Valence Massage and Physical Therapy

Of ten common orthopaedic procedures, a specialty which accounts for a quarter of all operations in Britain and a similar share in America, only three—for carpal tunnel and total replacement of knees and hips—offer outcomes that are clearly superior to non-operative care. https://www.facebook.com/100064455893534/posts/1617282127096968/?app=fbl

Surgeons must be taught to present patients with a range of options and choose the best one together. Register for free to read why millions operations should be scrapped, bit.ly/3V2zX0v

Illustration: Mojo Wang

Imagine if treating stiffness and pain required snapping bands of corrective tissue! Good luck with that. Massage, manual therapy, and myofascial techniques are about interacting with the nervous system and brain of the patient. If someone tries to break up your anything, run. https://www.facebook.com/100063836049326/posts/1619131813558005/?mibextid=rS40aB7S9Ucbxw6v

🤔 CAN FASCIA WITHSTAND 2,000 PSI AND STILL BE “BROKEN UP” BY A THERAPIST?

You may have heard the claim that fascia can withstand around 2,000 pounds per square inch. It is often used to explain how powerful fascial restrictions are and why they might contribute to pain. Yet therapists are also told that they can break up those restrictions or scar tissue using their hands, cups or tools.

Both claims cannot comfortably sit together.

📚 The 2,000 psi figure comes from Katake’s 1961 study. Lower limb fascia taken from four cadavers was clamped and pulled along its fibres until it eventually failed and ripped apart. The figure describes the tensile stress the tissue tolerated as it was pulled towards breaking point. I actually have a copy of this paper from Kyoto University and it's just over 4 pages long.

This paper does not show fascia producing 2,000 psi inside someone’s body. It does not tell us that fascia compresses other structures with this pressure, and it certainly does not give us a treatment pressure that therapists must overcome.

But let’s imagine for a moment that we do accept the figure as evidence of how incredibly strong fascia is. How could a therapist then physically break it apart using manual pressure without also injuring the skin, nerves, blood vessels and other tissues around it - or themselves?

🔬 Chaudhry and colleagues explored this problem using a three dimensional mathematical model. Their calculations suggested that forces outside normal physiological ranges would be needed to produce even 1 per cent compression and shear in dense fascia lata and plantar fascia. They concluded that the feeling of tissue 'releasing' beneath a therapist’s hands could not be explained by directly deforming these firm tissues, although softer superficial tissues could change shape more easily.

This does not mean nothing happens during manual therapy. Of course something happens. Living tissues temporarily change shape whenever we touch, move or load them, but temporary deformation is not the same as breaking collagen fibres, removing adhesions or permanently releasing fascia.

Scar tissue can also change over time through biological remodelling, particularly during healing and with appropriately graded movement and loading. A therapist may help someone feel more comfortable, move more confidently or tolerate contact and movement more easily. These are valuable outcomes, but they do not prove that scar tissue has been physically broken apart.

We do not need to dismiss what therapists feel beneath their hands or what clients experience. We simply need a better explanation for it. Changes in sensation, attention, movement tolerance and protective responses can all alter how an area feels during and after treatment. Softer superficial tissues may also deform temporarily without dense fascia being permanently changed.

💡 So the problem is quite simple. We cannot use the 2,000 psi figure to show how incredibly strong fascia is and then claim that routine manual pressure can break it up.

People may genuinely feel and move differently after treatment. The change is real, but that does not make a story about breaking, melting or releasing fascia true.

👉 The technique describes what the therapist does. The outcome belongs to the client.

📖 Katake, K. (1961) ‘The strength for tension and bursting of human fasciae’, Journal of Kyoto Professional Medical University, 69, pp. 484–488.
📖 Chaudhry, H., Schleip, R., Ji, Z., Bukiet, B., Maney, M. and Findley, T. (2008) ‘Three-dimensional mathematical model for deformation of human fasciae in manual therapy’, Journal of the American Osteopathic Association, 108(8), pp. 379–390.

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Just a reminder, you don't have to chase profitability and productivity; there are other options:

How long should it take to heal?

Exercise is medicine: https://www.facebook.com/100049680654059/posts/1580220183643988/

I believe firmly that moving in more diverse and complex ways enhances your movement vocabulary. Don't buy in to the idea of fragile bodies and specific "correct" patterns. It's just marketing. https://www.facebook.com/100063944655596/posts/1430606292414179/?app=fbl

Exercise and even just moving around more can have profound benefits far beyond just strength or weight loss. If you need help getting movement, I'm here to help!

Surgery does not seem to outperform "conservative care" in many musculoskeletal pain conditions. I wish to see every person made aware of this before they go under the knife! https://www.facebook.com/100064622535057/posts/1236777958486277/

Biomechanical explanations for pain and dysfunction often rely on old narratives that imaging and science has shown to be wrong. Moving more, increasing load tolerance, and training can help with pain, even spinal flexion.