Knot a Problem

https://m.facebook.com/story.php?story_fbid=1676076827648357&id=100057381674189

I am not a physio.
I studied massage first, but recognised this training didn't leave me feeling knowledgeable enough to be confidently treating people with complex issues. So i then went on to study physiotherapy. This gave me a deeper understanding of causes and science backed treatment protocols for different health conditions.
However, as i applied these therapies to myself and was still in chronic pain. I could see the people that were being left behind by the system when healthy medical professionals with no personal experience of living with chronic health problems would get frustrated at the lack of progress. These patients would get branded as difficult and non compliant.
I saw past this and knew from my massage training experience how much benefit myself and clients get from hands on therapy rather than exercise programs alone. Physiotherapy used to be a more hands- on profession but has moved away from that because exercise therapy has more reliable data to support its efficacy. (In the entire 4 year degree, we were given 2x 2 hour massage lessons 😳) But with my background, it really put me off being a physio. There are plenty physios. But not many therapists with experience of both living with chronic pain and fatigue as well as an understanding of what is going on physiologically and how physios clinically reason.

So i changed trajectory and trained further in sustained myofascial release - the first treatment i had tried that gave me instant significant relief, as well as measurable improvements after just one treatment technique. Physiotherapy is all about measurements to check if the treatment is having effect. On my first myofascial course my mind was blown because as a physio student, i had been prescribing exercises then seeing the patient weeks later and commending them on the few degrees increase in range of motion while they still performed the test with lessening pain as the weeks went on. Then on this Myofascial course (at the end of my third year studying physio), one technique on a client was having instant and significant measurable improvement in range of motion, function and reported pain 🤯
This was enough for me, alongside my own significantly worsening condition, to decide to set up my business as a massage and myofascial therapist instead of being a physio.

Is myofascial release a miracle treatment that i believe always works for everyone? No. But it is one type of treatment in my toolkit alongside various others that i use and have had repeated undeniable positive results.

I'm obviously not bashing physio as a profession. Do the patients need the exercises for the best overall outcome? Absolutely! And I encourage clients to see a physiotherapist along side my treatments.
But my treatments also provide so much value to a group of people who would otherwise feel abandoned and judged for their ongoing health problems. Discharged from physio for lack of progress, and repeated dismissal from doctors etc who are very limited with short appointments. These clients feel seen and heard as I am able to hold space for them as their nervous system gets soothed. which plays a huge role in pain management. There are plenty studies to show that *how* a patient is talked to and supported has as much more positive impact on the treatment outcome than just medication or other treatments alone.

I recognised i could be that person for others.

If you are living with chronic pain and fatigue - I see you. I am here for you. And i will continue to strive to learn new ways to give you continued support

https://www.facebook.com/share/p/18v5F2Kugk/

https://www.facebook.com/share/p/1C2uMRdGYr/

https://www.facebook.com/share/1DCNw1HTG9/

Manual therapy is evolving, and that is a good thing. 🙌

For a long time, manual therapy has often been taught as if the therapist’s job is to find a faulty or restricted structure and correct or release it.

Those explanations made sense in the teaching culture many of us trained in. They gave therapists a clear rationale, matched what we thought we felt under our hands, and helped us explain treatment simply to clients.

But science has moved on. 🧠

The current evidence does not support the idea that manual therapy works mainly because we physically correct tissues, break adhesions, lengthen fascia, remove knots, realign joints, flush toxins, or reset the nervous system.

That does not mean manual therapy is useless.

It means many of the explanations attached to manual therapy are no longer strong enough.

Current research points towards a more realistic explanation. Responses to manual therapy may involve sensory input, mechanical loading, neurological modulation, contextual factors, autonomic responses, movement confidence, expectation, the therapeutic relationship, and short term changes in muscle activity and sensitivity.

In other words, touch is not just force applied to tissue.

Touch is information. ✋

The body is not passively waiting to be corrected. It is a living, sensing, predicting, adapting human system. When we use our hands, we are interacting with the client’s nervous system, prior experiences, expectations, sense of safety, confidence, sensitivity, movement options and current state.

That requires a different level of clinical reasoning.

Recent papers and frameworks have helped the profession move away from older structural stories. Reviews now map possible manual therapy mechanisms across neurological, autonomic, neuromuscular, neuroimmune, vascular, biomechanical and contextual domains. Best practice guidance also reminds us that care should be person centred, active where appropriate, reassuring, evidence informed and not dependent on passive correction.

Contextual factors research also reminds us that expectation, language, trust, consent, environment and therapeutic alliance are not background noise. They can influence the response to care.

That is not a weakness in manual therapy.

That is part of the biology of being human.

The outdated part is not the use of hands. The outdated part is claiming that our hands are doing something more precise, more structural or more permanent than the evidence supports.

We can still use massage, myofascial approaches, pressure, movement, stretching, rhythm, stillness, active participation and skilled touch.

But we need to update the story. 📚

Rather than replacing one simplistic explanation with another, we need to become more comfortable with uncertainty and complexity. Changes in pain, movement, comfort, confidence or function rarely come from one single factor.

