September 2, 2023 • 30 mins
Gua Sha is soft tissue manipulation but all not all soft tissue manipulation is Gua Sha.
There is a difference and here's what it is.
https://richardhazel.podia.com
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Episode Transcript
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(00:01):
Welcome to the Acupuncture Outsider podcast.
My name is Richard Hazel and in the time it takes for you to commute to or from work,
I hope to have shared something of interest about orthopedic acupuncture using motor points,
trigger points,
(00:23):
myofascial slings,
neuro functional acupuncture segmental treatments.
Anything that crosses my mind that seems to be of interest.
I hope you'll enjoy it.
Hello and welcome to another episode of the Acupuncture Outsider.
(00:45):
This is Richard Hazel and today we are going to talk about the difference between and iastm or instrument assisted soft tissue manipulation.
Um I may just call it soft tissue manipulation.
Uh just so I don't have to say iastm over and over.
(01:10):
Um But you know,
there one's a larger subset of or one's a larger group and then there's a subset I would say that um all is soft tissue manipulation but not all soft tissue manipulation is.
(01:32):
So,
let's talk about the differences.
Um The first,
my first exposure to Guha was in um acupuncture school and I,
I took a weekend seminar with two well known uh sports um acupuncturist.
(01:53):
And um I learned there uh a little bit like a more aggressive Guha than we were taught in our school.
Um,
education.
Um One of the,
one of the instructors wanted us to understand that when he does an aggressive treatment with Guha,
(02:19):
the intent is to basically reinjure the area that did not heal properly the first time.
So if you have a sports injury and you have residual issues,
like,
I guess adhesions or,
you know,
the muscles just um,
(02:40):
aren't firing,
right?
Um Still causing you pain.
The goal with an aggressive Guha treatment is to basically injure the area so that your body will recognize that it didn't do a good job the first time and will come back and hopefully heal it properly.
(03:04):
So that treatment was really interesting and,
and he had an athlete in,
I think,
who was,
I think he was like a squash player or something like that.
But anyway,
he had some neck trap leder sort of issue going on.
Maybe it was even Ron Boyd's,
I'm I don't,
it,
it's,
it's m many years ago.
(03:26):
Um but he told the guy and he,
and he was gonna use um he used,
I don't know what kind of emollient.
Um It was probably uh a Chinese herbal um emollient um because part of the uh education that weekend was about different herbal tinctures and Linas,
(03:50):
et cetera,
so soaks things like that.
So,
um so he told him um you know,
sit on the table,
he had his shirt off he said,
I want you to see what I'm using.
I'm using this uh soup spoon.
It,
if you're familiar with the Chinese soup spoon,
that's porcelain.
(04:12):
It looks a bit like a ladle.
It has a,
an,
a very smooth edge.
It's not like a metal spoon.
It's porcelain.
He said,
I want you to see what I'm using because you're gonna think it's a knife scraping you and it's not,
it is a soup spoon.
So he really dug it from the oxy,
(04:34):
put down the back of his neck,
maybe partially to the sides of his neck,
you know,
probably where the trapeze is all attach and then into the upper traps,
middle back,
probably the rhomboid areas if I remember correctly.
And then he was,
the guy was given instruction,
you know,
no drinking tonight and take these,
(04:56):
this uh um or uh it was a pill and um and so the,
and the guy came the next day and,
and reported that yes,
he was terribly sore.
Um But he felt better.
So the aggressive treatment um he was able to tolerate and probably did him some good.
(05:23):
Now,
I don't use that in my treatments because I feel well,
I know that I can accomplish what I'm trying to accomplish with the use of motor points or motor point,
acupuncture and dry needling those two things,
(05:48):
in my opinion can resolve most uh musculoskeletal issues.
Um I'm not talking about uh scars or uh you know,
uh surgical adhesions.
But the,
you know,
most muscular skeletal issues that you're going to see in your clinic can,
(06:08):
in my opinion,
and my experience be resolved by treating the muscles.
