Myofascial Pain Conference Pittsburgh 2010 – Day 1

One of the funny things about this conference was how many Chiropractors and how few massage therapists there were in attendance. This was very different from Boston 2007 where LMTs seemingly out-numbered other therapists. Rolfing also barely got a mention, but trigger points were a constant topic and of all the presenters Jay Shah, MD, trigger point researcher extraordinaire from the NIH, Bethesda, was the man most inundated at the end of his presentation. More on this in the next blog.

As an aside, it was especially nice for me to catch up with colleagues in the myofascial trigger point therapist community. We had myself and Erika Bourne from Myopain Seminars, Bethesda, Mary Biancalana and Julie Zuleger from the Chicago Myopain group and Jeff Lutz and Richard Finn from the Pittsburg School of Pain Management.

Each day began with 3 one-hour lectures and ended with 2 two-hour practical demonstrations. This was a great balance. Well done Dr Schneider, DC, who introduced himself on-stage as ‘Doctor Michael Schneider’ and then said that he was pleased to announce that the name badges purposely didn’t have people’s qualifications. LOL.

Day one started with cuddly Leon Chaitow and his usual rambling and shambling and entertaining thoughts on soft tissue manipulations and myofascial dysfunction. Leon is a man who never lets a square inch of power point screen space go unwasted. This time the information crammed into each slide described the attributes of  HVLA (thrusting is a favourite of the DCs), trigger point stuff like ischemic compression and pressure release, positional release like strain/counterstrain, stretch techniques like MET and a personal favourite of mine Ruddy’s pulsed MET, plus the more deep and meaningful connective tissue manipulation (CTM) and fascial manipulation. All seem to work he said, although I think his main point was that he would prefer to use all of them instead of the HVLA thruststhat the DCs use.

The next delivery was from a restrained Tom Findlay, MD, a great friend of the massage profession. Tom has an encyclopaedic memory and a gift for simplification that (luckily for us) helps connect we arty LMTs to the rest of the medical professions. The way he summarized the previous two FRCs, made me think that I must have been asleep throughout much of them, both in Boston in 2007 and Amsterdam in 2009. (See my separate jottings on these.) Funny how each of us has a different memory of the same event.

Suffice to say that one of Dr Findlay’s points was that if you want to start the healing processes you’ve got to get the myofibroblasts enlisted. These connective tissue cells were only discovered in the 1970’s making them the new kids on the block. They are involved in wound healing, tissue fibrosis and pathological fascial contractures. Their differentiation (switching) from stem fibroblasts is controlled by mechanical tension, cytokines, and specific proteins from the ECM. Educated fascial manipulation and stretching gets them to front up in a positive way.

Rounding out the pre-lunchtime gigs was Terry Loghmani, a PT with a presentation on the Graston technique. This instrument assisted fascial stimulation involves abrading the skin with really expensive steel, aluminium (sic), acrylic or polymer tools, that all seem to have been made in Indiana. I kid you not. Alternatively, you could also use a 70¢ Chinese soup spoon, as found in 360NMT clinic rooms.

The afternoon practical sessions comprised four presenters, each presenting their preferred modality, all at the same time. Your choices were Aaron Mattes on Active Isolated Stretch (AIS), Leon Chaitow on Positional Release Technique (PRT) or Muscle Energy Technique (MET), Tom Hyde on Functional and Kinetic Treatment with Rehab, Provocation and Motion (FAKTR-PM) (Oh please, this acronym will never catch on) or Graston technique, and lastly Julie Ann Day giving us Fascial Manipulation© all the way from Italy via Australia. (Funny how you can copyright the words fascial manipulation?). She was my ‘pick-of-the-day’ (get it?) and I hope to study more with her next year when Jan Dommerholt plans to bring her interpretation of the Stecco family work over to the USA. I say this while admitting to a conflict of interest, as a fellow antipodean.

Rather than describe each of these techniques above (I did them all accept Graston, mostly because I can’t afford their equipment – I’ll carry on using my soup spoon) let me tell you that most of the presenters have the utmost belief that all you’ll ever need to cure everything from pain to watery scrambled eggs is their technique. The exception to this is Mr Chaitow. He is the epitome of informed consent. He tells you that his technique is good (but not great), and that you should play around with it regardless. As editor of the wonderful JBMT of course he has to be equivocal, but that is to our advantage.

More on this in the next blog – the best is yet to be poorly described by me.

Kia ora,