The Unification of Regeneration – Manual Therapy

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By James Smith

Smith writes for blogs on the websites Global Sports Concepts and Athlete Consulting and he recently published the book, Applied Sprint Training.

According to the US census bureau, listed in an executive summary authored by Manhattan Institute fellows Edward Glaeser and Jacob Vigdor from 2012: “The most standard segregation measure shows that American cities are now more integrated than they’ve been since 1910. Segregation rose dramatically with black migration to cities in the mid-twentieth century. On average, this rise has been entirely erased by integration since the 1960s.”

The authors make clear that segregation has no doubt improved since the 1960’s; however, it is a complex issue and racial inequality is very much a problem.

In the sports world, however, segregation is alive and well and as profound as ever; though the divisiveness is not rooted in race, it is rooted in professional disharmony.

Those familiar with my work on Global Sport Concepts are aware of the means by which I’ve expounded upon this subject in the context of the sectarian and compartmentalized nature of the coaching industry:

• One or more rooms of technical/tactical/skill coaches specializing in this;
• Another room of physical conditioning coaches specializing in that;
• A physiotherapy room specializing in the other;
• And most individuals in most rooms know very little about the professional specifics of what goes on in the other;
• Further, the loading resultant of the work performed by each room of specialists results in a far greater cumulative total when combined with the other rooms than what any single person in any room is often aware of.

What’s curious is the fact that movement is the common bond that links the professional responsibilities of each person in each room; however, a specialists understanding of movement is not a requirement to earn a high level position in any one of the three professions.

In this article we will address the same sectarian nature of the fields within the realm of manual therapy.

As I expound upon at length in my talks on Global Sport Concepts, the most prudent course of problem solving action begins with reducing the constituents of the problem(s) down to their basal level. In this way, we are left with the raw materials and thereby obviate the possibility for debate.

Consider some of the sectarian divisions of manual therapy:

• Self-massage (sticks, foam rollers, etc.)
• Trigger Point Therapy
• Swedish Massage
• Deep Tissue Massage
• Sports Massage
• Reflexology
• Cranial Sacral Therapy
• Prenatal Massage
• Geriatric Massage
• Shiatsu Massage
• Myofascial Release
• Active Release Techniques
• Rolfing
• Graston
• Chiropractic

In reducing this mosaic of specialty techniques down to their basal level we are left with pressure and release, nothing more, nothing less.

• Self-Massage, depending on the implement used, offers the user with a variety of concentrations of pressure based upon their self-induced effort combined with the rigidity and surface area of the tool.
• Trigger Point Massage introduces isolated pressure and release in order to focus on acute areas of muscle spasm.
• Swedish Massage introduces medium to light amounts of pressure; most often for the purposes of general relaxation.
• Deep Tissue Massage introduces the highest amount of pressure of the traditional massage techniques and the purpose is the affect the deepest levels of skeletal muscle fiber.
• Sports Massage techniques draw from traditional massage techniques and the title implies being directed towards specific muscle/tendon/joint problem areas that trend within different sports.
• Reflexology introduces pressure specifically to areas of the hands, feet, and ears according to what practitioners claim corresponds to various organs.
• Cranial Sacral Therapy focuses pressure specifically to the bones of the head, spinal column, and sacrum based upon what practitioners claim associates with various fluid pressures (cerebrospinal, arterial) in order to achieve a therapeutic result.
• Prenatal Massage is nothing more than a practitioners choice of traditional massage techniques, i.e. pressure manipulations, adjusted for the physiological and structural condition, as well as needs, of pregnant women.
• Geriatric Massage, similar to prenatal massage, are various traditional massage techniques adjusted for the elderly community.
• Shiatsu Massage consists of specific pressures and stretches applied with the fingers and palms, sometimes tapping, around acupressure locations.
• Myofascial Release techniques are divided in to active, passive, direct, and indirect modalities. All forms are geared to utilize various means of introducing pressure in such a way as to treat the fascial network that runs throughout the body with the primary directive being to restore/enhance the patient’s movement. Active and passive techniques are differentiated based upon whether or not the patient takes an ‘active’ role in the treatment by providing resistance for the practitioner to exert against. The biggest distinction between direct and indirect treatments lies in the magnitude of pressure that is administered to the patient.
• Active Release technique is a direct, active, and passive form of myofascial release in that it is movement based; in terms of the practitioner creating motion with the patient’s limbs while he/she exerts specific pressures. Different gradations of treatment determine whether or not the patient participates in an active sense.
• Rolfing, or Structural Integration, is also a form of myofascial release. In this method the conceptual basis is rooted in the network of soft tissue systems in the body existing as a unified whole; versus a conglomerate of individual parts. The practical administration of the treatments may look very similar to a variety of other soft tissue therapies in that the practitioners will apply pressures using various instruments of their own bodies. In this way, the biggest distinguishing characteristic of Rolfing lies in the conceptual basis and knowledge which serves as the operating system for the practitioners.
• Graston Technique is also a form of myofascial release; however, it is specifically characterized by the use of metal tools that the practitioner utilizes in order apply specific pressures to the patient.
• Chiropractic Treatment, different from all previously outlined manual therapies, is, in the traditional sense, primarily based upon the manipulation of the spine and joints.