Uh first,
the motor points to release the entire muscle and restore elasticity and contractivity and,
and excitability.
And then if there's uh if there are taught bands in the muscle that are still causing pain and dysfunction,
(06:29):
then you dry needle and really in,
in almost all cases,
uh when it's just musculoskeletal that will resolve your issue.
Um So I don't use,
now,
I do use soft tissue manipulation.
So that's a different thing because when I do soft tissue manipulation with a metal scraping tool,
(06:57):
you know,
it's,
it's not,
um it's not a soup spoon,
but I believe that I could use a soup spoon to achieve what I achieve with the metal tools.
Um I,
I got mine from um the rock tape company.
It's like a rock blade.
Um But I'm not endorsing anything.
(07:18):
You can get a decent stainless steel or surgical steel tool online on Amazon.
Just search for soft tissue manipulation or iastm tools.
Um You could,
you could choose to pay hundreds or maybe even thousands of dollars for soft tissue tools,
(07:41):
but I don't,
I don't see any huge benefit in paying four or $500 for a tool that,
you know,
will not work any better because you paid more for it.
Um the benefit is gonna be in your ability to use it and to use it in the right places.
(08:08):
So you really,
if you're,
you know,
especially if you're new,
just pick something up for 20 bucks,
30 bucks a metal steel,
stainless steel that you can sanitize.
You know?
Of course,
you,
you,
you have to always consider that we all have bacteria on our skin.
So we want to sanitize our tools.
(08:29):
Um But,
you know,
you just need,
you just need a tool that,
that will work.
It's a,
it's another argument against plastic tools.
I really think steel is easier to keep clean.
So,
um so I have a nice uh rock blade tool that I use and I use a CBD cream um that I love and it's got,
(08:51):
it's all CBD and there's no menthol in camp four.
It is mostly shea butter,
um some cotton,
no,
not cotton,
um coconut oil and CBD,
but you can use whatever you want and it can have mental or care for.
I just personally am not a fan.
And if you get a good CBD or,
(09:14):
you know,
if you're in Australia,
a hemp product that's anti-inflammatory and it's got a nice base of shea butter or coconut oil.
It's a great emollient and most people will tolerate it well,
and have no skin irritation at all.
Um Not everybody can tolerate menthol or um camp four.
(09:38):
And um you know,
you combine a cream with menthol or cam four with any kind of heat and the person's gonna have a lot of skin irritation.
So I keep,
I,
I keep it really simple.
But um when I'm doing soft tissue manipulation,
it's on FASA and tendons.
And the intent is not to try to do anything directly to the muscles.
(10:05):
As I said,
I,
you know,
I treat the muscles with uh trigger point release and uh motor point release.
But you can,
you can achieve some really amazing things by treating fascia and tendons.
So,
one of my favorite things with soft tissue mani manipulation is the uh the thoraco lumbar fascia,
(10:33):
which is hugely proprioceptive.
It's huge part of si joint stabilization.
It's where the lats and the glutes connect the QL.
There's different layers,
you know,
the,
the QL is attached to it,
the erects,
the uh lats,
um just so many of the core stabilizers,
(10:56):
the,
the uh abs,
all,
all of these things that,
that helps stabilize the core are attached to the thorac lumbar fascia and the fat that fas is hugely important because it's so strong and it helps us to create inter abdominal pressure for core stabilization.
But it's also uh proprioceptive.
It's,
it's giving our core or,
(11:21):
you know,
the stabilizers of the si joint,
for instance,
a lot of uh proprioceptive feedback so that our,
our subconscious motor control can make instantaneous adjustments in how much we use our muscles to stabilize.
(11:41):
So the so the thre lumbar fas,
as you probably already know when we have pain,
it can get very,
very tight and on,
on people with uh spinal stenosis.
Um you will find a,
a firmness in the thoraco lumbar fas that that can be a little bit shocking.
