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Modernizing Views of Manual Therapy – Guest Blog by Walt Fritz
Walt Fritz is a physical therapist from Upstate New York. Since beginning work as an educator in the myofascial release (MFR) field in the mid-1990s, he has more recently developed his unique take on manual therapy. His approach attempts to move the bar from singular tissue-specific models into a multifactorial narrative; one leaning heavily on biopsychosocial influences. Walt teaches internationally to massage therapists, physiotherapists, speech-language pathologists, and other professionals through his Foundations in Manual Therapy Seminars, details of which can be found at waltfritzseminars.com. If you are a therapist looking to update your practice to incorporate modern concepts from pain science, be sure to check out the superb articles, podcasts and live/online courses linked on Walt’s website.
Modernizing views of manual therapy
Walt Fritz, PT
Foundations in Manual Therapy Seminars
As a physical therapist schooled in the early 1980’s I began practicing before the mandate for evidence-based practice (EBP) became the norm. While we learned anatomy, physiology, neurophysiology, kinesiology, etc., from science-based perspectives, putting our learning into action was not required to fit within the EBP framework. When I became interested in specializing in manual therapy via myofascial release (MFR) education, not expecting that MFR meet the EBP criteria merged well with that modality’s self-distancing from EBP as a whole.
How MFR was taught to me was done so in a counterculture-ish manner, pitting itself as a result-driven intervention rather than worrying about the evidence. (Apparently, we were supposed to believe that evidence-based models were less effective) MFR’s evidence, it was often repeated, was the happy patients. Having emerged from the back end of the MFR culture, I see how effective manual care and evidence-based practice can co-exist.
Last year, as I bid farewell to the MFR brand name for my courses (in favor of manual therapy), I came to realize that we need not abandon the good that we’ve learned to stay abreast of the latest science. I continue to use what I call an MFR style of engagement, which means that I continue to use my hands in a manner taught to me decades ago, though I’ve allowed the explanation of my work to evolve. Seeing the limitations of silo approaches used by most manual therapy education systems, where problems and solutions are narrowed to a single tissue or pathology, I began seeking common denominators.
Most interventions that we use meet with success, so what do all of our tools have in common? While we might be directly impacting those single tissues, we are engaging with another human. That human has a nervous system and brain, capable of feeling what is happening in the periphery, can process those inputs, and can manifest changes back to the periphery. That human has expectations and values that we may or may not meet. I now see the importance of including a more comprehensive range of explanations, not to be all-inclusive, but to acknowledge that there is much that we don’t know. The more I learn, the more I realize that I’m not sure what is happening when we use our hands to help people in pain or those with functional deficits.
I’ve also gotten to an age where I’m pretty comfortable saying, “I don’t know.” We must back a statement with some scientifically plausible ideas, but it truly comes down to not knowing. One aspect of MFR that bothered me was the insistence that evidence didn’t matter in the traditional sense. But it does. Evidence is what allows us to elevate our work above the doings of charlatans. What constitutes good evidence? That is a loaded question, as most models seem to put forward a reasonable number of science-sounding narratives, but will that evidence hold up to the scrutiny of external review? I look for narratives that are clear of silo-based jargon. For example, in MFR, words such as “release” are used to express the concept of change. But a release is seen by the MFR community as a physiological event when the fascia lets go, though such ideas have yet to be proven to be correct by science at large. That should be a problem.
The other thing to look at is the distinction between outcome-based studies, where intervention is used to address a specific issue, and a mechanism of action study. A deeper look is taken at just what happens in the body (or brain) when intervention happens. Many conflate the two, but they are entirely separate.
No matter which road you choose to update your model, be it better understanding the evidence or allowing many different potential explanations to chart your course, I encourage you to pursue excellence. Like me, you can continue to use what has worked for you, sterilizing older views to align better with current understandings. But always strive to update. I make a wide range of information available on my website. There you’ll find dozens of articles that I’ve written about my approach to manual care, as well as many podcasts with interviewers that span many professions.
We all have excellent skills, and often, all it takes is a new perspective to take off and fly.