Massage & Bodywork

JANUARY | FEBRUARY 2020

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Ta k e 5 a n d t r y t h e A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 97 control theory of pain, which is not inaccurate; it's just not . . . TL: Not the whole story. GL: Yeah. I mean, you bang your thumb, you put your hands on it, it will feel better. With even gentle mobilization, you'll have viscoelastic changes in tissue, meaning it will move more easily, and that might help people build some confidence. And it'll feel different. You're less stiff in the short term, and then you're like, "Oh wow, I'm not as bad as I thought." So, it's like little wins to build on. TL: I'm thinking that so many of the people I work with want to touch the problem. They want to say, "OK, tell me where to press or touch or move or feel so I can get my hands on it and change it." I think that's part of the conceptual shift we're being faced with too. GL: Yeah, and I think you can still do that. Touch can be a great desensitizer. It's just having a better explanation for it. SUMMARY TL: All right. Any other questions I should be asking? GL: No. I would just reiterate, going back to the SI joint, you can use that model at every joint. So, people say, "Oh, you have scapular dyskinesis, and your shoulder blade rolls forward and it wings. That's why you have pain, and then it impinges." The other way to view it is, well . . . impingement is normal. Scapular winging is normal. It hurts because something is sensitized in the shoulder. It could be the rotator cuff, it could be the capsule, it could be some nerve, it could be a bursa; and your worry about it, your lifestyle, your sleep, those are making you respond in a greater extent to the nociception there. So, what do we work on? We work on all the things that sensitize you. We don't have to blame the shoulder [blade] position. The SI joint, same thing. The SI joint is sensitized, there's nothing wrong with the joint. You don't have faulty movements, you don't have faulty control. It just got sensitized somehow. So, let's work on building it up and desensitizing it, and lots of things can do that. That's why there are so many different people out there who [can] help. There's not one right way. I would stress that to people. TL: OK. Anything else? GL: Like . . . No, I'm good. TL: Like, what? What were you going to say? I want to hear that one, that was sounding good. GL: I was going to say, it must be interesting in the classes you teach. People probably have a lot of different techniques, and that just tells us what we want to do is find . . . the common threads among different people. I think if we find these common threads, then ultimately maybe we find the true mediators of recovery. Why can someone have an exercise approach and help a group of people, and someone else could have a manual therapy approach and help a group of people? What's the commonality [here]? We find those common threads, and then we're like, "All right, wicked." I know what really has to change, or what really has to occur, to mediate recovery. Notes 1. Thorvaldur Palsson et al., "Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area," Physical Therapy, Epub. ahead of print (July 2019), https://doi.org/10.1093/ptj/pzz108. 2. Thorvaldur S. Palsson, "Lumbopelvic Pain—Sensory and Motor Aspects" (PhD thesis, Center for Sensory Motor Interaction Department of Health Science and Technology Aalborg University, Denmark 2014), www. fysio.dk/globalassets/documents/fafo/afhandlinger/ phd/2014/phd_thorvaldur-skuli-palsson_2014.pdf. 3. A. Vleeming and M. Schuenke, "Form and Force Closure of the Sacroiliac Joints," PM & R 11, Supplement 1 (August 2019): S24– S31, https://doi.org/10.1002/pmrj.12205. 4. Ajit M. W. Chaudhari et al., "Perceived Instability Is Associated with Strength and Pain, Not Frontal Knee Laxity, in Patients with Advanced Knee Osteoarthritis," Journal of Orthopaedic and Sports Physical Therapy 49, no.7 (2019): 513–17, https://doi.org/10.2519/jospt.2019.8619. 5. T. Tullberg et al., "Manipulation Does Not Alter the Position of the Sacroiliac Joint: A Roentgen Stereophotogrammetric Analysis," Spine 23, no. 10 (May 1998): 1,124–28, https://doi. org/10.1097/00007632-199805150-00010. Til Luchau is the author of Advanced Myofascial Techniques (Handspring Publishing, 2016), a Certified Advanced Rolfer, and a member of the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the United States and abroad. He invites questions or comments via info@advanced-trainings.com or @TilLuchau on Facebook, Twitter, or Instagram. Watch "Bucket Handles III: Rotation, Supine" Watch Til Luchau's technique videos and read his past articles in Massage & Bodywork's digital edition, available at www.massageandbodyworkdigital.com, www.abmp.com, and on Advanced-Trainings.com's YouTube channel. Watch Til's ABMP video playlist where all his videos have been compiled.

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