(12:07):
Um And I love to do soft tissue man uh manipulation on the low back for people with uh stenosis and different uh disc issues that would create pain and inflammation and,
and and in incredibly tight thorac lumbar fascia.
So I will use soft tissue manipulation there.
(12:30):
Um uh You know,
I do demonstrate some of that stuff in,
in courses and maybe I should do some demo videos of just that.
So you can see how it's done but,
but really,
I can probably explain it to you.
Um You put your emollient on the low back and you use your scraping tool and you go gently over the whole Thao lumbar FASA area and what you're feeling for is anything that does not feel smooth when there are adhesions.
(13:09):
And,
and uh yeah,
I mean,
really when when things are stuck,
um you're gonna feel a very bumpy sort of feel under your tool and you're gonna want to dig in and really go at it to try to free that up.
And I'm telling you that the FASA research,
(13:33):
um if you look at Robert Schlep's uh work with uh FASA research,
um you'll see that you don't want to dig in because then you're stimulating different sensory um mechanisms.
Really,
the light touch,
uh pressure vibration,
(13:55):
um mechanical receptors are the ones that we're trying to stimulate.
So we stay really light and that is going to have an effect on the autonomic nervous system which will then relax the fascia because they found uh again,
look at Robert Schlep's uh research.
(14:17):
They found that the fascia has smooth muscle cells very similar to the way the body controls vaso dilation.
The the autonomic nervous system can relax or tighten FASA.
So if you're stuck with short,
you know,
like tight uh FASA,
(14:40):
even if you've treated muscles that you think are gonna free up the low back,
a person may still have a very tight,
low back and it very likely is the fascia.
So you're gonna go really lightly over that thre lumbar fascia area into the sarum area along the spinal erects into the QL gently uh using your tool.
(15:06):
And it's very relaxing for the patient because of the autonomic effect you're having,
you're putting them into a more parasympathetic state.
So they really feel great.
It's a great end to a treatment and you really only have to do this for a few minutes,
three minutes,
five minutes,
you know,
(15:26):
when to stop,
when you can tell that that crunchy bumpy sort of feel under your tool has now smoothed out.
Um And the person if,
if they're capable,
you can have them bend over and touch their toes.
And they're always amazed at how much more flexible they are when the low back has been released like that.
(15:51):
Um You can,
you can use the same technique.
The other,
the other thing that I love,
love,
love is to use it on um hamstring,
insertion hamstring,
uh like up,
up at the uh tuberosity area and into where the actor Magnus is and then also behind the knees,
(16:17):
right above that um Pope FASA area.
The the best result is gonna come from working the tendons,
not the belly of the muscle.
So you go really lightly over tendons and you get,
and it releases tension and you get such good flexibility.
(16:41):
After working in these areas,
it's high pro reception areas that get you the best bang for your buck.
Um work on the hip flexor right around right below the A SI S in the front.
So you're going into the Sartorius and the recti femurs area,
(17:03):
the TFL um you can even go a little further down into more of the adu territory but that whole area right under the A SI S is full of fas that when you do some soft tissue manipulation,
(17:23):
you,
if you do a test before and after of hip extension lay,
lay your patient flat uh on their stomach.
So and then,
and then test their hip extension either with a straight leg,
you could have them lift their straight,
their leg keep it straight,
lift it back,
see how far back they can go.
(17:44):
Um,
you'll have some patients where they can barely get the,
the leg off the table and you work on that area under the A SI S and,
and you will be amazed,
well,
they will be amazed too at how much better their hip extension is when you do something like that.
So it's a good prep for somebody like who's a runner who uh you want to help their speed.
(18:09):
Um working in something like in that A SI S area is awesome.
You really help improve their stride.
So,
so you combine that with freeing up tight muscles and then you do soft tissue manipulation and you get great great results.
(18:30):
The other time I like to use soft tissue manipulation is on tennis,
elbow and golfer elbow.
