A woman named Jennifer took my session at IDEA and wrote a query to Tom Myers:

First, I'd like to thank Thomas Myer for his extremely informative article in the April issue of IDEA Fitness Journal.  My colleages and I at Rio Sport and Health in Gaithersburg, MD have been very interested in "fascial fitness".  We are confused with information and training techniques that we recently learned at the IDEA personal Training conference and hoped you might be able to shed some light on the subject or suggest some further reading. 

Here's the issue...Some of us attended Sue Hitzman's Melt Method Training.  She made it very clear that body work of any sort that causes discomfort (like foam rolling the IT band) is detrimental to the neurofascial system.  Her products and techniques are gentle and soft, and as I have been practicing the few techniques she shared at the conference, these techniques are very effective.  Others on our personal training team took Cassidy Phillip's Trigger Point class.  These techniques, though also seemingly very effective, are terribly painful, even more so than the standard foam rolling techniques.  Given that we still know so little about this newly emphasized fascial system, should we be concerned about damaging the tissue as Sue promotes or do we need to dig in to get this facsial tissue to behave.  I saw that Thomas is a trained Rolfer and I understand that technique to be painful as well.  Any guidance you could give us regarding this conflicting information would be very much appreciated.  and P.S. I will be asking for your book Anatomy Trains for my birthday! 

Jennifer

Tom's Reply:

You raise some interesting and as yet unresolved points.  Everybody has a point-of-view, and almost all of them are valid in differing situations. 

Trigger Point therapy is traditionally quite painful, but involves the fascia less and is more directed at specific neuro-muscular junctions that have isolated themselves to tighten specific muscle areas at high efficiency / low energy cost.  Getting to them and getting them hydrated and relaxed involves significant pain in my experience, but is effective is ridding the body of that holding and the pain in the trigger point - at least temporarily.  How permanent such treatment is - i.e. whether the trigger points will simply re-establish themselves given the same posture and habits - is open to question.  I've seen both responses.

Building fascial elasticity and other elements of 'fascial fitness' can be (and should be) done without pain.  For fascial therapeutic work, I am in general agreement with Sue that slow and soft and melty is better.  'No pain, no gain' is an outdated concept, and rolling up and down the ITB, so commonly seen in gyms, is demonstrably an exercise in uselessness.  However, effective fascial therapy can still involve the perception of pain.

You can do three activities usefully in the fascia, IMHO:  (These are a little separate from all the things you can do with a muscle - stretch, strengthen, the trigger point stuff, active stretch, anaerobic training, etc.)  1) wake up the proprioception in 'dead' areas, 2) plastically change the length of a fascial sheet or string, and 3) create shear between adhered fascial laminae. 

Any of these three can involve pain or no pain.  Waking up an area that has been held still for so long is not inherently painful, but the reason the area has been held still for so long can involve either physical or emotional pain, which must be 'felt' in order to leave.  To lengthen short fascia, some 'sweet discomfort' similar to the practice of yoga is frequently felt, whether self-induced as in deep stretch, or therapist induced such as rolfing and its cousins.  Getting separation between adherent fascial sheets can likewise involve burning, or can be accomplished pain-free if one goes very slowly and carefully.  Generally, the body tightens into the perception of pain, so relaxing and opening is easier with softer sensations.

I think the main difference is between the imposition of pain and the exposure of pain.  I was too strong a therapist in the early days after my training with Ida Rolf, and I think I was (slap my wrist) imposting pain on my clients in my attempts to eradicate it.  I no longer have any interest in imposing pain, and too much pain is being imposed in gyms, over rollers, and by hand in the name of fascial release.  However, many (most) people are carrying around pain, felt as pain or as simple fatigue and inability and limitation, and this pain can be eased out of the body, at a rate agreed upon by the client's inner sense and tissue response. 

Too often a battle between the will and the body (a spiritual materialism so common in yoga, dance, and fitness training) results in self- or therapist-imposed pain.  Working with oneself or through another's hands with connection can still result in 'sensation-ful' therapy, but the perception is not that of pain entering the body, but of pain leaving.  This pain I will tolerate, both as client and practitioner, for the freedom and relief that follow it.

"Pain is sensation accompanied by the motor intention to withdraw" said Ida Rolf, probably quoting someone else.  I watch carefully in my clients for that 'motor intention to withdraw', often expressed first in the corner of the eyes.