A traditional oversimplification of the various domains of manual therapists would be to state that the conceptual frameworks upon which the various fields operate is as follows:

• Masseurs — muscles
• Myofascial Specialist — fascial network
• Chiropractors — bony alignments/musculoskeletal system

What all specialists share in common, specifically in the context of treating athletes, is the administration of pressure and release in order to restore and enhance the systemic function of the body for the demands of sport.

If we agree that movement unifies the physical actions resultant of the work of technical/skill specialists, physical preparatory specialists, and physiotherapeutic specialists then we may also agree that pressure and release unifies the physical actions taken by manual therapists.

Now we may discuss the basis upon which pressure and release is manipulated in order to yield specific results. In this way, we may contemplate the physics of applying the force of pressure and the corresponding considerations:

• Tool (human limb or external device)
• Stiffness of the tool
• Surface area of the tool
• Magnitude of applied force
• Speed of movement
• Slickness of body surface
• Leverage

The tools used to administer pressure will vary from the practitioner’s hands, fingers, thumbs, knuckles, palms, and elbows to external devices made of a variety of alloys and composites. Additionally, self-massage sticks, foam rollers, and other implements which enhance leverage are used on behalf of the patient.

The stiffness of the implement utilized to administer the pressure correlates to the degree of energy that is transferred from the practitioner or user, through the tool, and into the part of the body that is being treated. The greater the stiffness the less the deformation and the greater the transfer of energy. Alternatively, the lesser the stiffness the greater the deformation and while this equates to a mechanical disadvantage for transferring high forces it must in no way be viewed as a contraindication for manual therapy.

The surface area of the tool that makes contact with the body will, in addition to its stiffness and the magnitude of applied force, influence the concentration/acuity of the contact area as well as the degree of tissue deformation incurred by the patient.

The magnitude of applied force will, in conjunction with the stiffness and surface area of the tool, influence the degree of tissue deformation and/or skeletal adjustment. In addition, with respect to the speed of movement and the slickness of the treated body region, the magnitude of force will influence the generation of friction.

The speed of movement affects the friction as well as excitation of the tissues. For example, a deeply penetrative force may be applied to a concentrated area of a muscle; however, if very slow movement is used to mobilize the pressure along a longitudinal axis of the tissue the level of discomfort experienced by the patient will be dramatically reduced.

The slickness of the body surface is also linked to the friction generated by the tool in contact with the body.

The practitioner or the user will enhance his or her leverage, with respect to the area of the body that is being treated, by ensuring that their direction of applied force is perpendicular to the target area of the body. Alternatively, in regards to direct means of mobilizing a patient’s joints, the practitioner may be applying rotational force to an arm or leg. In this way, leverage will be enhanced by maximizing the length of the lever arm and applying force in the direction perpendicular to the lever arm.