Um If you treated uh tennis elbow or golfer elbow with motor points,
you become aware of how the muscles are all layers.
There are multiple layers.
(18:51):
If you're going deeper than you think,
then you may be getting finger flexor instead of the palmeri longus,
et cetera.
So,
um so what happens with an injury and especially overuse injury that's creating really tight finger flexes and extensors is the muscles don't pass over each other as well.
(19:11):
We have um Hyaluronic acid that,
that,
that's in the fascia that lubricates because our,
when our body moves,
the,
the muscles need to move smoothly and not irritate nerves and vessels.
We have fas that,
that protects the nerves,
(19:33):
the,
the arteries and veins and that allows our muscles to glide over each other.
And when there's an injury,
a lot of that can get kind of stuck and things aren't gliding.
Well,
so sometimes what you'll see is you've treated muscles and you didn't see the patient get the flexibility that you were hoping you were gonna see.
(20:00):
And it might just be that their fascia is sort of stuck.
So you've freed up the muscle,
you made the muscle more elastic.
But if it can't pass over it,
the neighboring muscles,
then it still acts like it's stuck or short.
So I like to use some soft tissue manipulation for tennis,
(20:25):
elbow and golfer's elbow to get that added level of flexibility that's gonna help take tension off the joint and tendons to improve the,
the uh elbow pain.
And um I,
I highly recommend you try that.
Um You can do some really good,
(20:46):
nice FASA work on the plantar surface of the foot as well.
Um So,
you know,
if you're thinking about a plant or fasciitis or foot pain and you think there's some stuck fas and come on,
like most of us as we age,
everything's stuck.
So you can get some really good,
(21:09):
good release uh working on the plantar surface of the foot.
Some people might be a little ticklish,
but um you'll find a way you can find a way to make it um less ticklish like by touching next to where your tool is,
it can help desensitize um that,
(21:29):
that ticklishness.
But um you know,
working on planter fas is great.
You know,
we,
we're trying to restore proprioception and that's one of the 1st 1st areas of proprioception that we lose with age is the,
is the feat.
So working on the plantar surface of the foot can be awesome.
(21:52):
Um And you gotta do it gently.
Uh what Robert Schlep's research showed was that going too heavy on soft tissue manipulation and creating pettier was actually doing the opposite of what the goal was,
which was to,
to relax the fas when you're,
(22:13):
when you're stimulating to the level of creating peti,
you're actually,
you're actually introducing a noxious um stimulate and that,
that will stimulate the pain sensors,
the that the discomfort will make the area want to tighten up.
(22:36):
So we don't want to create pet a,
we don't want to create too much uh pink in the skin because then we're probably pushing a little too hard.
It should be so light and that it feels good and it should,
you'll know you're doing it right.
If you're doubting that what you're doing could possibly work.
(23:00):
It's,
it's a,
it's a weird paradox.
You're,
you're running your tool just with the weight of the tool over the area and you're thinking this is so useless.
There's no way this is helping.
Um And you do that for 3 to 5 minutes and you're really trying to get to where you don't feel that vibration of,
(23:20):
of stuck FASA and you start feeling smooth uh underneath your tool.
You know,
you've accomplished what you were trying to do and the proof is in having the patient actually move that limb and see and feel for themselves.
The improvement and,
and it's often quite significant.
(23:43):
Um So that is soft tissue manipulation.
That is not,
is the,
is the,
that's what you're doing with Guha.
You want the pink and you want the red and you want the stripes.
Um because you're,
you're trying to work on the muscles,
you're trying to break up tight muscles and,
(24:06):
and make the area re uh heal itself.
Um So there's,
there very likely is a role for Guha for people who especially people who don't do much with motor points and trigger points.