A more honest position is that we cannot always know exactly why someone responds positively to care. We can observe change, monitor outcomes, explore what seems helpful for that individual, and use the best available evidence to guide our decisions, but we should be cautious about attributing success to one tissue, technique or mechanism.

That does not weaken our role as therapists. It strengthens it by encouraging better clinical reasoning, greater humility and a more person centred approach to care.

Many of us were taught explanations that sounded certain but were never as well evidenced as we were led to believe. That is not a personal failure. It is how professions develop. Training reflects the knowledge and culture of its time. Good clinicians are allowed to learn, revise, question and move forward.
Manual therapy does not become less valuable because we stop over claiming.

It becomes more credible. ✅

Therapists still play an important role in health and wellbeing. Skilled touch can help people feel safer in their body, help reduce sensitivity for some people, explore movement, build trust, ease protective guarding, support recovery, and reconnect with activity. For many clients, being listened to, touched with consent, treated with respect, and guided with confidence is deeply meaningful.

The future of manual therapy is not about defending old stories.
It is about becoming more person centred and more scientifically honest.

We do not need to pretend we are fixing tissue to be valuable.

Touch, used well, can be a powerful input into an adaptive human system.

That is a stronger, cleaner and more mature place for the profession to stand. 🌿

The attached image represents my interpretation of some of the current evidence. I've added the associated papers to the comments.

https://www.facebook.com/share/p/1DPfD4tLzD/

Healing crisis, or time for a better explanation? 🤔

‘Healing crisis’ is one of those phrases that sounds wise until you stop and ask what it actually means.

Historically, pain was not always seen as something to ease. In older models of care, pain and irritation were sometimes taken as signs that illness was active and that the body was responding. Some practitioners even provoked painful reactions because they believed that a stronger reaction meant a stronger healing process. 🕰️

That old thinking still echoes in parts of complementary therapy. ‘Healing crisis’ is often used to explain why someone feels worse after treatment, especially later that day or the next morning. The idea is that the body is ‘processing’, ‘releasing’, ‘detoxing’, or somehow getting worse before it gets better. In some traditions, a temporary aggravation is even treated as proof that the treatment is working.

The problem is that the phrase carries baggage. It suggests that something was wrong, blocked, broken, dysfunctional, or in need of being fixed, and that the worsening somehow proves the therapist has found the problem. That is a big leap, and in many cases it is simply not justified.

Current evidence does not support that explanation. If a client feels worse after treatment, the answer is not to dress it up as healing. The answer is to understand it properly.

So what might actually be happening when someone feels stiff, sore, or more painful the day after a treatment that did not hurt at the time? 🧠

Usually, the simplest explanation is the best one. The treatment may have been a bit too much for that person, on that day, in that area, at that dose. Pressure, duration, stretching, repeated contact, and time spent on a sensitive spot can all lead to a short lived post treatment response. Research on manual therapy and massage shows that soreness, stiffness, tiredness, and increased pain are common mild reactions, often showing up within 24 hours and usually settling within 24 to 72 hours.

That is not a ‘healing crisis’. It is a response to treatment.
Pain science also helps here. Pain is not a simple readout from tissue. It is a personal experience shaped by the body, the brain, the situation, previous experience, stress, sleep, and expectation. So someone can feel fine during a massage, especially in a calm room where they feel safe and supported, then feel more sore later when the system reassesses the input. Add in existing sensitivity, worry, poor sleep, or the normal ups and downs of symptoms, and the next day response starts to make much more sense.

This also matters for therapists. A mild next day reaction does not automatically mean the therapist has done anything wrong. But it does mean something important has been learnt. The client is telling you the treatment was not as well tolerated as hoped, and that needs reflection, not spin. 👂

It is also not enough to protect yourself by casually saying, ‘You might feel a bit sore tomorrow’, then applying whatever pressure or technique you like and using next day pain as a convenient excuse. That is not thoughtful practice, and it is not good consent. ⛔️A warning does not make an excessive, poorly matched, or badly judged treatment appropriate.

Therapists cannot simply apply any technique with too much confidence, then hide behind the idea that soreness proves it was effective.

The real question is whether the treatment was suitable, well judged, and responsive to the person in front of you.

Was the pressure too much? Was the area already irritable? Did the client feel able to give feedback during the session? Were expectations discussed clearly and honestly? Does the next treatment need to be lighter, shorter, slower, or more tailored to that person’s current state?

That is the issue. Not blame, not mythology, but clinical reflection.

If a client reports more pain the next day, the therapist should listen, document it, explain it honestly, and adjust the plan. If the reaction is strong, unusual, or lasts beyond a couple of days, it needs proper reassessment rather than being brushed off as a positive sign. ✅

Changing the language changes the practice. ‘Healing crisis’ makes worsening sound meaningful by default. ‘Post treatment response’ asks us to pay attention, adjust the dose, and take the client’s experience seriously.

Less mythology, more honesty. Better for clients, better for therapists, better for the profession.

https://www.facebook.com/share/p/1GYzxtyXHU/