My wonderful colleague David Fluecke sent me an email this morning sharing a piece of research that shows that massage of the calf has no effect on range of motion. Here is part of David's email:
This came across my facebook feed this morning. It showed that massage helped people feel looser, but objective measurements found no change in ankle dorsiflexion. At first I was dismayed. Then I read this. "Massage of the calf complex was performed for 10 minutes and consisted of petrissage (kneading) strokes, with linking effleurage, applied distal to proximal over the belly of the calf muscle complex. The massage intervention was administered by one of two qualified and experienced physical therapists" David's comment- "I think I would restate their conclusion. It seems more likely that 10 minutes of non-specific massage is worthless."
I could not agree more; that is exactly what this study shows. Instead of a broad pronouncement about the value of massage, it shows that the approach used by the physical therapists did not increase range of motion. This study is not, however, an indictment of massage as an aid to increasing range of motion. (I can see a debate being raised on Facebook now, with some people saying that massage is only a placebo.)
This debate about the value of massage misses the point completely. In the clinic, those of us who use PNMT begin each session by measuring/assessing the client, so we know our starting point. Just like a map, you cannot navigate anywhere unless you know your present location. With the knowledge of where we want to go, such as a range of motion increase or a particular movement without pain, we use the most appropriate treatment approach to get where we want to go. Next, we reaudit the original assessment. Unfavorable result? Change strategies. Retest. Instead of holding fast to a singular approach or technique, PNMT is flexible and fluid in treatment approach but not in attaining the intended goal. In reality, it is a simple process. Test, treat, retest. Simple, however, is not easy. (Telling the truth is very simple, but not easy) Getting to the intended goal is often a labyrinth of strategies, which is often quite challenging.
I have heard criticism that PNMT is too hard to define. Therapists are used to a "this is how we do it" approach. The problem with marrying one approach is the idea that for every question, that approach is the answer. Fascial work is great, when fascial restriction is the problem. The clinical reality is that each client will have a different reason for their discomfort. Over the years, I keep asking myself and my students "What do you do when your go-to strategy doesn't work?" Clinical experience will show you that indeed, your favorite and best strategies are going to fail. You need multiple options, which is why in PNMT, we teach multiple approaches with several variations. If the first one fails, we have many more to explore. This harkens back to teaching therapists to be artists, not technicians. The artistry is in the choosing. As PNMT Instructor Christopher Sovereign said, "Do you want to be a cook or a chef?" We teach therapists a deep understanding of functional anatomy coupled with rock solid manual treatment approaches.
Every client is an opportunity to create and learn something amazing. Let's seize the moment and elevate our work to the level of artistry and mastery. It will benefit our clients and also provide us with a rich and fulfilling career.
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