Guha can probably be a really helpful uh addition to the treatment you um I think it was C Chan Gunn who hypothesized that um that acupuncture that was not orthopedic could still be helpful because it would create um some breaking of capillaries and the blood that was um escaping to touch the muscles was,
(24:59):
was similar to like a prolotherapy,
you know,
where,
where the the exposure of tissue to the blood and the stem cells could help to reheal the area.
So the hypothesis is that when you're breaking up the little vessels like that,
you're causing an exposure of blood on the muscle in the area that needs healing.
(25:26):
It's sort of like the,
the poor man's version of prolotherapy.
I guess it's,
uh you know,
you don't need a doctor to expose the area to blood.
So if you're breaking up those capillaries,
perhaps there's a stem cell sort of healing that you would get from something like prolotherapy.
(25:48):
Um So there probably is a,
an argument to be made that there that in there is a time and place for the more aggressive uh treatment.
Um I personally just don't feel the need to do it because I feel like I,
like I said,
I can,
(26:08):
I can free up the muscles and top bands with dry needling and then I can use uh the,
the soft tissue manipulation when necessary to get better,
even better flexibility and better mobility of the muscles,
the muscles passing over each other.
Uh the muscles not hitting nerves,
the muscles,
not irritating nerves uh causing edema.
(26:33):
So,
um that's just,
you know,
that's just me and my interpretation of how things need to work and,
and what I feel gets the best result.
Um Because when,
you know,
when people ask me,
do you do copping or do you,
my answer is,
is,
is,
(26:53):
is most of the time.
No,
I do not.
Um But that is not the same as me saying they're not effective or that they're,
they're not useful.
Um,
I just think that what I'm doing is more effective.
So,
you know,
and,
(27:13):
and if you do cupping in,
you know,
how much work it is,
there's a lot of clean up too.
So,
um,
for efficiency,
time management.
And because I think what I'm already doing,
if I'm already getting someone to 100% pain free,
do I really need to add another modality?
(27:34):
No,
in my opinion,
I don't need it.
Um However,
if you do like to do it and your patients love it,
then I'm all for it,
I think,
you know,
we should always do what we love and we should do.
You know,
and you,
(27:54):
you want to do what your patients love and if you have patients who love cupping,
then then and you're already doing cupping,
then keep doing cupping.
I'm all about it.
Um But my explanation was more an answer to someone from our uh mentoring a pod group who had asked me about the differences.
(28:17):
And so I wanted to explain my take on the difference between and the way I do soft tissue manipulation.
And,
and just to be clear,
there are plenty of people who do soft tissue manipulation and do it aggressively enough to be considered.
(28:43):
Some,
you know,
there are plenty,
plenty of people doing soft tissue manipulation for pet A for the red Streep streaks and the and you know,
digging in really hard aggressively.
I would I would bet most of the people who do that if they were trained and licensed to do acupuncture in the motor points and could do dry needling would cease doing aggressive soft tissue manipulation because they would have a much more comfortable and much more effective,
(29:24):
fast way to get the get to the goal that they're trying to achieve with soft tissue manipulation,
with aggressive soft tissue manipulation.
So,
ok,
I've talked enough.
Um But that's uh that's my take on the difference between and working with the FAA to release the FASA.
(29:50):
All right,
have a great week and I will talk to you soon.
Welcome to the Acupuncture Outsider podcast.
My name is Richard Hazel and in the time it takes for you to commute to or from work,
I hope to have shared something of interest about orthopedic acupuncture using motor points,
trigger points,
(00:23):
myofascial slings,
neuro functional acupuncture segmental treatments.
Anything that crosses my mind that seems to be of interest.
I hope you'll enjoy it.
Hello and welcome to another episode of the Acupuncture Outsider.
(00:45):
This is Richard Hazel and today we are going to talk about the difference between and iastm or instrument assisted soft tissue manipulation.
Um I may just call it soft tissue manipulation.
Uh just so I don't have to say iastm over and over.
(01:10):
Um But you know,
there one's a larger subset of or one's a larger group and then there's a subset I would say that um all is soft tissue manipulation but not all soft tissue manipulation is.
