Recently, OPTIM Manual Therapy Fellowship wrote a response blog post to a Move Forward PT podcast entitled: "Could that Pain be Unhealthy Fascia." It appears that OPTIM was not the only group of individuals upset by this segment. The APTA removed that segment from the Move Forward PT website after backlash from a number of individuals. In short, the segment discusses fascia, how it is injured, and how the fascia can inhibit movement. This post is not to meant to criticize the podcast (that has been done by many others before me), but bring light to other issues and concepts surrounding the podcast.
First, I agree with the OPTIM PT response. When assessing patients with musculoskeletal dysfunction, one must go to the joint level first. This statement transcends fascia. It applies to muscles, nerves, and other connective tissues as well. For example, if the IT band is causing a friction syndrome, go to the levels that innervate the TFL. If an individual has a positive Thomas Test for two-joint shortness, assess L2-L4 for dysfunction. A novice clinician might only treat the tight rectus muscle with stretching or a tight IT band with a foam roller. Typically, this does not treat the cause of the dysfunction. In many instances, assessing the joint will lead you to the cause of the dysfunction. Go to the joint level before going to the tissue!
Second, in the podcast the interviewee, who is a PT, DPT, OCS, discusses using the foam roller as an initial line of treatment for patient's with IT band pain. If the foam roll does not correct the problem, the individual should then go see a physical therapist. Why is it not the other way around? The patient should first go see a PT who can properly diagnose the problem. As a profession we need to stop promoting passive modalities to take the place of our job. If we ever expect to advance in the medical world, we need to promote ourselves as the first line of defense in musculoskeletal dysfunction.
Finally, having a specialty certification does not automatically place your above and beyond your colleagues (sad to say since I am currently studying for my OCS). In the segment, the PT is also an OCS. Despite having these initials, she is still discussing the fascia as a cause of the problem and administering foam rollers for treatment for IT band pain. Simply having a specialty certification is not enough, we must stay on top of the literature and learn advanced treatments in order to practice with the highest quality care.
To check out OPTIM's response click HERE
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James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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