blog post #289
This is one of the most striking stories of incompetent and harmful manual therapy that I have ever received from a reader. It is notable not only for the seriousness of the outcome, but also for the glaring excess of the treatment: so unnecessary! It may also be a good example of how rough therapy can provoke the nasty phenomenon of “central sensitization” — a long term reduction in the patient’s pain threshold.
Many of my critics think I am too "negative" about alternative therapies. Well, I would like them to put this story in their collective pipe and smoke it. If condemnation and negativity isn’t justified here, I don’t know where it is: the degree of incompetence and dangerously poor clinical judgement is appalling. What happened to this patient needs to be discussed openly. Although this is an unusually nasty example, negative outcomes like this are shockingly common, and almost never reported to the therapist who perpetrated them — or, if it is, the therapist rationalizes it away as a "healing crisis" or any one of a list of other intellectually dishonest evasions.
I have re-written the story a little to anonymize and condense it, but it is otherwise presented as it was received:
I visited a massage therapist a month ago for treatment for soreness/achiness in the balls of both feet and in the toes. Claiming that tight calf muscles and hamstrings were causing my heel to lift too far (thus placing pressure on the balls of my feet), she proceeded with a half hour myofascial release therapy on my calves, using her full weight and her elbows.
It was extremely painful, but I gritted my teeth, thinking it necessary "to break up the knotty muscles." She moved from point to point up and down my calves, twice. A week later I had another such treatment, and she also also persuaded me to buy a rubber roll so that I could do the "therapy" at home. She told me I should try to reproduce the same pain level, on calves and hamstrings. I did this every day for one hour for five days. I did the same with a wooden roller under my feet, using my own weight.
During that time, I started getting stabbing and burning pains in my feet, the backs of my legs, and then later my hands and armpits. The stabbing pains varied from a pinprick feeling to electric-shock/lance-like, and they varied in their frequency rate. The burning was either tingly or felt like bad sunburn. The pain seemed to be aggravated by walking, and was always worse by afternoon/evening. I had trouble sleeping, because I could not have heavy bedclothes on my feet, and nor could I put one leg on top of the other, without pain.
I returned to my GP, had blood tests, x-rays, a CT scan. Because my symptoms seemed neuropathic in nature, I was referred to a neurologist. After eliminating a number of other diagnoses, the neurologist thinks the problem is biomechanical or related to muscles, and that the MFR may have caused an oversensitivity to pain.
I then searched the Internet for information about myofascial release being damaging or making pain worse. It was very difficult to find, because of all the "positive" hype around MFR. Fortunately, I found your website …
What happened here? Aggressive and intense manual therapy with no regard for the state of the patient's nervous system or the potential to provoke an extremely serious chronic pain state, probably via the mechanism of "central sensitization." This patient’s prognosis is impossible to call: it could last another week, or this patient could suffer excessively for the rest of her life.
For the duration of my decade as a massage therapist, I had a reputation as a gentle therapist, and many of my patients were "refugees" from excessively intense treatment, many of whom vented angrily to me about the abusethey had received from other therapists. Vancouver is a "fascial release" mecca, with many therapists who believe that there is no gain without pain, and many or all painful problems are caused by fascial "restrictions" that must be painfully "released." As a therapist who defined himself in opposition to this trend, I was treated to many, many outraged patient anecdotes about the brutality of other therapists.
Having experienced that intense style of fascial release myself many times, I knew all too well what these patients were talking about. Almost none had found the courage to discuss their concerns with the confident (overbearing?) therapists who had mistreated them. Almost all had even earnestly tried to like it, at first. Sometimes, rather sadly, they were even still trying to rationalize it as positive, i.e. “I’m sure it was probably what I needed, but I just couldn’t take it anymore!”
Of course some people enjoy intense therapy — if your nervous system is okay with it, that’s fine. Most of those therapists have many devoted patients who, for various reasons biological and psychological, are more willing and able to tolerate extreme therapy. However, they are also leaving behind them a trail of angry, injured patients … patients who never raised a word of objection.
That's why stories like this are important. There are bound be therapists reading this who have actually done this to patients, who do it every day. Many will react defensively. Many will delude themselves into believing that they are the more judicious exception to the rule. But some, perhaps a few who are already questioning their own methods, will probably be moved further in that direction. I hope.
Better still if patients feel emboldened to reject such treatment more quickly.
The conceptual cancers at the heart of this incident are structuralism and the for-profit trademarking and packaging of treatment methods, what I call modality empires. Follow those links for more information and perspective.
There are also 247 more articles and eight big tutorials on the website, plus dozens more timely updates and “posts.” See the complete categorized index, or get some reading recommendations for patients or professionals.