(01:32):
So,
let's talk about the differences.
Um The first,
my first exposure to Guha was in um acupuncture school and I,
I took a weekend seminar with two well known uh sports um acupuncturist.
(01:53):
And um I learned there uh a little bit like a more aggressive Guha than we were taught in our school.
Um,
education.
Um One of the,
one of the instructors wanted us to understand that when he does an aggressive treatment with Guha,
(02:19):
the intent is to basically reinjure the area that did not heal properly the first time.
So if you have a sports injury and you have residual issues,
like,
I guess adhesions or,
you know,
the muscles just um,
(02:40):
aren't firing,
right?
Um Still causing you pain.
The goal with an aggressive Guha treatment is to basically injure the area so that your body will recognize that it didn't do a good job the first time and will come back and hopefully heal it properly.
(03:04):
So that treatment was really interesting and,
and he had an athlete in,
I think,
who was,
I think he was like a squash player or something like that.
But anyway,
he had some neck trap leder sort of issue going on.
Maybe it was even Ron Boyd's,
I'm I don't,
it,
it's,
it's m many years ago.
(03:26):
Um but he told the guy and he,
and he was gonna use um he used,
I don't know what kind of emollient.
Um It was probably uh a Chinese herbal um emollient um because part of the uh education that weekend was about different herbal tinctures and Linas,
(03:50):
et cetera,
so soaks things like that.
So,
um so he told him um you know,
sit on the table,
he had his shirt off he said,
I want you to see what I'm using.
I'm using this uh soup spoon.
It,
if you're familiar with the Chinese soup spoon,
that's porcelain.
(04:12):
It looks a bit like a ladle.
It has a,
an,
a very smooth edge.
It's not like a metal spoon.
It's porcelain.
He said,
I want you to see what I'm using because you're gonna think it's a knife scraping you and it's not,
it is a soup spoon.
So he really dug it from the oxy,
(04:34):
put down the back of his neck,
maybe partially to the sides of his neck,
you know,
probably where the trapeze is all attach and then into the upper traps,
middle back,
probably the rhomboid areas if I remember correctly.
And then he was,
the guy was given instruction,
you know,
no drinking tonight and take these,
(04:56):
this uh um or uh it was a pill and um and so the,
and the guy came the next day and,
and reported that yes,
he was terribly sore.
Um But he felt better.
So the aggressive treatment um he was able to tolerate and probably did him some good.
(05:23):
Now,
I don't use that in my treatments because I feel well,
I know that I can accomplish what I'm trying to accomplish with the use of motor points or motor point,
acupuncture and dry needling those two things,
(05:48):
in my opinion can resolve most uh musculoskeletal issues.
Um I'm not talking about uh scars or uh you know,
uh surgical adhesions.
But the,
you know,
most muscular skeletal issues that you're going to see in your clinic can,
(06:08):
in my opinion,
and my experience be resolved by treating the muscles.
Uh first,
the motor points to release the entire muscle and restore elasticity and contractivity and,
and excitability.
And then if there's uh if there are taught bands in the muscle that are still causing pain and dysfunction,
(06:29):
then you dry needle and really in,
in almost all cases,
uh when it's just musculoskeletal that will resolve your issue.
Um So I don't use,
now,
I do use soft tissue manipulation.
So that's a different thing because when I do soft tissue manipulation with a metal scraping tool,
(06:57):
you know,
it's,
it's not,
um it's not a soup spoon,
but I believe that I could use a soup spoon to achieve what I achieve with the metal tools.
Um I,
I got mine from um the rock tape company.
It's like a rock blade.
Um But I'm not endorsing anything.
(07:18):
You can get a decent stainless steel or surgical steel tool online on Amazon.
Just search for soft tissue manipulation or iastm tools.