A reduction of these points down to the basal level leaves us with stiffness, deformation, friction, excitation, and leverage. These are some of the primary physical considerations that must be accounted for by the practitioner or user.

Following are some useful links regarding mechanical principles:

• Newton’s Three Laws of Motion
• Rapid Design through Virtual and Physical Prototyping

This knowledge of force, or pressure, application and manipulation must then be coupled with, at minimum, the anatomical knowledge that is necessary to optimize the applied physical actions and ultimately the effect of the therapy.

In the interest of considering, first and foremost, the basal constituents it is suggested to review the following anatomical resources:

• The Fascia of the Limbs and Back — A Review
• Photo Gallery of Anatomy Models
• Gross Anatomy
• The Study of Upper Limb and Back
• Anatomy of the Human Body

In regards to the effects of various manual therapies, clinical trials and reports issued by a host of medical associations and societies often dispute the validity of a variety of treatments. Those who have been involved with athletics, among other sports, for any period of time know something altogether different, however. Most important is to minimize the room for debate and recognize the truth of the organism’s adaptation to stress.

All manual therapy induces stress; however, this is not to be taken in a negative context. Adaptation does not happen unless some stimuli presents stress to the organism. Adaptation is the organism’s defense system. Survival is linked to stress adaptation.

In sport, the advancement of technical and physical qualities is directly linked to the optimal loading of developmental stressors. In the manual therapy division of regeneration, all positive after effects are linked to the means by which stress is introduced via the manipulations of pressure and release.

For example, the state of tone of a muscle indicates how many fibers are passively partially contracted. When a fiber is in a partial state of contraction it is both resistant to passive stretch and favorably enhanced for elastic function. If a sprinter enters a race in a state of tone that is too low, they will be operating at an elastic deficit and in no way be in a position to achieve personal best. Alternatively, a sprinter who enters a race in a state of tone that is too high will be more susceptible to pulling a muscle.

Manual therapy techniques have the ability to influence a muscles state of tone; most prevalent regarding the reduction of tone that is too high. While excitatory techniques are viable for pre-training stimulatory applications, the degree of stress required to increase muscle tone is more favorably and substantially achieved via training modalities that require the athlete to actively use their muscles in a way the closely corresponds to the way they function during competition. In this way, a sprinter will sprint in order to raise their level of tone.

Tone reduction is most favorably achieved through soft tissue treatments that present greater tissue deformation and low friction. Remember that tone reflects the degree of muscles in a state of passive partial contraction. From this we know that excitatory methods are counterintuitive as this only increases the possibility of elevating tone. As a result, movement speed and friction must be kept low, and while more penetrative pressure causes a stronger reaction within the muscle it is the greater tissue deformation that is necessary to relax the partially contracted fibers deeper in the muscle belly.

In regards to nervous system response to stress, we must acknowledge the autonomic system and the tone of the parasympathetic and sympathetic divisions. In this case, tone refers to the state of firing of the respective neurons.

Modern research suggests that the two branches do not oppose one another as has been historically suggested. In contrast, the two systems serve complimentary roles. For example Olshansky, MD, Sabbah, PhD, Hauptman, MD, and Colucci, MD in Contemporary Reviews in Cardiovascular Medicine — Parasympathetic Nervous System and Heart Failure Pathophysiology and Potential Implications for Therapy, state:

• Although the sympathetic nervous system has global effects on cardiovascular physiology in an all-or-none type of response, the parasympathetic nervous system can have selective modulation at various levels.

Further

• The sympathetic and parasympathetic nervous systems are not “opposites”; rather, the interactions are complex.A dynamic interaction occurs between them; these interactions are modulated partially by secondary messengers (cAMP and cGMP). The parasympathetic nervous system can inhibit sympathetic nerve traffic presynaptically. Likewise, sympathetic activation can inhibit parasympathetic activation presynaptically.

