"The Dance of the Tissues"

[James Boelter]

Bob, Arthur, Jarlo, anyone with relevant knowledge, I am trying to decide if a particular bodywork approach is worth pursuing, (What, again?)

I've been through Maitland's book , "Spinal Maniplation Made Simple" several times, and I think I have the basic methodology down. It seems like a very useful and powerful way to diagnose and help a client suffering from most types of spinal fixation issues. So, cool.

However, I've run down some of the links Bob has provided and some of the articles he has posted; some of the conclusions and opinions seem to invalidate much of what Maitland claims. That is, of course, assuming I really understand the issues and concepts involved.

To whit. I have seen in a couple of places PTs who opine that the whole issue of 'myofasical release' is something of myth. If I read these articles correctly, they view the fascie layers of the body as sort of a big 'rubber ball' - and if you push directly on it, all the fascie does is give and then bounce back.

Maitland's procedures essentially involve pushing on the relevant TPs of the vertebrae that are fixed open or closed while having the client extend or flex the spine (as relevant)...and waiting for what he calls 'the dance of the tissues' as the vertebrae release, rotate further into or out of rotation
and then back into their proper positions, etc.

Do I understand the process correctly? Is the 'awareness' or intent you are supposed to bring to the DOTT or the actual bending of the spine get 'past' the rubber-like fascie's refusal to change, or or you 'exploiting' the rebound effect to get the facets to go where you need them?

As I said, I am very excited by the possibilities of being able to resolve facet fixations with simple 'pushes' against the TPs, but I am new enough to this game that I can be easily fooled by some 'good sounding' terms and anatomy if the writing is well done and sincere. (Vis Arthur Jones, who made Nautilus sound like the fitness and strength invention of the century, and ended up wasting my time for 18 months before I figured out that the reason I wasn't turning into SuperMan on the Nautilus circuit was because Nautilus sucked. )

IS there such a thing as 'soft tissue release', or is it all just a matter of loosening adhesions and realigning collagen fibers?

[bob_stra]

> several times, and I think I have the basic methodology down. It
> seems like a very useful and powerful way to diagnose and help a
> client suffering from most types of spinal fixation issues. So, cool.

From a soft tissue point of view, I like muscle energy technique analysis system, as it places more emphasis on soft tissue as it affects spinal rotations etc.

It's all a bit of a fad really ;-) Long standing spinal pain is the most complicated thing to cross over your table. It's frustrating as hell. As wonderfully as all these systems are, mostly I think they're designed to stop the therapist from freaking out :-) After all, your patient must be reassured that you've spent the last x yrs in serious study!

Also, "manual therapy" comes in three flavours (joint manip, soft tissue, somatic). Any therapist worth their keep should be able to do all three. Note: I suppose you could argue for energetic approaches (TT etc) in there too.

IOW, I like the structural approach to assessment, but you really need to balance it off against a functional one.

> Maitland claims. That is, of course, assuming I really understand the
> issues and concepts involved.

I haven't seen much of Maitlands stuff. I think Jarlo mentioned he'd read the book to me in one of our emails.

> To whit. I have seen in a couple of places PTs who opine that the whole > issue of 'myofasical release' is something of myth.

I would tend to agree with them. See Threlkeld study.

If there is any therapeutic effect of MFR (and there is) I don't think you can put it down to fascia restructuring. Or perhaps only very rarely. More likely the effect is neurological.

> Maitland's procedures essentially involve pushing on the relevant TPs
> of the vertebrae that are fixed open or closed while having the client
> extend or flex the spine (as relevant)...and waiting for what he calls

That's fairly similar to MET, btw. Even SCS (strain counter strain) to be honest.

> Do I understand the process correctly? Is the 'awareness' or intent you > are supposed to bring to the DOTT or the actual bending of the spine
> get 'past' the rubber-like fascie's refusal to change, or or you
> 'exploiting' the rebound effect to get the facets to go where you need
> them?

AFAIK the last two. I don't think you could directly classify Maitland or MET as somatic approaches, if that's what you mean by awareness.

> As I said, I am very excited by the possibilities of being able to resolve > facet fixations with simple 'pushes' against the TPs

It'll pass :-)

> IS there such a thing as 'soft tissue release', or is it all just a matter of > loosening adhesions and realigning collagen fibers?

I'm not sure if I follow that one. Do you mean "does soft tissue stuff do anything, or is it all reflex action?"

Typically, soft tissue stuff, as backed by RCT's, is good for -

DOMS (only if within 2 hrs of activity)
Acute Low back pain
Some types of Odema
Bruise healing
Wound (esp burn) healing
Relaxation

Of course, soft tissue is used for other stuff with great success too. Just that those 6 have RCT to back em up.

Or did you mean "what is the mechanism by which soft tissue works?". For that I suggest Weintraub's "New Approaches in Tendon and Ligament healing." He covers the physiological responses to soft tissue better than anything else I've read (neurological, physiological, chemical and energetic).

Wait, I might have something interesting here too on that -

*digs*

http://www.healthy.net/bodywork/proflib/chaitow/

Or did you mean the whole "body armouring" aspect of things?

I hope this is all on topic. I'm kinda a wee bit tipsy at the moment ;-)
Remember kids, never drink bourbon out of a coffee cup. They're deceptively deep.

*urp*
*passes out*

[James Boelter]

Yes, I know what you mean about bourbon and coffee. I learned about that combo from Lawrence Block's 'Matt Scudder' novels. You can stay drunkenly alert for hours.

Or were you just talking about straight bourbon (yikes!)

I was hesitant to post my question, because I was sure I didn't have it framed properly, and I can see that was indeed the case. I did see that 'Tendon and Ligament Healing' book in my local Borders, and it is a high priority purchase.

I'll run down the book, run down the links you provided, and get back with a more coherent and integrated version of the question!

Much gracias, amigo!

[bob_stra]

> Yes, I know what you mean about bourbon and coffee. I learned about > that combo from Lawrence Block's 'Matt Scudder' novels. You can stay > drunkenly alert for hours.

*hic*

halret, thas me

*hic*


> I'll run down the book, run down the links you provided, and get back > with a more coherent and integrated version of the question!

You do that, I'll sober up, and who know what good things might happen ;-)

[Jay76]

James

Ever read: Stuart, Ph.D. McGill's book.."Low Back Disorders"

Great book on the spine...

Jay

[James Boelter]

No, I never ran into that one. Is it a 'layman's' text, or something addressed to the medical/bodyworker community? I'd certainly be interested to know more - please feel free to post or PM. There's gold in them thar backs!

[Jarlo Ilano]

James,

The only thing I can say is read everything and try everything. More than once, and at separate times in your development

There are so many ways to approach manual therapy, and some fit a practictioner like a glove immediately while others need some time to marinate.

Also, some approaches will instantly seem wrong to you. Feel free to not force yourself to try it anyway. Come back to it later as you gain more experience. You might see value where it wasn't apparent before. Or you might realize you were right the first time.

Some patients will also be prime lab rats for you, to try a variety of approaches. Seize that opportunity because a close majority may only respond to specific techniques.

(More specific to your first post, Jeffrey Maitland is a Rolfer, so his primary style arises from that. And Ida Rolf took alot of the joint mobilization from Osteopathic technique. "Waiting for the dance of the tissues" describes an indirect method which seeks the position of ease in the dysfunctional joint in question. (Bob's mention of SCS is an example of an indirect method) What follows is the "release" of tissues.)

And oh yeah, what Bob said!

Look forward to a reorganization of your post.

Regards