Um You could,
you could choose to pay hundreds or maybe even thousands of dollars for soft tissue tools,
(07:41):
but I don't,
I don't see any huge benefit in paying four or $500 for a tool that,
you know,
will not work any better because you paid more for it.
Um the benefit is gonna be in your ability to use it and to use it in the right places.
(08:08):
So you really,
if you're,
you know,
especially if you're new,
just pick something up for 20 bucks,
30 bucks a metal steel,
stainless steel that you can sanitize.
You know?
Of course,
you,
you,
you have to always consider that we all have bacteria on our skin.
So we want to sanitize our tools.
(08:29):
Um But,
you know,
you just need,
you just need a tool that,
that will work.
It's a,
it's another argument against plastic tools.
I really think steel is easier to keep clean.
So,
um so I have a nice uh rock blade tool that I use and I use a CBD cream um that I love and it's got,
(08:51):
it's all CBD and there's no menthol in camp four.
It is mostly shea butter,
um some cotton,
no,
not cotton,
um coconut oil and CBD,
but you can use whatever you want and it can have mental or care for.
I just personally am not a fan.
And if you get a good CBD or,
(09:14):
you know,
if you're in Australia,
a hemp product that's anti-inflammatory and it's got a nice base of shea butter or coconut oil.
It's a great emollient and most people will tolerate it well,
and have no skin irritation at all.
Um Not everybody can tolerate menthol or um camp four.
(09:38):
And um you know,
you combine a cream with menthol or cam four with any kind of heat and the person's gonna have a lot of skin irritation.
So I keep,
I,
I keep it really simple.
But um when I'm doing soft tissue manipulation,
it's on FASA and tendons.
And the intent is not to try to do anything directly to the muscles.
(10:05):
As I said,
I,
you know,
I treat the muscles with uh trigger point release and uh motor point release.
But you can,
you can achieve some really amazing things by treating fascia and tendons.
So,
one of my favorite things with soft tissue mani manipulation is the uh the thoraco lumbar fascia,
(10:33):
which is hugely proprioceptive.
It's huge part of si joint stabilization.
It's where the lats and the glutes connect the QL.
There's different layers,
you know,
the,
the QL is attached to it,
the erects,
the uh lats,
um just so many of the core stabilizers,
(10:56):
the,
the uh abs,
all,
all of these things that,
that helps stabilize the core are attached to the thorac lumbar fascia and the fat that fas is hugely important because it's so strong and it helps us to create inter abdominal pressure for core stabilization.
But it's also uh proprioceptive.
It's,
it's giving our core or,
(11:21):
you know,
the stabilizers of the si joint,
for instance,
a lot of uh proprioceptive feedback so that our,
our subconscious motor control can make instantaneous adjustments in how much we use our muscles to stabilize.
(11:41):
So the so the thre lumbar fas,
as you probably already know when we have pain,
it can get very,
very tight and on,
on people with uh spinal stenosis.
Um you will find a,
a firmness in the thoraco lumbar fas that that can be a little bit shocking.
(12:07):
Um And I love to do soft tissue man uh manipulation on the low back for people with uh stenosis and different uh disc issues that would create pain and inflammation and,
and and in incredibly tight thorac lumbar fascia.
So I will use soft tissue manipulation there.
(12:30):
Um uh You know,
I do demonstrate some of that stuff in,
in courses and maybe I should do some demo videos of just that.
So you can see how it's done but,
but really,
I can probably explain it to you.
Um You put your emollient on the low back and you use your scraping tool and you go gently over the whole Thao lumbar FASA area and what you're feeling for is anything that does not feel smooth when there are adhesions.
(13:09):
And,
and uh yeah,
I mean,
really when when things are stuck,
um you're gonna feel a very bumpy sort of feel under your tool and you're gonna want to dig in and really go at it to try to free that up.
And I'm telling you that the FASA research,
(13:33):
um if you look at Robert Schlep's uh work with uh FASA research,
um you'll see that you don't want to dig in because then you're stimulating different sensory um mechanisms.
