Protocols and Cookbooks

Discussion of Myofascial Release techniques, both generic and modality specific.

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Protocols and Cookbooks

Postby WaltFritz on Fri Apr 22, 2011 8:01 am

The use of protocols has gotten a bad rap in some areas of Myofascial Release. “Cookbook Therapy” it is often called. Certainly following a strictly defined treatment plan is out of line with most forms of MFR, but don’t we all follow certain protocols?

Each individual that comes into my treatment room is approached differently. That being said, there are certain trends that, in most cases, hold true. If a patient tells me that they have difficulty standing for any length of time, especially while performing an activity such as washing dishes, and, experiences difficulty coming to stand after working at the computer for a length of time, I immediately suspect hip flexor involvement. While I remain open to other possibilities, my experience has shown that I am often correct. This is a protocol, or recipe, that has proven to be valuable, in that releasing the hip flexors provides improvement, and I do not waste time treating the back.

Us this a recipe from my cookbook? It probably is, but it comes from years of experience. Have I narrowed my focus to soon, possibly missing some other cause? I do not believe so, as I always perform a complete assessment, head to toe, prior to coming to any conclusions. And, the assessment/evaluation is always a dynamic process. I am constantly re-assessing as I treat.

Peter Lelean’s Migratory Fascia Syndrome has a set protocol of areas to assess and treat. It does not preclude addressing other areas, but works from trends. I have seen great success using this protocol of evaluation and treatment. Cookbook therapy? Not in the least.

All myofascial release involves some sort of sequencing or protocol, though some would have you believe this is not so. The three step lumbosacral decompression is a perfect example. Perform the sequence in a certain order and results typically improve. Most therapist trained as I was follow these steps without feeling they are doing cookbook therapy.

Cookbooks are fine, as long as you write them.

What are your thoughts?
Walt Fritz, PT Pain Relief Center, Rochester, NY
http://www.myofascialresource.com
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Re: Protocols and Cookbooks

Postby Taoist on Fri Apr 22, 2011 8:39 am

This is a really funny comparison because thinking about the way I follow a recipe and the way I go about a massage really are the same. Whenever I find a recipe that I want to try, I've decided that it's impossible for me to follow it exactly. I constantly think to myself, "Well this would taste better in there than this" or "adding a little bit of this would make it perfect", or those times where I don't have everything that's listed so I use substitutes. Sometimes my little "experiments" turn out just the way I want them to, other times they're a plain and simple disaster. When that happens, I just try again since I usually know where I went wrong.

So on to my bodywork- Although I don't have any MFR training, I agree with what you said. I hear a specific complaint and automatically a protocol or two come to mind. However, as I start working and feeling the dynamics of the person's whole body, that protocol can be changed mid-massage or I'll make substitutions based on their individual needs (one protocol does not fit all!) Unlike my cooking, my sessions are effective more often than they are not. Sometimes they are not though, so I know that I need to change something next time whether it's where my focus is or what modality I use, or I'll send them to someone who is better suited to do the type of work they need.
"At the center of your being you have the answer; you know who you are and you know what you want."
Lao Tzu

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Re: Protocols and Cookbooks

Postby WaltFritz on Fri Apr 22, 2011 10:47 am

I relate well to cooking analogies! We all come up with our own recipes.
Walt Fritz, PT Pain Relief Center, Rochester, NY
http://www.myofascialresource.com
For therapists: MFRmail Newsletter (patient focused newsletter also available)
Foundations in Myofascial Release Seminars
Myofascial Release Mentoring Program
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