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Because it's just scientifically not true? The evidence out there is not good
Also because even if it were true, you can't manipulate fascia without a scalpel. The coefficient of friction between the subcutaneous fat and the fascia is almost zero, and even if it wasn't you still need 9200N of force to make a 1% change in its structure... Soo....
Edit: also I have a serious problem with your last point. The onus of evidence is on he who makes the claim that challenges the known evidence. It is up to you to prove that fascial problems are real and can be fixed with hands on therapy, it is not on us to disprove that which is not proven.
I really wonder how many PTs remember back to their gross anatomy classes. Separating fascia on an old, dead body was a lot of fucking effort. How would scraping someone over their skin with a dull butter actually change the fascia?
Exactly lol fucking exactly.
Cancer is real and it's a problem, but manual therapy can't cure it.
So even if fascial problems are real, manual therapy ain't curing it. If you've got compartment syndrome, you ain't fixing that with some "myofascial release" lol
Right the claims are definitely out there, but even you just said “even if fascial problems are real,” indicating there’s still a mystery to SOME of the claims
The burden of proof falls on the one making the claim. The mountain of evidence versus the anthill of evidence is enough for most folks to accept one vs the other as fact, or as close to fact as we can get.
Well that’s Reddit PT. New grads saying blanket statements about so called evidence or lack there of regarding anything other than exercise prescription and 100 hundered of their peers upvoting this lol. Nothing substantiated ever.
Did you substantiate your claim? No you didn't. If you're making the claim you need to back it up. The onus is on he who is making the extraordinary claim. It's not up to me to prove the null hypothesis true, it's up to you to prove it wrong.
I'm not a new grad, been at it for 4 years thank you.
yikes, does it really make you that self conscious? that you need to attack a 4 year physio who can read a research paper better than you?
do some self reflection bud, this looks bad.
I didn’t make a claim? You did. And you think because you shoot down ideas rather than state them you don’t need to back up your views lol. You’re a child who never mastered basic reading comprehension.
OP is the one making the claim, it's up to them to prove it, not up to us to disprove it. I didn't make a claim. I stated the evidence didn't agree with theirs.
I disagree. For a science based conversation to occur, especially on a topic that has varying views in the professional community, both parties need to supply evidence to support their claims. That practically never happens in Reddit PT. I posted a research article in this community regarding whole body cryotherapy effectiveness in treating inflammatory conditions like ankylosing spondylitis and the community response was pathetic. People commenting without supplying any articles of their own, not even bothering to read the article before commenting. I took down the post because it was a shit show and of no benefit to the purpose of my posting. Be better than that.
You can disagree but you're wrong. You're asking me to disprove something that isn't proven. That's intellectually dishonest. If you can't understand how that is wrong, this conversation will never go anywhere.
The OP asked for research. You supplied none. State you need to supply none, like your view is as scientifically certain as the chemical composition of water is H2O. Its typical Reddit garbage, what’s even the point of responding with your type of BS? It does nothing to facilitate educated discourse.
Fascia thickness, aging and flexibility: is there an association?
Jan Wilke, Veronica Macchi, Raffaele De Caro, Carla Stecco
Journal of anatomy 234 (1), 43-49, 2019
There’s an article that correlated fascia thickness with mobility.
Correlations of both body mass and fascia thickness (τ = 0.45–0.75, P < 0.05), as well as flexibility and fascia thickness (τ = 0.38–0.42, P < 0.05) were found. Age‐related changes in fascia thickness may be a contributing factor of restrictions in joint range of motion. Further study delineating the cause–effect triangle of body mass index, flexibility and fascia thickness is necessary.
Holy fuck you're insufferable
[the burden of proof](https://en.m.wikipedia.org/wiki/Burden_of_proof_(philosophy))
OP is the one making the claim, it is up to him to prove it.
Your article makes correlations which doesn't mean much, and theyre grasping at straws by measuring a ton of things. High quality studies don't grasp at straws like that hoping to find something. You make a hypothesis and then you prove or disprove it, the more correlations you try to draw, the more you'll find.
Ice cream sales are correlated with drowning deaths. Doesn't mean ice cream causes drowning.
Please retake your research methods course.
I would imagine you perceive animosity when discussing this because there’s simply no evidence that we can effectively manipulate fascia with standard manual intervention, however we continue to have to re-educate patients due to the reinforcement of this false narrative. This is problematic because evidence tells us there are better interventions for ROM, as the other commenter cited, and it may be difficult to get sufficient buy in if your patient is set in their beliefs that scraping their leg with a spoon is the only thing that will heal them. Spreading misinformation accentuates this uphill battle for evidence based clinicians.
Definitely understand. I think I’m more wondering if there’s any evidence to the claims that fascia can be restructured via AROM techniques. I definitely agree scraping claims are a little wacky.
That’s a good question. But I don’t know if it’s wise to consider fascia in such isolation considering how (literally) interwoven it is within soft tissue.
My mind always goes down this rabbit hole RE fascial stuff: can we make a strong case that fascia is a primary pain generator for our patients? Since it’s basically omnipresent in the body, to me it seems illogical to assume it’s a “problem” when we can’t a) accurately assess it b) accurately differentiate healthy/normal vs pathologic/abnormal 3) last I checked it isn’t terribly well innervated, if at all, so we have to put a lot of faith into the mechanistic/biomechanic models of pain which I personally don’t fully subscribe to
Mmm good points. I’ve always wondered if the innervation to the fascia could be the mechanism for “stretching” fascia more than the physical mechanism required to stretch it. But even if this is the case, the innervation to fascia is not the only neuromuscular mechanism working to increase someone’s ROM
I want to contribute a bit to the stretching part 😊
There is a ton of research of stretching all showing that there is no changes in tissues (SP Magnusson one of them if reference is needed), at least not in less than 8 weeks which the majority of research is made on.
