Issue link: https://www.massageandbodyworkdigital.com/i/640605
D CLINICAL ORTHOPEDIC MANUAL THERAPY A disconnect between the sciences and hands-on work may not be of the utmost importance when manual therapy is done for the purpose of relaxation, but it matters greatly if clinical orthopedic manual therapy (COMT)—sometimes referred to as medical massage—is being performed. COMT's goal is to remedy a specific musculoskeletal condition with which the client presents. This requires an understanding of the mechanism of the client's condition, as well as an understanding of the mechanisms of the appropriate assessment and treatment techniques. It also requires a clear understanding of the science— in other words, the structure and function of myofascial tissue. In these circumstances, a disconnect between science knowledge and hands-on knowledge can result in therapists being less able to render effective and successful manual therapy for their clients. INTEGRATING SCIENCE AND HANDS-ON WORK Following are examples of how the knowledge and understanding of the science of myofascial tissue can lead to an enrichment and empowerment of our skills as manual therapists. Understanding Versus Memorizing Having a command of the actions of muscles is critically important to both assessment and treatment techniques. When learning anatomy as students, we are first confronted with two tasks: learning the attachments of the muscle and learning its actions. I believe this work can be cut in half if an understanding of muscle function is applied at the same time, which is why most schools teach kinesiology in addition to anatomy. At its essence, a muscle is a pulling machine. When it contracts, it creates a pulling force toward its center. It is as simple as that. Therefore, if we look at the line of the pull of the muscle compared to the joint it crosses, we can figure out the action(s) of the muscle. For example, every muscle that crosses the hip joint anteriorly with a vertical component to its fiber direction can flex the thigh at the hip joint. Instead of memorizing this joint action individually for each and every muscle that crosses the hip anteriorly (i.e., the tensor fasciae latae, rectus femoris, sartorius, iliacus, psoas major, etc.), this one concept can be applied to all the muscles in the front of the hip. So, if we know that a muscle crosses the hip joint anteriorly with a vertical component to its fiber direction, we know it is a hip flexor (Image 1). Similarly, all muscles that cross the hip joint posteriorly, with a vertical component to their fiber direction, can extend the thigh at the hip joint. 62 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 6 All muscles that cross the hip joint anteriorly with a vertical component to their fiber direction are hip joint flexors. Muscolino, Joseph E. The Muscular System Manual, 3rd ed. Elsevier, 2010. 1 Do you bring science to your massage table and to your hands-on work? Or do you treat them exclusively from one another? In some schools, science and technique are taught independently from each other, sometimes leaving practitioners without the important interfacing of disciplines that could positively inform their work. With a true integration of science and manual therapy, new therapists are empowered to think critically, creatively applying their assessment and treatment techniques to address a client's needs.