Bridging the Gap: Fascia and Pain Science
This year marks my 25th year in this profession although I ‘dabbled’ for about 10 years previously jumping from course to course none of which had any formal structure or qualifications; they were simply out of interest.
It’s fair to say that throughout this career there has been many times of challenge. Putting Covid and the financial crash of 2008 aside, these challenges have resulted due to finding an interest in research and following other opinions and points of view to those I initially experienced. This has, many times, made me stop and ask, ‘what is it we do when we touch?’ closely followed by ‘how does MFR actually work?’ I have always accepted these challenges head on and prioritised understanding as many different points of view as I could so that I was better informed as a therapist and a teacher. I have had many occasions where I have had to reconcile new learning and understanding with those from previous training formulating a different opinion and thought process which ultimately has taken my teaching to a higher level.
It is human nature to follow what we have been taught for quite a long time honing our skill before we have enough of our own experience to rationalise, critique, ask questions and adapt. It is also through passion and enjoyment of what we do that reinforces this learning and for me, it is also a drive to learn more. I have always been solid with the fact that whatever it is that I do, I do make a difference, and this is the foundation of what I teach.
If you think of this from a Blooms taxonomy point of view, you may be able to see how our skills grow. Blooms is a framework of cognitive domain learning and hierarchy of complexity usually depicted in a pyramid with the base level of ‘remember’ followed by ‘understand’ then ‘apply’. These levels are commonplace across education with level 3 qualifications sitting around the 3rd level of the pyramid in the ‘apply’ domain. Next in the pyramid is ‘analysing’ then ‘evaluating’ and lastly at the top of the pyramid is ‘creating’. While Blooms is old, and arguable out of date, it is still a good way of thinking about where you are at with your working skills and also a good way to judge and add continuing professional development (CPD).
I’d suggest that after a while in the profession, adding numerous CPD, you do climb higher up this pyramid although this pathway isn’t always in the form of recognised qualifications. If you have completed a bachelor’s degree, this is the top of Blooms pyramid at the ‘create’ level where students are asked to write a project or report. At this level, this dissertation (or research project) should showcase all the levels in the pyramid and more specifically analyse and evaluate the subject then create a new idea or concept for the final submission. While this is very documented if you follow a degree pathway, it is also very possible to do without the degree status. However, if you do study at level 6, this is not automatically a degree in that subject. It is a statement of fact that you have been assessed as meeting your learning objective regardless of curriculum or subject.
I have always wanted to understand more about the human and have been fascinated by responses to touch. This has resulted in climbing higher up the Blooms pyramid literally picking apart what I have been taught, adding in other concepts and hypotheses and creating a concept of what happens when I touch based on available evidence. But, as with all research and learning, the more we learn, the more questions we have. This should never be taken as a bad thing but instead is an acknowledgement of uncertainty that puts a totally different perspective on the evidence that we have.
Why do we have the results and responses we have and how different are all the various therapies out there? Are my skills with MFR that different to therapies such as Bowen or Rolfing? Does a Rolfer do something different to what I do? Are self-care approaches, that I call Self-Myofascial Release (SMFR), doing something different to other self-care approaches that also use foam rolls or balls? If so, exactly how are they different? With all of these questions, I think we are perhaps looking at this around the wrong way.
We strive to give credibility to our training, our trademarked named therapies and to historical practices that would appear to have stood the test of time. It is common to read research papers and books quoting narrative from the 18th century and before or to see the same people quoted as being ‘the’ person who was ahead of their time. While we would have learned nothing without this rich and diverse history, current science and research may not agree with this past or may add new valuable insight opening up other thoughts and ideas. This I believe is where we need to go.
We consistently look for evidence of effectiveness of our chosen therapy. In research this is done with one therapy in the investigation group and another therapy in the control group or a sham (fake) therapy makes up the control group. There is a battle of effectiveness between therapies. However, until we can clearly demonstrate how each therapy actually works and if indeed therapies are different, what is the point in placing them in a contest?
The most valuable outcome that we claim that our therapies do is resolve pain. However, pain is not as simple as being caused or generated by dysfunctional fascia, leg length discrepancy, poor posture (whatever that is) or trigger points. Pain is complex and involves multiple factors which are totally unique to each individual person. We know that many people have pelvic asymmetry and do not experience any pain. We also know from research that many people can have degenerative lumbar discs and not have low back pain. Pain and (soft) tissue issues rarely relate.
Fascia anything is trendy. What we claim to do to fascia with our hands or in movement is also trendy and (unfortunately) full of marketing hype. The phrase ‘it’s always been done this way’ comes to mind which is synonymous with ‘if it aint broke, don’t try to fix it’. It therefor appears that until proven otherwise, fascia-oriented therapies will continue to stake claim to being magical, unexplainable, mysterious and quantum based. What if there was another way?
What if we investigate and acknowledge what touch does as everything we do across the soft tissue professions involves touch? There are so many claims of what a therapy does that just haven’t yet been identified such as releasing fascial restrictions and their 2000lbs psi of pressure or releasing trauma from restricted fascia. The old adage that lack of proof of efficacy is not the same as proof of lack of efficacy is all too often quoted which arguably is simply an excuse for bypassing what evidence there actually is.
Understanding how pain works is paramount. It is an outdated concept that pain is due to some kind of dysfunction, imbalance or restriction of physical tissues. Again, often quoted is the phrase, ‘fascial dysfunction does not show up on scans or x-rays’. This is no longer the case with the advancement of imaging technology. We can see the molecules of fascia’s ground substance in high resolution MRI machines. Add this advancement to the current understanding of pain leads us on another pathway very different to the one I was taught some 25 years ago.
Just because we know so much about fascia (and fascial research is fascinating), it doesn’t automatically translate into what we do with our hands or in movement in our fascia-oriented therapies. In fact, fascia-orientated therapies has always portrayed such an ironic point of view claiming to be holistic yet having a very distinct myopic viewpoint on fascia ignoring the other effects and responses in the human body.
Is It not time to bridge the gap between historical understanding and narrative of fascia and current science and evidence, specifically pain science? There is so much research on the power of touch that every manual therapy does that isn’t discussed enough in foundation or advanced training. The focus on fascia is interesting but, the gaps need to be filled. This bridging of the gaps would make us better informed to critique claims and help us pick out marketing misinformation from legitimate evidence. This doesn’t mean that we should all become research buffs (or nerds). But, if we do claim to be skilled staking claims of what we do, then we need to be able to provide robust evidence that supports these claims.
How often do you take a step back, reflect and revise what you say and do?
If you want to learn more about pain, join me on my Understanding Pain course and become an influential therapist. This comprehensive online course helps you identify many pain mechanisms allowing you to teach your own clients about how pain works. Not only that, I will give you ideas and concepts to add into your therapy practice so that you can help your clients back to wellness.
Go here for the next course dates.
If you, like me, have questions and want to understand more about fascia, what it is and what it's not - join me on my Fascia, Fact and Fiction master sessions online. There are various dates (or recordings) with numerous topics discussing some of the misunderstanding about fascia and what we do with our hands.
Please email me if you would like any further information.
