Could that Pain be Unhealthy Fascia?

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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-Jim

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