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I remember reading once that you have not mastered a new language until you begin to dream in that language (or maybe I dreamt that, I’m not sure). Either way, I have long realized that the “structuralist” mentality that I possess is a hard one to shake. What is a structuralist? One who sees pain/dysfunction as a result of a structural problem in the body; a problem with alignment. I evaluated posture to check for asymmetries, checked for pelvic issues, recorded scoliosis, etc, etc. All of these observations were based on the opinion that all treatment can be based on the results of these findings. I was taught this manner of evaluation/treatment and I dutifully followed through on it. Of course myofascial release is more than just a collection of structural observations translated into treatment.
Then Paul Ingraham messed up another perfectly good dream. In a post entitled Your Back Is Not “Out” and Your Leg Length is Fine – The story of t..., Paul does a quite decent job undoing most of which I was taught in my myofascial release training, as well as perfectly describing structuralism. And, he places a firm reminder that I need to revisit much of this for my own Foundations in Myofascial Release Seminars (No, I have not changed the name of them yet. I know you think that as long as I keep those words in the name, I am only playing lip service to change. I don’t plan on changing the name.) Talk about the baby and the bathwater!
Structure does have importance, but it ranks right in there with all the rest, maybe higher, probably lower. I saw this coming, though. For years (decades), pelvic blocks or wedges were a regular part of every treatment day. But over the years I’ve used them less and less, without every realizing why. Now I drag them out at most once a month. In a recent blog post titled “1.6%“, I spoke of just how common scoliosis is in our society, when viewed as any lateral deviation of the spine. Scoliosis IS the norm, as well as all that comes with it; unlevel hips and shoulders, leg length discrepancies, pelvic torsions, etc, etc, etc. In my myofascial release training, I was taught to look at these asymmetries and “fix” them. And you know what? It worked many times. Reducing what was the apparent pelvic torsion, for instance, often reduced or eliminated the offending low back pain. I bought into this for years, I even taught it. I developed a language for all of this as well. If the patient came in with back pain and the pelvis was asymmetrical and their leg lengths different, I told them how these asymmetries can create “crushing pressures” and cause pain. They listened politely, but waited for the results. I dutifully placed the wedges under their pelvis, as I was taught, and performed myofascial release in an “Operator” fashion (Intrigued by the concept of operator vs. interactor model, check out SomaSimple. You are going to have to use the search feature). Most of them improved…but why? Was it because I “balanced their pelvis”, or was it other things that were happening under my hands? This is my interest right now. What is happening under our hands?
There was a wonderful article written by Eyal Lederman, PhD, DO in 2010 titled “The fall of the postural-structural mechanical model in manual and physical therapies: Exemplified by lower back pain”. This article was reprinted in 2011 in The Journal of Bodywork and Movement Therapies, along with four “rebuttals” to the original article. You can read the entire article here. When I first read Lederman’s original article, well before I began crawling out from the sea and growing appendages, I complained and disagreed loudly as I read the article. I had “but what if’s…” to nearly every point. Then, as my appendages took shape and I began to walk, I read through the rebuttals and noted that all of the writers of these rebuttals were saying “but, what if..”. OK, I am making myself sound a bit superior, as if I have now reached a point of understanding what mere mortals have yet to achieve. Not so, I have just begun to learn a new language. I am learning what is happening under my hands and am a happier person for it. Why? Because I am not continuing to buy into the pseudoscience that I was taught. Looking at pain from different perspectives is a very different language for me, and a hard one at that. That perspective tends toward basic, simple neuroscience, which was gathering dust in the back of my brain, long forgotten.
Learn a new language; question what is happening under YOUR hands!
Walt Fritz, PT