“I just need you to dig into this spot, right here.” “This needs to pop, then I’ll feel better.” “It just needs a good stretch.”
Does this sound like someone you know?
I am constantly hearing this from patients when they initially come to see me. They present with pain and an increased sensation of tension and stiffness that gives the impression that it will be relieved with soft tissue massage, manipulation or stretching.
Nearly all clinicians, coaches and trainers, myself included are people pleasers. As such we want to make our patients/clients happy and oblige their requests. However it is essential to ask ourselves, why? Why does he feel that he needs to “pop” his back to feel better? Why does she feel she needs a weekly massage to manage her discomfort?
An area of the body does not simply become tight or stiff. Soft tissue adhesions and trigger points do not just magically develop. These things occur when the body is moving poorly. If an area is being abnormally stressed during a commonly performed activity such as walking or running the brain will increase muscular tension in this region to protect from a more significant injury. The real magic is discovering where these movement compensations are occurring via a comprehensive evaluation.
Now don’t take this the wrong way and think that I am saying manual therapy is bogus. Manual approaches are often warranted and I perform a great deal of manual therapy in my own practice. However blindly performing such techniques without having a reason to do so is negligent.
At Cohen HP we utilize dry needling as a soft tissue modality (among many others); however it is only implemented with the ultimate objective of improving movement and function. The immediate goal with this could be to reduce pain which would decrease soft tissue guarding. Perhaps the short term goal is to minimize soft tissue adhesions and tension that cause mobility restrictions. Both of these immediate goals allow the clinician to coach proper movement by gaining a full range of motion to work with.
Optimal movement patterns can now be restored. When the body is moving optimally joints are being stressed normally, soft tissues are being shortened and lengthened through a full arc of motion, and a neurologically rich environment is introduced which allows for optimal motor learning. The sensorimotor system will now be constantly adjusting to full ranges of motion which allows for mastery of optimal movement. Movement compensations are no longer necessary however these old motor programs are still present in the brain so they must be watched out for. The new and improved ways of moving will allow the brain to develop new motor programs or patterns (software) to control the body (hardware).
Often times the first step of utilizing manual therapy can be skipped altogether. If the patient/client possesses no significant soft tissue abnormalities, mobility restrictions or abnormal pain responses then treatment time would be best utilized elsewhere. This allows for the clinician/coach to immediately address the root cause of symptoms.
Weekly massages, multiple sessions of getting “adjusted” and constantly feeling the need to pop joints should not be essential. Having a massage is a great thing however if you fall apart without it then a larger issue is staring you in the face. All you have to do is ask why!