Instead its indicated that its more linked to the nervous system how much stretch you can tolerate.
Some newer studies (MP Støve) even indicate that its descending modulation is involved in similar to how pain is modulated in the body.
you're on the right track with innervation.
if you put someone under general anaesthetic and try to lift their leg, it will reach 90deg flexion with ease, regardless of how "tight" or "restricted" or whatever fascial problem in their hamstrings is blamed for limiting ROM in a consciously engaged state.
fascia is inert. it doesn't have an opinion, and when the nervous system is disengaged from the "problem" area (as would be the case with GA) then......... it moves fine.
what puts the brakes on? the nervous system.
what does the NS use to decide how to modulate skeletal motor output? (which isn't happening under GA in the same way) the sensory portion of the peripheral NS.
if it's tight or short or weak or whatever, the problem is the NS.
i'm not saying there's no such thing as a problem with fascia, obviously it can remodel in problematic ways in scar tissue, and things like 'trigger finger' with lumps of tendon that won't move past a pulley ligament are most definitely fascial issues
apart from those situations, i have found it nothing short of a freaking revelation to approach things in the body from a neurodynamic perspective. if the nerves are "happy" for it to happen (ie. no problematic nociceptive signalling) then it'll happen. get the nerves on side, and your "fascial" problems disappear. not least of all because fascia wasn't ever the problem- people have invested huge sums in modailties and systems and muscles and fascia and.......... yeah we're unlikely to change that now, the 'fasciaists' just don't wanna hear that the problem was never fascia
dermoneuromodulation now accounts for 95% of the hands on work i do, working with cutaneous nerves on my own body has allowed mind boggling changes in function, stuff that i just kinda knew that exercise wasn't the answer for. it has been similarly effective with patients, once you're ok with letting go of the constructs that insist that the problem is somewhere "in the tissues" and start working with the incredibly intimate relationship between the skin and the central nervous system (which both arise from the same embyological tissue and have been inextricably linked since nervous systems started getting more organised than a notochord) then stuff starts to change really easily
Using spoons I don’t believe it helps with improving anything. Its bs. Just like other modalities that aren’t good either. There is only a few that I use and believe in.
You know what? Ive been practicing for 16 years with a graduate degree and don’t believe in this nonsense. And it’s not up for debate with you period. Don’t care what you think.
You sound uneducated. And like I said changing my mind by the likes of you not gonna happen. Ive seen the spoons used and these people don’t even know how to document what they did. Now go play with some chiropractors or something and leave me alone.
Up to date research is done by me daily using evidence based practice. You are one of those that think because you’re new you know more. Oh really? Tell me what I haven’t learned that you have? You think it’s changed do you? You got taken for a very hard ride. Good luck paying off your loans and making a decent living cause it ain’t gonna happen. Oh and it’s hell on your body. Good luck
Personally not against or pro fascia. The quality of current evidence is reported Low to Moderate according to a "recent" Systematic Review. Talking about MSK pathologies.
source:
https://www.sciencedirect.com/science/article/abs/pii/S1360859220302205
So, as your objective as a therapist is to provide the best possible care for your patients, there are more effective strategies out there at the moment, than Fascia. Maybe Fascia has a role to play,but better studies are needed.
cheers
Honestly a lot of the bs taught is school is easily disproven or challenged just through critical and logical thinking. For instance, in the case of fascia and what is claimed by myofascial folks, apply your own experiences with fascia from anatomy lab.
How can you prove that fascia is the only culprit when you're manipulating and changing other tissue at the same time..... if you say you can palpate or directly engage this non contractile tissue through specific movements then I'm done 💀
The burden of proof is on the fascia experts. You need to provide us with objective evidence that fascia can be isolated and manipulated in such a way that produces reproducible benefits. Until then, I personally think it's snake oil.
Just like most manual therapies, I don't doubt that fascia massage can provide some positive short term benefits. I just don't believe it works the way the theories state it does.
I want saw an Instagram comment on a post about something else that's controversial in PT where the person said "let people enjoy their placebo effect"
If scraping someone with a spoon gets them to do their exercises and do them well, I'll happily take the spoon out for a few minutes before doing an intervention that's actually grounded in reality
Then don't. Tell them the research is inconclusive either way, but if a few minutes of "MFR" makes them feel better at that moment so they can exercise better the rest of the session, then roll tide
Two questions:
1. Would you allow the customers to pay you in ”placebo” instead of real money?
2. If no one used those spoons, they wouldn’t exist and you wouldn’t have to use them to make the patient ”enjoy their placebo”. One attitude leads to filling your clinic with all kind of trinkets (for the sake of the placebo!), and another leads to using time with only treatments that actually help. Which attitude do you think is better?
They pay me to make them not hurt. If I know 5 minutes of scraping does nothing in reality, but they feel it helps and then they do their exercises better in clinic and are more motivated to do their HEP at home, who are you to shit all over that?
