How many sessions of myofascial release do I need?

This is the best image I could find that represents my feelings when asked this question. My frustration is not with the client asking a very reasonable question. My frustration lies with the healthcare system. Here’s why.

Background

Insurance companies ask us (healthcare providers but I’m speaking about therapists specifically) to be soothsayers. Healthcare providers are expected to make accurate predictions about the healing trajectory of the diagnosis in front of us. Anyone who has seen an occupational therapist, physical therapist, or similar in a traditional healthcare setting is used to hearing about their “plan of care.” The document must be filled out by the therapist and signed by the overseeing physician. In that document, we must predict the number of visits needed, which is written in the frequency and duration of visits. Example: the elbow pain requires 3 visits per week x 4 weeks. By the way, in healthcare, you are mostly referred to by your diagnosis, not your name.

Standard Definitions: Patient vs. Client

Traditional healthcare refers to the consumer as a patient. You are also expected to be a patient patient and play a passive role in your care. We wait patiently for our provider to come to our room and tell us what to do. Have you ever tried to start telling your story and you get cut off? I’m sure you have. In traditional care, there is no time for stories. The story is important. That’s where the clues to healing are.

Below are definitions found on the internet for “patient” and “client.”

• Patient: a person receiving or registered to receive medical treatment
• Client: a person who engages the professional advice or services of another

At Mayer Fascia Wellness, we refer to you as a client. We want you there to engage with us. We drop some knowledge on you (as a recent client described it) and do what we do best. Then we decide together what’s next. The passive role we have traditionally taken in Western medicine has trained us to turn over all the decision-making to the provider.

You are a Person, Not a Diagnosis

Western medicine is reductionistic. This is not a new thought, but here is what it means in this context. You are a complex person with a complex history. Now, let’s say you have back pain. Traditional healthcare has decided how many physical therapy visits BACK PAIN should need to heal and what should happen next if that doesn’t go well. An injection or surgery, perhaps? But how many sessions do YOU need to heal?

Let’s look at three scenarios.

Client Jack has back pain. He is in his late 50s and has driven a delivery truck for most of his adult life. He took up CrossFit recently and has lost 20 pounds. He feels stronger and healthier than he has in a long time but is frustrated with the low-back pain that lingers no matter what he does.

Client Tammy has back pain. She’s in her 50s and has been the office manager for a large plumbing company for 30 years, which requires a lot of desk time. The low back pain has been creeping up on her for years.

Client Orin has back pain. He’s in his 50s and has been in car sales for a few decades. He was recently in an accident where he was rear-ended.

The Reductionistic Approach

All three clients above have back pain. All three will likely be treated similarly in a traditional setting. Jack, Tammy, and Orin will head to the doctor and be prescribed pain meds and rest first. If that doesn’t work, then the doctor will suggest trying some physical therapy. Their insurance company will likely give them each the same number of visits and expect them to get better within those visits. If they don’t, they go back to the doctor and are told they have failed physical therapy, so they must consider an injection or surgery. They are sent off to a specialist who gives them their options.

A Holistic Approach

In a holistic approach, we don’t put the diagnosis aside completely; instead, we look at the person first. A holistic practitioner wants to understand more about the person and their life. This helps to create a more individualized approach to care.

A Fascia-Focused Holistic Approach

A fascia-informed practitioner also layers in the knowledge of fascia. The research is abundant, but unless you are actively looking for it, as a traditional healthcare provider, you aren’t going to easily come across it.

As a fascia-informed practitioner, here is what I also need to know about each client to help you decide how many sessions of myofascial release you may need.

• Past surgeries or accidents such as falls, MVA, broken bones, cesarean section, etc.
• Major illnesses such as cancer, MS, diabetes, heart disease, seizure disorders, etc.
• Incidents such as stroke, brain injury, etc.
• Mental and Emotional Health and history of trauma.

Even incidents that happened as a child can play a role in the current back pain experienced by Jack, Tammy, and Orin. Tension can stay in the fascia for years, depending on how the person has lived their life.