Non-invasive means of measuring heart rate variability are viable methods of assessing autonomic tone. Symptoms of elevated parasympathetic tone include decreased heart rate, blood pressure, and respiration rate while symptoms of elevated sympathetic tone include increased heart rate, blood pressure, and respiration.

From this we may associate the physiological implications of various manual therapy techniques based upon what we know about excitatory and inhibitory stimuli and their effects on the organism.

Following are some links to comprehensive online physiological resource portals:

• Medical Physiology and Pathophysiology
• Contemporary Reviews in Cardiovascular Medicine
• The Autonomic Nervous System

Further, what must be elaborated upon are the temporal considerations of training effects. For example, in the acute sense, a direct and active myofascial release treatment that includes high degrees of tissue deformation via concentrated areas of pressure along with muscle lengthening will elevate sympathetic tone in the immediate sense; however, in the hours and days following, the delayed effect will result in the relaxation and enhanced suppleness of the treated fibers.

The Unification of Manual Therapy Regeneration

While the sectarian divisions and titles of the realm of manual therapy techniques are intrinsic to capitalistic interests (as each one generates its own revenue stream), the coach and athlete will benefit much more greatly from a holistic view of pressure and release.

Consider one of the most profound regeneration experts in all the world: Waldemar Matuszewski. What do we know of him? Do we associate him with one or a variety of certifications or do we know that he was heralded as master of regeneration by one of the greatest coaching minds the world has ever known (the late Charlie Francis).

The preparation of track and field athletes, particularly sprinters, entails one of the most volatile coaching processes in the sporting world. The neuromuscular intensities, muscular contraction velocities, power outputs, associated with sprinting reside at the apex of sport demands. The state of readiness of a sprinter’s soft tissue network is elemental towards a successful training session and ultimately long career of high level competition. If Sinatra was right, and if one can make it in New York then they can make it anywhere, then track sprinters are some of the most viable proving grounds for regeneration specialists.

Numerous coaches and therapists have consulted with Matuszewski based upon his acumen; yet if you are not privy to the subculture of track enthusiasts, the associated network of support specialists, or the work of Charlie Francis, it is likely that you have not heard of Waldemar Matuszewski. Due to what we know about the unique demands of international class T&F sprint demands, however, we are right, via the process of association, to conclude that he has a uniquely comprehensive understanding of mechanical principles, anatomy, and physiology.

In the movie Good Will Hunting, the character Will recognizes his innate ability to solve complex mathematical problems yet he is not sure why:

In another scene, Will has an exchange with a Harvard man and suggests that his opponent wasted hundreds of thousands of dollars on a degree that he could have received via a couple dollars at the public library.

This is a movie; however, these scenes describe the power of aptitude- a natural ability to do something. In the sport world this is often described as ‘talent’.

Many would suggest that any athlete, coach, scientist, doctor, musician, mathematician, or manual therapist that achieves the highest degree of excellence in their respective field shares at least one thing in common- an aptitude for that specific endeavor.

While the Good Will Hunting example was not given in any way to subvert the value of formalized higher education, it was given in every way to elucidate the fact that aptitude is the most potent intrinsic potential upon which formalized efforts may be built.

The aptitude, however, must be combined with motivation and resources in order for it to be actualized.

In order to unify the segregated professional ranks of coaching and manual therapy it is suggested that those interested determine whether or not they possess an intrinsic aptitude for solving the associated problems and then actualize that potential by examining its basal constituents.

As the problem of technical/skill coaching, physical preparatory coaching, and active physiotherapeutic modalities may be reduced down to basal constituents of movement, so may the problem of manual therapy regeneration be reduced down to those of pressure and release.

Those who have been coaching long enough are aware of the fact that high level manual therapy is not intrinsic to most sport organizations. As a result, it behooves all coaches to broaden their skill set in this regard.

This article has presented some of the basal constituent resources that are relevant for anyone with an aptitude for manual therapy to unify its sectarian divisions and more effectively assist in the regeneration of their athletes.

Please share this article so others may benefit.

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