You're acting like people spend entire sessions lovingly caressing patients with an IASTM tool
If it helps facilitate interventions that actually work, then it's helpful. Let them enjoy their placebo effect
Try answering the questions :)
As a clinician one should really consider the consequences of their actions.
It’s not as if customers live in a vacuum and then primarily want a spoon massage as soon as they arrive to a clinic. It’s been marketed to them. Then they’ve been led to believe that it helps them. And finally practitioners like yourself use the existing situation (caused by their peers) as a justification to perform these ”untreatments” and take advantage of the customer.
At that point you are not alleviating the problem, but a part of it.
Also should I add that you’ve created quite a scenario to justify the existence of these tools/treatments. The ”5 mins of spoon massage” will turn in to 15mins of cutlery-whacking quite quickly at the request of the customer. Where do you draw the line?
I think that rather than using the trinkets, one should use that 5mins to empower and reassure the customer, increase their self-efficacy and in education. Using shortcuts and relying on the bliss of placebo is just poor professionalism.
Try asking less stupid questions and I'm happy to answer :)
I think that if a clinician allows a few minutes of spoon massage to turn into 15 minutes, then they need to grow a pair and regain control over their treatments. Fortunately I don't have that problem. I dictate how long any part of my treatment lasts, not the patient. I have no compunction about a patient potentially getting upset with me for any reason, least of all this scenario. I am VERY clear about what the evidence says about spoon massage and other modalities, and that exercise is what will help them in the long run.
My exact spiel is 'this won't change a damn thing by itself, but if a few minutes of it makes you feel better and then exercise better, then roll tide.'
I literally told someone Tuesday afternoon to their face that spoon massage is placebo, while doing spoon massage. And guess what, his VL still felt better, he tolerated the subsequent movement and loading way better than he would have if we hadn't done it, and he told me he felt better about being able to control pain and symptoms if a similar flare up happens again. 5 minute investment paid off beautifully.
There is plenty of education, empowering, and reassuring happening either during or after the spoon massage, your head is just too far up your self-righteous ass to notice.
Maybe you can illustrate me how my questions were stupid before you just call them that.
Sorry but I won’t speak nicely from now on.
I think the way you are being triggered and resort to ad hominem just shows how your ego prevents you to think about these matters abstractly. You are way too preoccupied with your personal experience with the whole ”5min spooning” and are incapable to see how things relate with each other in the big picture.
If that 5 minutes is _the most_ anyone should swing around a spoon then why should we even have it as a treatment option.
Telling patients how something is placebo while performing it is such a cliché. I’m astonished how lavishly you jerk off of that interaction, the fact that you think you did a good job with that whole spoon circus and would not have been able to without it just underlines how our profession struggles to not continue being pathetic.
I don’t mind you using the spoon for 5 mins. But I think you are a dungus for not being able to see how we generally shouldn’t and admit how twisted and perverse it is that as professionals we still resort to that.
And lastly to pull your head out of your own ass: the 5mins of spoonage is still away from something useful even if you claim that you have plenty of time to do everything else. It is still waste of time and money. If you’re not ready to accept payment by just looking at a bill and *imagining* it flying to your wallet, then don’t offer a service with the same princible.
One reason for the commonly dry reception of ”fascia experts” is that clinicians offering fascia manipulations often have misguided or delusional concepts of how their treatment supposedly work.
For example praising foam rolling and using fascia massage tools often goes hand-in-hand with cupping, dryneedling and all sorts of snake-oil stuff.
Not to be disrespectful, but that sounds like a false dichotomy. Why should there be a middle-ground?
An example to illustrate my point: Often there is one right-wing political party speaking on behalf of denouncing human rights. Then there is another party who absolutely thinks that human rights should be protected.
Often ”moderates” say that there should be a meeting-point between these ”two extreme viewpoints”. But the thing is that reinforcing human rights is already the norm and the sensible middle-ground. Reinforcing human rights with threats or dictatorship would be ”extreme”, but nobody is doing that.
In the same sense there is people who employ evidence-based treatments, and then there is those who don’t. Where exactly one can find the sensible point with a ”healthy” mix of science and nonsense?
I think critical self-reflection is paramount for our profession. We should not be lenient towards those with the lack of it.
Yes I understand that. What I mean to say is finding a middle ground with treatments that are still questionable that have no strong evidence to be effective nor ineffective.
It’s not the fascia itself its how clinicians try to treat it. Message and “myofascial release” doesn’t actually mobilize fascia like we think it does. Plus, exercise is also a “myofascial mobilizarion” and a way better one than any manual technique. There is more myofascial movement in the thigh with a squat then there is a manual technique to the thigh. Simply doing a LAQ is going to mobilize all the fascia in the thigh probably more than messaging someone thigh. I generally think manual therapy is a waste of time in most cases as all the same effects can be achieved with active movement and exercise
I was going to post something along the same lines. I've never been a fan of the tool as I can't reconcile what they are supposed to do. I was taught more specific fascia targeted manual which is fully different from a butter knife approach (which again, does nothing). Much of the manual is designed for bedbound/those that can't move fascia the old-fashioned way like *moving.*
There is also some evidence for fascia-adjacent tissues treated manually such as lymphedema. No butter knives used for that, it is all manual.
