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Fascial Restrictions, Adhesions, Trigger-Points... Eye-roll.

I’m using this blog post as an opportunity to vent about an annoyance of mine. In my decade-plus career in this profession, I have noticed a common belief among most people. It’s the idea that massage therapists have some otherworldly ability to feel “things” in other people’s bodies. These “things” are believed to be the cause of their pain and discomfort.

I wish it was true, my job would be so much easier. Alas, we have no special powers, we can only feel what other humans feel. So, when I hear the inevitable, “what do you feel?” or the slightly more ominous, “do you feel anything?” I am annoyed. Because I don’t like telling people I’m not special.

Once the question is asked, I usually let it hang there like a fart not yet smelt, while I gather my thoughts and try to formulate my words. Do I have the energy and gumption to say what needs to be said? Is this the type of person who will even listen? Or will they just tune-out and wish they were seeing the other therapist, the one who can magically feel the origin of pain.

The conundrum: speak the truth and risk losing the patient, or tell them fanciful stories and draw them in. The truth is boring. Most, if not all of the time, I feel nothing of note. Zip. Nada. Oh sure, I feel skin, bone, striation of muscle, and other structures that aren’t buried too deep. What people expect to hear, is something a lot more ill-fated. That their body has fascial restrictions, adhesions, and trigger points. After all, that’s why they’re seeing me. They have been led to believe their pain is being caused by something physical that exists inside their body.

The truth is, these things most likely don’t exist (read this). And if they do, we can’t reliably palpate them (and this).

It would be so easy to perpetuate false beliefs and say I can take care of their trigger-points like the Death-Star took care of the planet Alderon; or tell them their fascial adhesions can be melted away like butter on a hot stove with a series of just ten treatments. This is a good business model. But I just can’t. I have to answer with more integrity. I feel nothing out of the ordinary. The problem with the latter option is it’s hard to get people to return when there is nothing wrong with them. This is a not-so-good business model. This is part of the reason why so many therapists hold onto these old-school beliefs. Check out this blog from my good friend, Eric Purves, for more reading on this topic.

The more I am steeped in the study of pain science and skepticism, the more I am disheartened to hear people talk about these mythical little pain generators. However, they are not to blame for their beliefs. It seems as though there has been a public awareness campaign on the importance of fascia, and that trigger points are the cause of all evil. If you’ve ever opened up a fitness magazine, been to any type of fitness class, or worked with a personal trainer, you have probably been told you have fascial restrictions or trigger points. You will continue to have pain until these sinister lesions are rolled out with a foam roller, blasted away with metal instruments, or stabbed to death with needles. There’s even a device now being marketed known as the “fascia blaster”! Worse still, even in the face of research contradicting the existence of these things, my own profession is guilty of bombarding the unsuspecting public with these messages of dire consequences.

When I first discovered this was all just nonsense, I was consumed with the desire to set everyone straight on the matter. Everyone who came into my clinic received a lecture on how a belief in trigger-points can lead to more pain, and that three thousand pounds of pressure is required to deform fascia an inch. Of course, very few people are willing to have their beliefs challenged. Unfortunately, it’s not that easy to convince people fascial adhesions aren’t a thing, and I can’t feel them. To argue otherwise is not good for business. This approach had to be ditched.

Now I choose a different approach, a much softer one. When the question arises, I don’t mention these out-dated terms. There is no talk of trigger-points, adhesions, restrictions, or even tightness. I turn the question around, and let the patient tell me how it feels to them. This is important information, much more important than what I think I feel.

Please, if you’re a therapist and you’re still talking to your patients about fascial adhesions or trigger points, step out of the dark-ages and take a look at some research. Get onto social media and see what other therapists are saying. Use your critical thinking skills. And most importantly, stop pathologizing normal tissue. This can only lead to more fear surrounding the issue.

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