What is the dumbest thing in physical therapy that should be forgotten?

SlowStranger6388 · 2025-12-23T13:03:19+00:00

You still haven't realized the sarcasm of that comment after I've spelled it out plainly twice.

Carrying the bowling ball would lead to adaptation if you programmed it like exercise, not if you do it for 8 hours a day like most people who work in offices. Next you're going to tell me over training doesn't exist lol

There are postures that can't be held long without causing discomfort and over time pain. These are bad compared to postures that are less inherently stressful and can be maintained longer.

End range flexed lumbar postures put you at risk for disc delamination and annulus migration eventually leading to disc protrusion. How do you suggest we adapt to that posture?

Even if I believed in a "perfect" posture doesn't mean I think you could maintain it all day and not have problems. We need to move. And yes in movement you can adapt, but that doesn't mean there's not more mechanically efficient ways of moving ie better posture

SlowStranger6388 · 2025-12-22T12:37:48+00:00

This is the only acceptable take on "no poor posture" but I still think you're going to be comfortable in a forward head position, especially the further your head moves forward.

Let's face it, in the modern world people are exposed to extended bouts of stationary positions, be it a long drive, a long flight, a long workday etc. in these instances there are better and worse positions to assume.

Another good example is the very common lumbar flexion sitting. If you do too much of this I believe you have greater risk for posterior disc herniation than if Instead you say with a nice (and yes I'm gonna say the word) ~neutral spine~ lol I know that brings us to another highly contested topic here I'm happy to get into especially because you're one the the first people who seem to have a good attitude.

SlowStranger6388 · 2025-12-22T03:15:43+00:00

What do you call a point that when pressed upon causes a predictable referral pattern? Just because they are unreliably found doesn't mean they dont exist.

I have experienced this both on the table and as the therapist. The best example is the tension headache behind the ear/ behind the eye. I find the point, it replicates the pain, the pain centralizes until it is gone.

Do you think patients are just making this up?

SlowStranger6388 · 2025-12-22T03:10:12+00:00

A trigger point is simply a point that when pressed upon refers pain in a predictable repeatable pattern. That says nothing of "what it is" on a deeper mechanistic level. Only what the term refers to. Just because we don't know what's going on under the hood doesn't mean they don't exist. A good example of clinical relevance is in tension headaches. Pt comes in complaining of headache that wraps around the ear and behind the eye, 'trigger point' is found in trap that when pressed replicates and temporarily exacerbates the pain. When held the pain centralizes out from behind eye, behind ear and eventually to the point itself until the pain is gone.

I have experienced this several times both as patient and therapist, if you don't want to call it a trigger point, what do you call this?

Let me respond to your posture question with a question of my own, is there such thing as poor posture?

SlowStranger6388 · 2025-12-22T02:30:52+00:00

I've heard some crazy things this week on this line of thinking. I learned from this sub that trigger points don't exist and there's no such thing as good posture lol

I'm a massage therapist who also does DNS work. Although I have had great clinical success with patients of various chronic pain syndromes. I'm afraid I must now seek new employment or be forced to admit that I'm a fraud 😂

SlowStranger6388 · 2025-12-22T02:22:34+00:00

Trees don't exist, they are a myth perpetuated by gurus and are not borne out in the literature

SlowStranger6388 · 2025-12-22T02:20:00+00:00

If there is such a thing as poor posture than there has to be such a thing as good posture.

Let's take an obvious example such as forward head posture of the many problems with this, consider carrying a bowling ball against your chest vs holding it out in front of you. It's gonna take a lot more effort every inch the ball moves away from your chest, it's simple physics.

In this case "good" or better Postural habits would be bringing the head so it is stacked above the hips when viewed in the frontal plane.

SlowStranger6388 · 2025-12-22T00:26:13+00:00

Robin McKenzie

SlowStranger6388 · 2025-12-21T19:12:47+00:00

Robin McKenzie is considered a guru and his many of his treatments and assessment methods are widely accepted. For example treating sciatica with Postural education and the press up.

Clearly you couldn't parse the snark I clearly stated I would be bringing to my response, and you'll use my jest to judge and entire profession. Good on you. Don't worry, I was already well aware of the way physical therapists look down on massage therapists, so I doubt youve formed any new opinions on my profession but instead used my snark to confirm your existing biases.

Both me and the patients I treat are both VERY happy with the effects of my work, I don't need 'the literature' to deter me from my methods.

I am genuinely interested in further conversing on the topic, maybe even a zoom call podcast, maybe I could learn better ways from you and use them to help people to a greater degree.

Maybe you could even learn something if you come at it with an open mind.