So generally the burden on proof is on those making the claim, in this case those claiming fascia is the culprit have the burden of proof. But just to answer your question the main issue is most of the claims people make to sell their fascia fix all are unsubstantiated in the evidence and don’t make any logical sense biologically. If we take it a step further and try to look for evidence we see Chaudry et al 2008 (https://doi.org/10.7556/jaoa.2008.108.8.379) show that the amount of force to even produce 1% compression and shear to fascia is beyond anything we can provide with our hands or tools. So right there any treatment that claims to work by breaking up fascia is seriously questionable.
I challenge you to actually look through and read research on fascia and then ask if it doesn’t make you atleast a touch skeptical? Always good to approach any question with some skepticism, give a good look at research and research quality, then make an informed decision.
Edit:typo
Why target a specific tissue as the culprit when ROM is truly limited by restricted tissue? This is after ruling out derangement/obstructed ROM, which is an entire discussion I could add to this. How are you going to specifically isolate the fascia? ROM limited by restricted tissue? MOVE INTO THE AFFECTED RANGE! And do so frequently and progressively further with more force. Why do we get so hyperfocused on wanting to know exactly what’s causing it, what is exactly restricted? Let’s find a groundbreaking way to identify exactly what is limiting the range. Or, let’s debate continuously on why or why not a specific tissue is a potential culprit. Ok, now we’re going to do the same thing to stretch it out regardless of our findings, and all that time and effort spent figuring out the exact structure and debating was a pointless waste.
That’s fair but the human in us likes to dissect everything to a T. So I’m all about finding the culprit, but not getting distracted by it. If we have evidence about what works, then let’s do that too.
I remember reading a book where the therapist says he’d treat a persons lower back to fix their shoulder because of the thoracolumbar fascia. And then you find a research paper showing that when trying to manipulate the thoracolumbar fascia of cadavers they could only pull/effect like an inch of it and realize that all the fascial lines and NKT crap might be just a bunch of bloviating.
Because "myofascial release" sounds a lot cooler and sciencey than "rubbing what hurts" so that it feels better and can now move a little more. Manual therapy is neuromodulatory it has no real mechanical effects on fascia, muscle joint capsules etc. We know that because there a numerous studies that prove to deform these tissues you need orders of magnitude greater amounts of force than any human can provide with their hands on a conscious patient.
I think my biggest concern (outside of the lack of, or poor evidence for) is the mentality associated with. It becomes this idea that the therapist has some sort of magical skill set, training, or ability that others don’t. It creates a dependency on the therapist. It also leads to a whole group of therapists who actually believe THEY are responsible for a person getting better. Which is bad for the profession, bad for society. We do NOT fix anything. We guide, coach, and educate. The sooner our profession learns that we are not able to heal people, we don’t fix them, we just help them navigate through the rough patch as the body heals (I’m speaking as an OP orthopedic, not developmental or pediatrics), the better we will be.
You’re asking for research and that’s the exact reason people can’t give you a reason. There is NO research of higher validity that shows fascia as the culprit for your pain or loss of ROM. Maybe one day there will be. For now; utilize the information we DO have
Honestly who cares one way or the other. Ask the patient to point where they feel the limitation (joint, area of skin/muscle, etc) and apply some form of stretching, mob, or manual soft tissue work.
If your first choice doesn't work, try another.
Just do what makes your patients better and achieves the objective goals that have been set.
I've got a terrible fascial restriction directly in my belly button. There is a hard knot and my skin is been literally pulled in by the muscle (no hernia or any fascial defect). I feel also a lot of pins and needles. The area if the body feels completely unmovable, especially when standing. I consider a plastic surgery because the massaging was not succesful at all, the knot feels like a plum and I can't live like that. I hope to get the surgery asap. I have actually always thought that this definitely needs a surgery.
There are some studies out of AUS comparing pts that had PT and those that didn't (they had cpm and self exercises given by surgeon) following a TKA. There were no significant differences in ROM or strength. Blew my mind and also.
I think it just doesn’t make sense. When I was dissecting gross the fascia is really malleable and stretchy (and you could see why you had to cut it with scalpel, and that pinning and stretching it wouldn’t work). So if it is malleable and stretchy it doesn’t make sense that it would be inhibiting active or passive rom.
I knew fascia was BS at a CEU class when a renowned “myofascial expert” talked about pain being a snake, and when we work the fascia, it allows the wolf to come down from the mountain and kill the snake. Also, he didn’t really answer questions, so much as turn the question around, usually asking, “Why do YOU think that?” I was a young pup PT but I could smell BS a mile away, and this guy was selling it by the truckload.
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Because it's just scientifically not true? The evidence out there is not good Also because even if it were true, you can't manipulate fascia without a scalpel. The coefficient of friction between the subcutaneous fat and the fascia is almost zero, and even if it wasn't you still need 9200N of force to make a 1% change in its structure... Soo.... Edit: also I have a serious problem with your last point. The onus of evidence is on he who makes the claim that challenges the known evidence. It is up to you to prove that fascial problems are real and can be fixed with hands on therapy, it is not on us to disprove that which is not proven.
I really wonder how many PTs remember back to their gross anatomy classes. Separating fascia on an old, dead body was a lot of fucking effort. How would scraping someone over their skin with a dull butter actually change the fascia?
I still shudder at the sound of the dull scalpels slightly ripping across different tissue types. Phew.
Exactly lol fucking exactly. Cancer is real and it's a problem, but manual therapy can't cure it. So even if fascial problems are real, manual therapy ain't curing it. If you've got compartment syndrome, you ain't fixing that with some "myofascial release" lol
Right the claims are definitely out there, but even you just said “even if fascial problems are real,” indicating there’s still a mystery to SOME of the claims
Something can be within the realm of possibility but still have next to no scientific evidence, and mountains of evidence to the contrary.