We also want to look at the wellness practices of each client. Positive habits accelerate healing, while not-so-great habits can make healing an uphill battle.

• Posture habits. Posture has a profound influence on the health of the fascia.
• Water intake and general nutrition habits. Healthy habits reduce the presence of inflammation and support the healing process.
• Exercise habits. A mix of linear and nonlinear full-body exercises supports a balance of healthy fascial tension.
• Leisure choices. Leisure choices can influence tension in the body just as work posture may.
• Stress levels and how they are managed. Chronic stress can prevent healing.
• Tension-holding patterns if known. Many people hold tension in their bodies without recognizing their habits.
• Sleep quality. It is important to understand if the current problem affects the ability to sleep. Quality sleep supports the ability to heal.
• Diaphragmic breathing check. Mouth vs. nose breathing check. Good breathing practices are foundational to good health and healing.

We ask our clients about their perception of their own health and how they see themselves relative to peers in their age group. This speaks to mindset. A positive mindset about themselves affects their potential to heal.

We look deeply at posture and mobility. A client with poor posture habits and decreased mobility should expect a longer healing trajectory. Poor posture habits and decreased mobility create tension in the fascia. If these are not part of the healing plan, expect progress to be slow or non-existent.

You are Complex, Healing is Complex

How many sessions of myofascial release do I need? Hopefully, you understand now why this is such a tricky question to answer.

I had a client march into my office a few years ago. It was his 4th or 5th visit. He demanded to know what his goals and plan of care were exactly. He used those words even though he was not a healthcare professional. Clearly, he was well-experienced in the patient role. He was frustrated that I wasn’t making him better quickly enough. He wasn’t sure this (myofascial release therapy) was working for him. We had made a dent in his persistent pain, but it was not big enough for him. I took him through what you just read above in this blog. I also hold him that since he was unwilling to make changes in his wellness practices or posture, he was creating a very uphill battle for us. He simply didn’t see the relationship of those things to his pain. He stuck with it for a while longer, and we made progress, but he eventually dropped off my schedule, and I haven’t seen him since. I hope he’s doing well.

In traditional care, I was expected to create a plan for each patient and stick with that plan during the duration of their time coming to therapy. Now, each session is a new plan. When a client walks in the door, I ask two questions while looking at their body and feeling their energy (read as state of mind or mood). I ask How are you feeling? and What is your priority? We get started, and we go from there.

Sometimes, things go really well, and people walk out of my office feeling amazing after one or two visits, but most often, it takes longer. None of us are perfect with our wellness practices and posture. These changes take time.

Change is hard, and healing is not linear.

Life continually puts tension into our bodies. We are not living in nature which is where our bodies are designed to function best. So, we must continually chase out the tension our modern lives create.

As therapists, we do our best. We get into these professions because we truly do want to help people, not to swindle anyone into spending more money on their care by talking them into more treatment sessions. If we wanted to make more money, we would have gone to medical school or another much better paying career trajectory. We want to help and hope you will take our advice and also help yourself. That will save you money and time in the long run.

Final Thoughts

Here are the final thoughts I would like everyone to reflect on.

• Pain sucks. We all end up with it at some point and need help.
• Sometimes, the pain is very specific, and myofascial work can chase it out pretty quickly. More often, it is not, and healing will take time.
• You have a huge role in your healing. Our habits often hinder healing (think posture, movement, attitude, stress, and wellness). Be willing to change. Even small changes are helpful.
• If you don’t understand why a practitioner asks you to change something, ask. We try to explain why something is important very clearly and practically. We want it to make sense. If it doesn’t explain in a way you understand, say so.
• Be patient with yourself and your practitioner. You are both likely doing the best you can.
• Prevention is important. Many clients come regularly once the original problem is under control. Regular sessions keep flare-ups at a minimum.
• Find a practitioner that listens to your story. The often the clues to the root cause are hiding there.

If you want to be a client and not a patient, come see us. We’d love to work with you. My best recommendation is to come for at least three visits, collaborate with us, do your homework and see how you feel. If you can feel changes in your body, you are on the right track. You’ll know if you want to continue.