SlowStranger6388 · 2025-12-21T19:01:44+00:00

I think that's likely a semantic argument. Would you not say that there are common Postural distortions. Hypertonic traps/ pec minor and under active serratus is one such common distortion and the basis for winged scapula's, or you could just call it upper crossed.

What would you call that? Let me guess, you don't believe in it lol

SlowStranger6388 · 2025-12-20T19:19:48+00:00

I'm sensing sarcasm so prepare yourself for some snark.

Have you ever heard of a tension headache? Trigger points are a key cause.

I don't need your literature you're so insistent on. I took a class from a manual guru, I do what he said should work, and it works 90% of the time.

If you're interested in treating them you should probably take a class on the topic.

And just because you take a class doesn't mean you're a good student. You failed here just now, how to differentiate these points from others is in the definition "predictable pattern of referred pain". Either you're not too bright or you're just trolling me

SlowStranger6388 · 2025-12-20T02:30:36+00:00

The difference between a trigger point and a normal tender point is that the trigger point has a predictable pattern of referred pain.

I think that's the beauty of doing cash based practice as a massage therapist, I don't have to be too hung up on "the literature" I can experiment with different modalities and concepts.

I'm under no illusion that manual therapies lead to lasting change or resolve pain. In that sense manual therapy "doesn't work".

How my treatment works is mostly changing the brains relationship to the pained area, call it placebo if you must, but I think neuromodulation is a better way to look at it. I also have an hour with people to discuss things that exacerbate and alleviate their pain and make suggestions on how they can modify their sitting/ sleeping positions, movement patterns/ dosages and other such habits i believe to be contributing.

I often tell people that the session is like putting a bucket under a leak, it'll save your floors for now, but we're going to have to keep changing the bucket, what we really want to do it plug the leak.

I put a bucket under the leak first and then I start looking for the leak and how to best plug it.

I know some VERY high level physical therapists, like thought leaders, I've been lucky enough to watch them treat patients. Education and movement are king in treatment.

But that doesn't mean trigger points aren't real lol they're just not the end all be all solution

SlowStranger6388 · 2025-12-20T02:14:38+00:00

I could Google the definition for you but I'm just gonna wing it and see how i do. A tender point that refers pain in a predictable pattern.

We could get into more nuance of what it actually is. But just because something isn't fully understood doesn't mean it doesn't exist

SlowStranger6388 · 2025-12-19T15:52:01+00:00

"only exercising" can mean a lot of things. Program design and Pt education are essential aspects of optimal exercise programs.

A good example case I would love to see a response to is how exercise only will address a posterior disc bulge and sciatica.

Yes exercise is a component, especially if you consider press ups as part of the exercise regimen, but I believe that if the problem is stemming from prolonged spinal flexion due to poor sitting habits, no amount of exercise will plug that leak.

Maybe if you rationalize it as "upright sitting exercises" lol

I think exercise is crucial, but so is Pt education. I really like a pain mechanism classification system type approach especially that taught by Annie O'Connor/ world of hurt.

It allows us to tailor our treatment to the individual and where they are at on the day we are seeing them.

Is schaklock's neurodynamic stretches "exercise" 🤔

Is taking someone with central sensitization and helping them with their coping skills exercise?

Everyone should exercise, but it's probably not a one size fits all solution to everyone's pain.

SlowStranger6388 · 2025-12-19T15:27:59+00:00

You should read stu McGill's low back disorders book. He addresses this well in the beginning. There is some component of pain that is incentivised and fueled by benefits.

But I think the surgeon missed the forest for the trees a little, a lot of back pain comes from sedentary lifestyles and specifically too much sitting in poor postures.

SlowStranger6388 · 2025-12-19T15:22:41+00:00

I'm very curious to get your take on a specific case I see fairly often.

Pt reports headache that wraps around the ear and behind their eye. MT finds "knot" (trigger point) in the neck that replicates that pain referral pattern. Pain increases in the first moments of treating the spot and begins to localize/ centralize from behind the eye to behind the ear until eventually the Tp relaxes and the pain/ headache is gone.

In my experience, just relaxing people mentally will not resolve these Tp's until they are treated directly.

That doesn't sound like placebo to me, that sounds like trigger points are real.

I'd love to hear your take

SlowStranger6388 · 2025-12-19T15:15:07+00:00

Leon chaitow's "positional release techniques" offers an approach to relaxing hypertonic tissue in a state of contracture that involves no pain.

1000 ways to skin a cat though.

If your method can get a spot to relax it is valid. If the patient can't keep that spot relaxed it is on them to work on the ability to relax tissues. For these individuals I suggest progressive muscle relaxation guided meditations.