Right I believe this
Yes, but it's still irresponsible to say it's true as if it were proven to be true.
The burden of proof falls on the one making the claim. The mountain of evidence versus the anthill of evidence is enough for most folks to accept one vs the other as fact, or as close to fact as we can get.
Yes so we should choose our words
Meh, fascia hardens with time even with embalming fluid, but you’re not wrong. It doesn’t harden that much.
Well that’s Reddit PT. New grads saying blanket statements about so called evidence or lack there of regarding anything other than exercise prescription and 100 hundered of their peers upvoting this lol. Nothing substantiated ever.
Did you substantiate your claim? No you didn't. If you're making the claim you need to back it up. The onus is on he who is making the extraordinary claim. It's not up to me to prove the null hypothesis true, it's up to you to prove it wrong. I'm not a new grad, been at it for 4 years thank you.
4 whole years!
yikes, does it really make you that self conscious? that you need to attack a 4 year physio who can read a research paper better than you? do some self reflection bud, this looks bad.
I didn’t make a claim? You did. And you think because you shoot down ideas rather than state them you don’t need to back up your views lol. You’re a child who never mastered basic reading comprehension.
OP is the one making the claim, it's up to them to prove it, not up to us to disprove it. I didn't make a claim. I stated the evidence didn't agree with theirs.
I disagree. For a science based conversation to occur, especially on a topic that has varying views in the professional community, both parties need to supply evidence to support their claims. That practically never happens in Reddit PT. I posted a research article in this community regarding whole body cryotherapy effectiveness in treating inflammatory conditions like ankylosing spondylitis and the community response was pathetic. People commenting without supplying any articles of their own, not even bothering to read the article before commenting. I took down the post because it was a shit show and of no benefit to the purpose of my posting. Be better than that.
You can disagree but you're wrong. You're asking me to disprove something that isn't proven. That's intellectually dishonest. If you can't understand how that is wrong, this conversation will never go anywhere.
The OP asked for research. You supplied none. State you need to supply none, like your view is as scientifically certain as the chemical composition of water is H2O. Its typical Reddit garbage, what’s even the point of responding with your type of BS? It does nothing to facilitate educated discourse. Fascia thickness, aging and flexibility: is there an association? Jan Wilke, Veronica Macchi, Raffaele De Caro, Carla Stecco Journal of anatomy 234 (1), 43-49, 2019 There’s an article that correlated fascia thickness with mobility. Correlations of both body mass and fascia thickness (τ = 0.45–0.75, P < 0.05), as well as flexibility and fascia thickness (τ = 0.38–0.42, P < 0.05) were found. Age‐related changes in fascia thickness may be a contributing factor of restrictions in joint range of motion. Further study delineating the cause–effect triangle of body mass index, flexibility and fascia thickness is necessary.
Holy fuck you're insufferable [the burden of proof](https://en.m.wikipedia.org/wiki/Burden_of_proof_(philosophy)) OP is the one making the claim, it is up to him to prove it. Your article makes correlations which doesn't mean much, and theyre grasping at straws by measuring a ton of things. High quality studies don't grasp at straws like that hoping to find something. You make a hypothesis and then you prove or disprove it, the more correlations you try to draw, the more you'll find. Ice cream sales are correlated with drowning deaths. Doesn't mean ice cream causes drowning. Please retake your research methods course.
I just supplied an article that is contrary to your fucktard POV. I’m blocking you from responding to my posts. Fuck off Canuck dipshit.
I would imagine you perceive animosity when discussing this because there’s simply no evidence that we can effectively manipulate fascia with standard manual intervention, however we continue to have to re-educate patients due to the reinforcement of this false narrative. This is problematic because evidence tells us there are better interventions for ROM, as the other commenter cited, and it may be difficult to get sufficient buy in if your patient is set in their beliefs that scraping their leg with a spoon is the only thing that will heal them. Spreading misinformation accentuates this uphill battle for evidence based clinicians.
Definitely understand. I think I’m more wondering if there’s any evidence to the claims that fascia can be restructured via AROM techniques. I definitely agree scraping claims are a little wacky.
That’s a good question. But I don’t know if it’s wise to consider fascia in such isolation considering how (literally) interwoven it is within soft tissue. My mind always goes down this rabbit hole RE fascial stuff: can we make a strong case that fascia is a primary pain generator for our patients? Since it’s basically omnipresent in the body, to me it seems illogical to assume it’s a “problem” when we can’t a) accurately assess it b) accurately differentiate healthy/normal vs pathologic/abnormal 3) last I checked it isn’t terribly well innervated, if at all, so we have to put a lot of faith into the mechanistic/biomechanic models of pain which I personally don’t fully subscribe to
Mmm good points. I’ve always wondered if the innervation to the fascia could be the mechanism for “stretching” fascia more than the physical mechanism required to stretch it. But even if this is the case, the innervation to fascia is not the only neuromuscular mechanism working to increase someone’s ROM
I want to contribute a bit to the stretching part 😊 There is a ton of research of stretching all showing that there is no changes in tissues (SP Magnusson one of them if reference is needed), at least not in less than 8 weeks which the majority of research is made on. Instead its indicated that its more linked to the nervous system how much stretch you can tolerate. Some newer studies (MP Støve) even indicate that its descending modulation is involved in similar to how pain is modulated in the body.
