I have always had a keen interest in anatomy. My Gran trained to become a nurse but when she was due to sit her final exams she ended up having to look after her own Mother and was never able to complete her training. When I was at school, I felt as if I was going to train as a nurse because she couldn’t and this created a mysterious link with my Gran motivating my interest in all things anatomy.
Anatomy is the collective components and structures of the human form (and living organism). Physiology is how all those anatomical components work together to create function and life. As a manual therapist, how much anatomy and physiology (A&P) should we know to be able to safely and ethically work with people? Does a therapist who performs Swedish or Holistic massage need to understand as much A&P as a sports massage or neuromuscular therapist? Do I, and all other lecturers and workshop presenters, need to know more A&P and science to be able to teach?
I was attending a university tutorial once where the lecturer was asking a question about the molecular structure of an amino acid, she couldn’t answer her own question and totally confused all those attending. Mistakes are made – we are only human – but if you put yourself into a job, role, situation and position especially if it’s in front of a national and even international audience, what you say and write has to be correct. You can obviously have an opinion and write about your experience but what you write has to be accurate or at the very least supported by scientific evidence otherwise, it can cause more harm than good.
Does fascia actually release? Do you increase fluid (water) in the tissues from doing massage? Does drinking water after massage actually make a difference? Can we release scar tissue? Is a trigger point actually what Travel and Simons said it was? Do pain nerves exist and do the changes manual therapists make to the human body only include the nervous system and not the physical tissue?
Manual therapy training does provide essential A&P suited to the remit of that particular style or therapy approach (mostly, but that’s also my opinion!). But learning so much information can feel like overload with technicalities and long names and all you really want to do is do massage. So many manual therapists just get through the A&P and then it’s never really needed again and promptly forgotten and I include myself in that. However, writing articles, teaching and lecturing have made me go back to the books and upgrade and update my skills because if I put myself on that stage and platform, what I say and write should be correct.
I can read articles I wrote on Myofascial Release (MFR) in the early 2000s and realise how little I knew yet so excited to share the work. I have dyslexia and visual challenges making reading and writing very challenging so I learn better by watching and listening. I memorise everything and I realised I memorised the words and phrases I was taught throughout my massage and MFR training. Despite them being wonderful words of wisdom, they were not enough for me to be able to teach, lecture and write from a place of both knowledge and experience. Having a passion for manual therapy doesn’t always mean you have the skills to teach it, I certainly didn’t. Teaching is more than just having a passion for the work, you need to know accurate A&P and be able to make it clinically applicable. You need to be able to work with peoples different learning styles, their different personalities and capabilities and meet expectations as well as deliver the manual therapy applications. If you want to write articles and lecture, it’s more than just text and pictures. It’s about conveying a story to that audience in an understandable way to inspire people and more importantly, what you present has to be accurate otherwise it’s totally detrimental to the whole industry.
I have learned that to be able to teach effectively, I need to have knowledge of all sides of the debate about what MFR is, how it works and what it can and can’t do. I delved into pain science (which I love), the issue in the tissue versus the dermo neuro modulation debate as well as various myofascial therapies and contemporary A&P. Social media and the internet have changed the way we teach and how we teach. People already know more before they attend a workshop than in previous years as they have seen it on the internet and watched YouTube videos. They are coming with more in-depth questions and in turn, want to learn more.
MFR is built upon what you as a therapist feel under their hands, it is a hugely kinaesthetic therapy combined with intuition and therapeutic dialoguing. BUT the teaching of it has evolved due to the ability to share information on the world wide web. While I still teach the applications of MFR the way I was taught, I have left behind the almost wishy-washy ambiguous descriptions of what I’m doing and what I’m feeling under my hands not necessarily because they are incorrect but I was taught MFR to be a therapist, not a teacher, lecturer and writer. I was taught MFR to be able to communicate with patients in pain- these communication skills are very different from communicating everything fascia with other therapists.
Over the years I have tried really hard to understand science and expand my knowledge. There is nothing more annoying than seeing or hearing something about anatomy and more specifically fascia that is incorrect – and I’ve seen some crackers!!. If you write an article or show videos and lectures on the internet and get something fundamentally wrong or give incorrect information – that news spreads like wildfire and affects all manual therapy.
There is a huge pressure to get ‘it’ right and as I said before – humans make mistakes – but if you choose to teach, write and lecture, it is a very different platform to that of being a therapist requiring much more knowledge. I’ve learned from my mistakes and I’m still learning. I decided to go back to university to learn human and cell biology and scientific research because I was dissatisfied with my lack of knowledge in my teaching skills. The phrase ‘the more you learn, the more you realise you don’t know’ is certainly true. It frustrates me now when I see lecturers and teachers making mistakes as this then is learned as ‘truth’ by their students and followers. I believe to use MFR effectively you need to know so much more than just how to apply the technique and feel for any changes under your hands. Manual therapy is a skill and skill is increased with knowledge. Knowledge is increased by understanding clinical anatomy, biomechanics, science and A&P. MFR is highly intuitive but intuition is built on knowledge too. Good professional MFR training must provide more than just a technique description. A therapist needs to know why they are doing a technique and how to assess outcomes. They also need to have an understanding of how it works and be able to convey that information with good solid science to the patient to instil confidence. If the patient understands what you are doing, they are more likely to engage in the process, get results and then share their experiences. They will tell 7 people who will tell 7 people and so on!
I’m very fortunate to have had some amazing teachers throughout my career. This year I am in my 20th year as an MFR therapist and 15th as an MFR lecturer. Every year has challenged me to learn more, especially about fascia research. We live in an era where science is constantly changing and I feel that to deliver the best workshops I can, I must keep learning and deliver that learning in an accurate and understandable way.