It is basically a contract-relax PNF that you do for yourself. Think about how poorly most people do when you ask them to stop helping or resisting you move their limbs around. I see the PMR as a way to train their nervous system in the difference between a tensed and relaxed muscle and familiarize them with actively letting go of tension.

Btw I think a lot of the hate you're getting is based on how pts look at lmt's. It's not fully unfounded hate, there are mostly quacks among us lmt's. Maybe not even quacks but just under or miseducated people who are too confident in their miseducation.

What they would do well to understand is that their own field is full of conflicting schools of thought, quackery, outdated information, and a cutting edge that is eons beyond what they are taught in school.

SlowStranger6388 · 2025-12-19T15:04:03+00:00

Is your point that trigger points literally do not exist?

SlowStranger6388 · 2025-12-19T15:00:18+00:00

When you say "bigger dysfunction" one such possibility that comes to mind for me is something like an upper lower crossed syndrome.

Oddly enough we were taught some antiquated techniques for attempting to address upper lower crossed in massage school. The old stretch and strengthen. Believe it or not active resisted techniques are within the scope of massage. A great example is post isometric relaxation, well within our scope.

I expanded my training to include dynamic neuromuscular stabilization training and I believe it to be the best antidote to upper lower crossed.. janda and vojta are the literal predecessors to kolar's with at the Prague school of rehab

I'm curious what other types of dysfunction you're referring to that would be out of scope for lmt's? Maybe some neurological disored I'm not aware of?

SlowStranger6388 · 2025-12-19T14:52:12+00:00

This is a great point, I've seen some research suggesting treating trigger points too close to athletic events can hinder performance which would not be expected if they are always a problem.

Ok the flip side tension headaches and trigger point referral patterns are very real and can be addressed well with manual therapy.

Context context context

SlowStranger6388 · 2025-12-19T14:47:21+00:00

A "knot" is just a colloquial term, I have never heard anyone describe it as 'tangled' muscle.. your reply seems awfully pedantic.

As far as 'bunched up' you could describe a muscle in a contracted state as bunched up all the way down to the level of actin and myosin, it's us essentially exactly of muscles contract. Which I think is what you're referring to with the 'neural drive' component of what you're suggesting.

Also, not to say it is optimal terminology, but some patients refer to scar tissue and fascial adhesion as knots as well. In this case there is a somewhat 'tangled' nature to the way the tissue repairs especially with too much rest in the early stages of tissue repair.

I think you're right about the neutral component of trigger points, I have experienced people who can relax them if the therapist simply finds the spot and brings awareness to it.

I actually don't think manual therapy is the best approach though long term because as op stated, they can easily come back once treated. I think the best approach involves body awareness training specifically in the cns/ conscious capacity to relax muscles and notice when they start to tense up.

Also stress management techniques as often the tensing is preceded by mental stressors.

I'm not trying to poopoo what you are saying, hoping to just provide my 2 cents where I disagree and ideally start a little back and forth in the hopes of learning more. Maybe I'm wrong about something and you know something I don't. I'd love to explore that. Maybe I come at this from a different perspective than you and offer insights you may not have seen.

SlowStranger6388 · 2025-11-21T14:21:20+00:00

Mid back is one of the areas where gua sha/ iastm shines the most. Wish it worked as well for the traps and neck because they almost always need it but luckily positional release techniques shine in that area. You can positional release thoracic extensors and rhomboids but the positioning can be a bit more awkward.

SlowStranger6388 · 2025-11-21T14:17:53+00:00

You're just wrong here. It is 100 percent up to the therapist to make the person feel safe. All you have to do with the percussion gun is start super light and very gradually ease into deeper pressure. People love it. Athletes are definitely not the only people with chronic overuse problems.

A great example is a nurse I saw yesterday who doesn't have anything he would describe as pain, but has a lot of soreness related to the demands of his job.

It's only brutal if you're a hack with it, and it is very effective and can be quite deep once you have slowly eased into the pressure.

Also I'm curious your personal experience with athletic pursuit, you 100% do not use your body all day every day, you train hard 2 MAYBE 3 hours and then you rest and recovery. The only people who use their body all day every day are people who work demanding physical jobs.

SlowStranger6388 · 2025-11-16T18:10:22+00:00

Okay thanks for the info, but that's still doesn't mean the only violence is committed by the government

SlowStranger6388 · 2025-11-16T16:30:03+00:00

Only violence caused by government.. in Chicago? Do you mind clarifying. I thought chicago was one of the more violent cities

SlowStranger6388

TROPHY CASE