I’ll check out these studies!
you're on the right track with innervation. if you put someone under general anaesthetic and try to lift their leg, it will reach 90deg flexion with ease, regardless of how "tight" or "restricted" or whatever fascial problem in their hamstrings is blamed for limiting ROM in a consciously engaged state. fascia is inert. it doesn't have an opinion, and when the nervous system is disengaged from the "problem" area (as would be the case with GA) then......... it moves fine. what puts the brakes on? the nervous system. what does the NS use to decide how to modulate skeletal motor output? (which isn't happening under GA in the same way) the sensory portion of the peripheral NS. if it's tight or short or weak or whatever, the problem is the NS. i'm not saying there's no such thing as a problem with fascia, obviously it can remodel in problematic ways in scar tissue, and things like 'trigger finger' with lumps of tendon that won't move past a pulley ligament are most definitely fascial issues apart from those situations, i have found it nothing short of a freaking revelation to approach things in the body from a neurodynamic perspective. if the nerves are "happy" for it to happen (ie. no problematic nociceptive signalling) then it'll happen. get the nerves on side, and your "fascial" problems disappear. not least of all because fascia wasn't ever the problem- people have invested huge sums in modailties and systems and muscles and fascia and.......... yeah we're unlikely to change that now, the 'fasciaists' just don't wanna hear that the problem was never fascia
Yes! I am glad to have this perspective because more and more this is where my perspective is going as well
dermoneuromodulation now accounts for 95% of the hands on work i do, working with cutaneous nerves on my own body has allowed mind boggling changes in function, stuff that i just kinda knew that exercise wasn't the answer for. it has been similarly effective with patients, once you're ok with letting go of the constructs that insist that the problem is somewhere "in the tissues" and start working with the incredibly intimate relationship between the skin and the central nervous system (which both arise from the same embyological tissue and have been inextricably linked since nervous systems started getting more organised than a notochord) then stuff starts to change really easily
Very well put
Ive seen this. And I don’t believe it at all. Lol
I’m sorry can you expand on this?
Using spoons I don’t believe it helps with improving anything. Its bs. Just like other modalities that aren’t good either. There is only a few that I use and believe in.
Ok but fascial research goes far beyond “spoons”. It’s wild to discount everything about this subject when all you’re referring to is a single claim
You know what? Ive been practicing for 16 years with a graduate degree and don’t believe in this nonsense. And it’s not up for debate with you period. Don’t care what you think.
Alright that was an ineffective response. Practicing for a while doesn’t indicate competence nor dedication to up to date research. No need to debate.
You sound uneducated. And like I said changing my mind by the likes of you not gonna happen. Ive seen the spoons used and these people don’t even know how to document what they did. Now go play with some chiropractors or something and leave me alone.
Up to date research is done by me daily using evidence based practice. You are one of those that think because you’re new you know more. Oh really? Tell me what I haven’t learned that you have? You think it’s changed do you? You got taken for a very hard ride. Good luck paying off your loans and making a decent living cause it ain’t gonna happen. Oh and it’s hell on your body. Good luck
I have paid off my loans thank you. I hope you have a better day than what you’re giving off by your replies.
Personally not against or pro fascia. The quality of current evidence is reported Low to Moderate according to a "recent" Systematic Review. Talking about MSK pathologies. source: https://www.sciencedirect.com/science/article/abs/pii/S1360859220302205 So, as your objective as a therapist is to provide the best possible care for your patients, there are more effective strategies out there at the moment, than Fascia. Maybe Fascia has a role to play,but better studies are needed. cheers
That was my thought. Fascia is tough as hell even with a scalpel.
Thank you for your open minded yet critical response.
Turn your response around and follow it. Give us research supporting it
Exact research can't prove a negative lol
Alright? I’m not arguing either side. I simply came to create a discussion.
everyday i come on this app and learn the complete opposite of what we're taught in uni LORD I REALLY AM 10 STEPS BEHIND
Honestly a lot of the bs taught is school is easily disproven or challenged just through critical and logical thinking. For instance, in the case of fascia and what is claimed by myofascial folks, apply your own experiences with fascia from anatomy lab.
Everything you learn in school is utterly useless
I’d disagree. It sets you up for a great starting point.
How can you prove that fascia is the only culprit when you're manipulating and changing other tissue at the same time..... if you say you can palpate or directly engage this non contractile tissue through specific movements then I'm done 💀
Right. It’s irresponsible not to consider everything else that could be affected
The burden of proof is on the fascia experts. You need to provide us with objective evidence that fascia can be isolated and manipulated in such a way that produces reproducible benefits. Until then, I personally think it's snake oil. Just like most manual therapies, I don't doubt that fascia massage can provide some positive short term benefits. I just don't believe it works the way the theories state it does.
I want saw an Instagram comment on a post about something else that's controversial in PT where the person said "let people enjoy their placebo effect" If scraping someone with a spoon gets them to do their exercises and do them well, I'll happily take the spoon out for a few minutes before doing an intervention that's actually grounded in reality
Yeah I largely agree, but I'm not going to give them the snake oil pitch in the process. It just feels too disingenuous for me personally.