All that said, in traumatized areas much pain remains in the body, and sometimes this pain must be re-experienced on the way out.  In summary, I feel that Sue's injunction is generally a good one, and a good counter-balance to the tendency for many fitness folks to overdo it.  But ridding the body of various levels of pain - from misuse, abuse, disuse, and overuse, from physical to emotional to psychological to spiritual, is a complex issue.  The goal is to create the conditions for fascial remodeling and thus new pathways of movement.  Let's do as much of this as possible without pain, reserving those moments of useful pain for the highly traumatized areas that cannot, in my practice, seem to be cleared without a re-experience of the stored and as yet unprocessed 'pain'.

My reply:

First, this should totally not be kept to just us. I'm going to see if I can also post this to my facebook and will certainly blog. But seeing that someone is actually talking about me and MELT, I thought I would chime in. First, in my lecture at IDEA I did NOT say that "body work of any sort that causes discomfort (like foam rolling the IT band) is detrimental to the neurofascial system" though I appreciate how people interpret my message. The message I try to convey is, if you go too deep too fast and aimlessly roll back and forth over your body like you are ironing a shirt, the more important, superficial layers of connective tissue, with a massive volume of sensory nerve endings that we should be curious about, does not react in a way that gains benefits to reducing inflammation and chronic pain.

I've had more bodywork from different practitioners and different methods than really anyone I know. In an attempt to find great practitioners, I've had some amazing work and have been mauled by some, left bruised, swollen, and... in more pain than I walked into their office with. That being said, Rolfing and deep tissue techniques are quite amazing and beneficial - even though they often times induce a sense of pain. With a great practitioner like Tom or many of my colleagues with years of practice and skill, there is knowledge about what structures the pressure is aimed at, a clear intention, and again, although painful in certain areas, the deep pressure is necessary to regain blood flow to the muscles and allow chronic contracture in the tissue to let up.

I even appreciate Trigger Point and Cassidy Philips method and don't hold any negative voice to his deep pressure methods. His goal is also to restore blood flow to muscles or what's now the buzz word in fitness - myofascial and the myofascial layers.

I am a light touch bodyworker and have been practicing with a lighter touch for 12 years. Although in my earlier years, I practiced Neuromuscular Techniques and heavy pressured modalities, (which I still practice today) when I was in chronic pain not caused by muscle imbalance, (it was caused by connective tissue inflammation), none of the traditional heavy pressured techniques help me get out of pain.

My own pain was a catalyst to learning what causes CHRONIC PAIN symptoms and how to get out of it. In searching for that answer, my obsession went far beyond the myofasical models that are only  in recent years being discussed in fitness - the best of which is Tom's Myofascial Lines. It's been a great help for me when explaining complex concepts like Tensegrity, Whole-body communication, and why the single muscle theory is not aiding in functional longevity. I have great respect and love for Tom's contributions to both the hands-on therapeutic world and the fitness world now buzzing over his teaching.

My years of persistent study and practice has given me an in depth understanding of the full connective tissue matrix. Gil Hedley's body of work and methods of dissection has allowed me to trust my touch and knowing. It's only recently that curious researchers are more able to quantify and measure the behavior of connective tissue which are shattering the traditional school of thought that connective tissue is just a packing material. 

From the superficial fascial layers to the deepest layers around the bones and organs, my method, MELT and my hands on practice have a primary focus that is different from Trigger Point and traditional deep pressured techniques: Quiet the stress reflex in the nervous system and rehydrate the connective tissue matrix to restore the body's natural healing mechanism for the sole purpose of eliminating chronic pain. Although I use a roller, we do very little rolling. People who don't know what MELT is or have never fully experienced it just assume it's another "Myofascial Release Technique." It is not a myofascial release techinque. It is a technique that restores the natural balance back to a body by directly effecting what we call the Autopilot. The Autopilot is the neurofascial system - the system responsible for regulating natural balance and stability. As Tom said, our knowledge and respect for what this system does for us and how it plays a role in our emotional, physical, chemical, and mental balance is vast and under explored by science. Although new research is budding, there is a great deal for us to learn.

I have found that once a body's natural healing "door" is open, it offers an opportunity for all of the deep pressured techniques to work their magic... If you MELT first and then get Rolfed, I have to say, Rolfing sessions last a whole lot longer and actually hurt a whole lot less.

So Jennifer, I hope what you gain out of this thread both from Tom and I is, we are fascia-nated with connective tissue. I assure you, these concepts are not conflicting rather just hold different intent and technique. If I may speak on behalf of Tom and I when I say, it is our hope that with a fascial community growing strong, more science will arise to validate may therapeutic interventions and ultimately allow us to help people perpetuate an active, healthy, pain-free life longer.

Although a long winded reply, I hope my additions aid in your learning.

Any comments? Feel free to let us know!