Mission First: Manual Therapy

This week Ramona Horton sat down with Holly Tanner to discuss manual therapy and her course Mobilization of the Myofascial Layer: Pelvis and Lower Extremity. The following is an excerpt from her interview.

What do we really know about manual therapy? We have decent evidence that shows that asymmetry matters. The tenet of the myofascial course is an osteopathic tenet called ARTS:

• Asymmetry
• Restriction of Mobility
• Tissue Texture Changes
• Sensitivity

The whole myofascial course is designed around looking for ARTS. When you find the asymmetry within the myofascial system then that’s where you direct your efforts and energy.

Often patients have already tried breathing, yoga, medication, etcetera – and it’s the manual therapy piece that they often have not had. It’s not that uncommon for me to be someone’s second or third therapist. Some patients may have tried some type of manual therapy but it was more things like ischemic compression where the problem was that the manual therapy was triggering nociception.

So in the myofascial course, we start with ARTS but we also have an idea where we flip ARTS on its head and we go to STAR. In STAR, you take sensitivity and put it at the top of your list. That becomes the highest portion in your paradigm. Then we use simple techniques that are not non-nociceptive. Indirect technique versus direct technique, such as something as simple as positional inhibition.

The whole idea of the myofascial course is to teach people to think and problem solve. Then have a very broad spectrum way of you find an inner articular issue where this joint is moving and this one is not. Learn to not chase the booboo. Just because it hurts on the right doesn’t mean that you’re going to treat the right. It might hurt on the right because there is a hypo-mobility on the left. Let’s treat where the brain is protecting the tissue, and holding, and guarding the tissue. Trust in the belief that the body is a self-righting mechanism. The body will then normalize itself.

In manual therapy, our job is to get the body moving like it's supposed to. It’s not to fix the ‘booboo.’ The issue is not in the tissue. If the tissue is tight, it’s tight because the brain is keeping it that way. The way I teach manual therapy is the fascial system gives us access to the nervous system. By utilizing the fascial system in a non-nociceptive manner, what we’re really doing is just having a conversation with the brain. We’re not fixing the tissue. That’s the whole premise of the course - to get people to understand and change their thinking and their paradigm to ask what the brain is protecting and utilizing the fascial system.

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