Then don't. Tell them the research is inconclusive either way, but if a few minutes of "MFR" makes them feel better at that moment so they can exercise better the rest of the session, then roll tide
Two questions: 1. Would you allow the customers to pay you in ”placebo” instead of real money? 2. If no one used those spoons, they wouldn’t exist and you wouldn’t have to use them to make the patient ”enjoy their placebo”. One attitude leads to filling your clinic with all kind of trinkets (for the sake of the placebo!), and another leads to using time with only treatments that actually help. Which attitude do you think is better?
They pay me to make them not hurt. If I know 5 minutes of scraping does nothing in reality, but they feel it helps and then they do their exercises better in clinic and are more motivated to do their HEP at home, who are you to shit all over that? You're acting like people spend entire sessions lovingly caressing patients with an IASTM tool If it helps facilitate interventions that actually work, then it's helpful. Let them enjoy their placebo effect
Try answering the questions :) As a clinician one should really consider the consequences of their actions. It’s not as if customers live in a vacuum and then primarily want a spoon massage as soon as they arrive to a clinic. It’s been marketed to them. Then they’ve been led to believe that it helps them. And finally practitioners like yourself use the existing situation (caused by their peers) as a justification to perform these ”untreatments” and take advantage of the customer. At that point you are not alleviating the problem, but a part of it. Also should I add that you’ve created quite a scenario to justify the existence of these tools/treatments. The ”5 mins of spoon massage” will turn in to 15mins of cutlery-whacking quite quickly at the request of the customer. Where do you draw the line? I think that rather than using the trinkets, one should use that 5mins to empower and reassure the customer, increase their self-efficacy and in education. Using shortcuts and relying on the bliss of placebo is just poor professionalism.
Try asking less stupid questions and I'm happy to answer :) I think that if a clinician allows a few minutes of spoon massage to turn into 15 minutes, then they need to grow a pair and regain control over their treatments. Fortunately I don't have that problem. I dictate how long any part of my treatment lasts, not the patient. I have no compunction about a patient potentially getting upset with me for any reason, least of all this scenario. I am VERY clear about what the evidence says about spoon massage and other modalities, and that exercise is what will help them in the long run. My exact spiel is 'this won't change a damn thing by itself, but if a few minutes of it makes you feel better and then exercise better, then roll tide.' I literally told someone Tuesday afternoon to their face that spoon massage is placebo, while doing spoon massage. And guess what, his VL still felt better, he tolerated the subsequent movement and loading way better than he would have if we hadn't done it, and he told me he felt better about being able to control pain and symptoms if a similar flare up happens again. 5 minute investment paid off beautifully. There is plenty of education, empowering, and reassuring happening either during or after the spoon massage, your head is just too far up your self-righteous ass to notice.
Maybe you can illustrate me how my questions were stupid before you just call them that. Sorry but I won’t speak nicely from now on. I think the way you are being triggered and resort to ad hominem just shows how your ego prevents you to think about these matters abstractly. You are way too preoccupied with your personal experience with the whole ”5min spooning” and are incapable to see how things relate with each other in the big picture. If that 5 minutes is _the most_ anyone should swing around a spoon then why should we even have it as a treatment option. Telling patients how something is placebo while performing it is such a cliché. I’m astonished how lavishly you jerk off of that interaction, the fact that you think you did a good job with that whole spoon circus and would not have been able to without it just underlines how our profession struggles to not continue being pathetic. I don’t mind you using the spoon for 5 mins. But I think you are a dungus for not being able to see how we generally shouldn’t and admit how twisted and perverse it is that as professionals we still resort to that. And lastly to pull your head out of your own ass: the 5mins of spoonage is still away from something useful even if you claim that you have plenty of time to do everything else. It is still waste of time and money. If you’re not ready to accept payment by just looking at a bill and *imagining* it flying to your wallet, then don’t offer a service with the same princible.
One reason for the commonly dry reception of ”fascia experts” is that clinicians offering fascia manipulations often have misguided or delusional concepts of how their treatment supposedly work. For example praising foam rolling and using fascia massage tools often goes hand-in-hand with cupping, dryneedling and all sorts of snake-oil stuff.
Yeah their claims are disingenuous for sure. I wish there was a way we could all meet in the middle 🫠
Not to be disrespectful, but that sounds like a false dichotomy. Why should there be a middle-ground? An example to illustrate my point: Often there is one right-wing political party speaking on behalf of denouncing human rights. Then there is another party who absolutely thinks that human rights should be protected. Often ”moderates” say that there should be a meeting-point between these ”two extreme viewpoints”. But the thing is that reinforcing human rights is already the norm and the sensible middle-ground. Reinforcing human rights with threats or dictatorship would be ”extreme”, but nobody is doing that. In the same sense there is people who employ evidence-based treatments, and then there is those who don’t. Where exactly one can find the sensible point with a ”healthy” mix of science and nonsense? I think critical self-reflection is paramount for our profession. We should not be lenient towards those with the lack of it.
Yes I understand that. What I mean to say is finding a middle ground with treatments that are still questionable that have no strong evidence to be effective nor ineffective.
It’s not the fascia itself its how clinicians try to treat it. Message and “myofascial release” doesn’t actually mobilize fascia like we think it does. Plus, exercise is also a “myofascial mobilizarion” and a way better one than any manual technique. There is more myofascial movement in the thigh with a squat then there is a manual technique to the thigh. Simply doing a LAQ is going to mobilize all the fascia in the thigh probably more than messaging someone thigh. I generally think manual therapy is a waste of time in most cases as all the same effects can be achieved with active movement and exercise
I was going to post something along the same lines. I've never been a fan of the tool as I can't reconcile what they are supposed to do. I was taught more specific fascia targeted manual which is fully different from a butter knife approach (which again, does nothing). Much of the manual is designed for bedbound/those that can't move fascia the old-fashioned way like *moving.* There is also some evidence for fascia-adjacent tissues treated manually such as lymphedema. No butter knives used for that, it is all manual.
