works.
Some Fascial Manipulation instructors I’ve heard teaching using whatever you want at the points of Fascial Manipulation. Use the hard fingers, knuckles, elbows. Use IASTM. Use needles, just use them where Stecco says. I didn’t get the impression that Stecco supported that, but again we were all rookies in the room.
Something here that strikes me in using heavy knuckles and elbows, this is a technique that fairly sympathetic in its effects. What if someone is already sympathetic. For instance if someone measures one way in Recovery Pattern on Omegawave, it can tell you if you should use a hard technique like this type of cross-friction. If it measures another way, you would use something softer like needles or effleurage or Functional Range Release.
The other thing that may in fact be the most important thing that I am seeing in well taught soft tissue course is yet again the correlation of pH to soft tissue quality is made. Histological changes in fascia that suggest “lack of sliding” are found with a lower acidic pH. We see the same thing in measuring the milieu of Trigger Points, and we see the same thing in challenges in acquiring new motor skills. Nutrition comes to mind in managing blood pH, but just as important is aerobic or sub-threshold fitness. Anything we can do to push threshold to the right will allow any biomotor activity to be less lactic. And with less lactic buildup, pH is staved away from the lower measures. More balanced pH = less development of stiffness = less tension of vessels through tissue = less stimulation of Alpha-Pro-1 Collagen = less fibrosis.
Explain again how Training = Rehab is no good?