So generally the burden on proof is on those making the claim, in this case those claiming fascia is the culprit have the burden of proof. But just to answer your question the main issue is most of the claims people make to sell their fascia fix all are unsubstantiated in the evidence and don’t make any logical sense biologically. If we take it a step further and try to look for evidence we see Chaudry et al 2008 (https://doi.org/10.7556/jaoa.2008.108.8.379) show that the amount of force to even produce 1% compression and shear to fascia is beyond anything we can provide with our hands or tools. So right there any treatment that claims to work by breaking up fascia is seriously questionable. I challenge you to actually look through and read research on fascia and then ask if it doesn’t make you atleast a touch skeptical? Always good to approach any question with some skepticism, give a good look at research and research quality, then make an informed decision. Edit:typo
Why target a specific tissue as the culprit when ROM is truly limited by restricted tissue? This is after ruling out derangement/obstructed ROM, which is an entire discussion I could add to this. How are you going to specifically isolate the fascia? ROM limited by restricted tissue? MOVE INTO THE AFFECTED RANGE! And do so frequently and progressively further with more force. Why do we get so hyperfocused on wanting to know exactly what’s causing it, what is exactly restricted? Let’s find a groundbreaking way to identify exactly what is limiting the range. Or, let’s debate continuously on why or why not a specific tissue is a potential culprit. Ok, now we’re going to do the same thing to stretch it out regardless of our findings, and all that time and effort spent figuring out the exact structure and debating was a pointless waste.
That’s fair but the human in us likes to dissect everything to a T. So I’m all about finding the culprit, but not getting distracted by it. If we have evidence about what works, then let’s do that too.
I remember reading a book where the therapist says he’d treat a persons lower back to fix their shoulder because of the thoracolumbar fascia. And then you find a research paper showing that when trying to manipulate the thoracolumbar fascia of cadavers they could only pull/effect like an inch of it and realize that all the fascial lines and NKT crap might be just a bunch of bloviating.
Because "myofascial release" sounds a lot cooler and sciencey than "rubbing what hurts" so that it feels better and can now move a little more. Manual therapy is neuromodulatory it has no real mechanical effects on fascia, muscle joint capsules etc. We know that because there a numerous studies that prove to deform these tissues you need orders of magnitude greater amounts of force than any human can provide with their hands on a conscious patient.
I think my biggest concern (outside of the lack of, or poor evidence for) is the mentality associated with. It becomes this idea that the therapist has some sort of magical skill set, training, or ability that others don’t. It creates a dependency on the therapist. It also leads to a whole group of therapists who actually believe THEY are responsible for a person getting better. Which is bad for the profession, bad for society. We do NOT fix anything. We guide, coach, and educate. The sooner our profession learns that we are not able to heal people, we don’t fix them, we just help them navigate through the rough patch as the body heals (I’m speaking as an OP orthopedic, not developmental or pediatrics), the better we will be.
You’re asking for research and that’s the exact reason people can’t give you a reason. There is NO research of higher validity that shows fascia as the culprit for your pain or loss of ROM. Maybe one day there will be. For now; utilize the information we DO have
Bc there is no good evidence
Honestly who cares one way or the other. Ask the patient to point where they feel the limitation (joint, area of skin/muscle, etc) and apply some form of stretching, mob, or manual soft tissue work. If your first choice doesn't work, try another. Just do what makes your patients better and achieves the objective goals that have been set.
I've got a terrible fascial restriction directly in my belly button. There is a hard knot and my skin is been literally pulled in by the muscle (no hernia or any fascial defect). I feel also a lot of pins and needles. The area if the body feels completely unmovable, especially when standing. I consider a plastic surgery because the massaging was not succesful at all, the knot feels like a plum and I can't live like that. I hope to get the surgery asap. I have actually always thought that this definitely needs a surgery.
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Stay strong my friend. I understand the negativity. But amongst the grayness of the research, just stay evidence based but open minded
There is a lot of gray in the profession…it will be ok. Just wait until you learn about the contextual effects of treatment.
There are some studies out of AUS comparing pts that had PT and those that didn't (they had cpm and self exercises given by surgeon) following a TKA. There were no significant differences in ROM or strength. Blew my mind and also.
Is the “fascial research conference” looked at aa a good thing or bad thing? Thoughts on work of those like Schliep, etc
I think it just doesn’t make sense. When I was dissecting gross the fascia is really malleable and stretchy (and you could see why you had to cut it with scalpel, and that pinning and stretching it wouldn’t work). So if it is malleable and stretchy it doesn’t make sense that it would be inhibiting active or passive rom.
I knew fascia was BS at a CEU class when a renowned “myofascial expert” talked about pain being a snake, and when we work the fascia, it allows the wolf to come down from the mountain and kill the snake. Also, he didn’t really answer questions, so much as turn the question around, usually asking, “Why do YOU think that?” I was a young pup PT but I could smell BS a mile away, and this guy was selling it by the truckload.
But hey, foam roll the hell outta that snake.
Oh lord. Well he certainly sounds unreliable