Really,
the light touch,
uh pressure vibration,
(13:55):
um mechanical receptors are the ones that we're trying to stimulate.
So we stay really light and that is going to have an effect on the autonomic nervous system which will then relax the fascia because they found uh again,
look at Robert Schlep's uh research.
(14:17):
They found that the fascia has smooth muscle cells very similar to the way the body controls vaso dilation.
The the autonomic nervous system can relax or tighten FASA.
So if you're stuck with short,
you know,
like tight uh FASA,
(14:40):
even if you've treated muscles that you think are gonna free up the low back,
a person may still have a very tight,
low back and it very likely is the fascia.
So you're gonna go really lightly over that thre lumbar fascia area into the sarum area along the spinal erects into the QL gently uh using your tool.
(15:06):
And it's very relaxing for the patient because of the autonomic effect you're having,
you're putting them into a more parasympathetic state.
So they really feel great.
It's a great end to a treatment and you really only have to do this for a few minutes,
three minutes,
five minutes,
you know,
(15:26):
when to stop,
when you can tell that that crunchy bumpy sort of feel under your tool has now smoothed out.
Um And the person if,
if they're capable,
you can have them bend over and touch their toes.
And they're always amazed at how much more flexible they are when the low back has been released like that.
(15:51):
Um You can,
you can use the same technique.
The other,
the other thing that I love,
love,
love is to use it on um hamstring,
insertion hamstring,
uh like up,
up at the uh tuberosity area and into where the actor Magnus is and then also behind the knees,
(16:17):
right above that um Pope FASA area.
The the best result is gonna come from working the tendons,
not the belly of the muscle.
So you go really lightly over tendons and you get,
and it releases tension and you get such good flexibility.
(16:41):
After working in these areas,
it's high pro reception areas that get you the best bang for your buck.
Um work on the hip flexor right around right below the A SI S in the front.
So you're going into the Sartorius and the recti femurs area,
(17:03):
the TFL um you can even go a little further down into more of the adu territory but that whole area right under the A SI S is full of fas that when you do some soft tissue manipulation,
(17:23):
you,
if you do a test before and after of hip extension lay,
lay your patient flat uh on their stomach.
So and then,
and then test their hip extension either with a straight leg,
you could have them lift their straight,
their leg keep it straight,
lift it back,
see how far back they can go.
(17:44):
Um,
you'll have some patients where they can barely get the,
the leg off the table and you work on that area under the A SI S and,
and you will be amazed,
well,
they will be amazed too at how much better their hip extension is when you do something like that.
So it's a good prep for somebody like who's a runner who uh you want to help their speed.
(18:09):
Um working in something like in that A SI S area is awesome.
You really help improve their stride.
So,
so you combine that with freeing up tight muscles and then you do soft tissue manipulation and you get great great results.
(18:30):
The other time I like to use soft tissue manipulation is on tennis,
elbow and golfer elbow.
Um If you treated uh tennis elbow or golfer elbow with motor points,
you become aware of how the muscles are all layers.
There are multiple layers.
(18:51):
If you're going deeper than you think,
then you may be getting finger flexor instead of the palmeri longus,
et cetera.
So,
um so what happens with an injury and especially overuse injury that's creating really tight finger flexes and extensors is the muscles don't pass over each other as well.
(19:11):
We have um Hyaluronic acid that,
that,
that's in the fascia that lubricates because our,
when our body moves,
the,
the muscles need to move smoothly and not irritate nerves and vessels.
We have fas that,
that protects the nerves,
(19:33):
the,
the arteries and veins and that allows our muscles to glide over each other.
And when there's an injury,
a lot of that can get kind of stuck and things aren't gliding.
Well,
so sometimes what you'll see is you've treated muscles and you didn't see the patient get the flexibility that you were hoping you were gonna see.
(20:00):
And it might just be that their fascia is sort of stuck.
So you've freed up the muscle,
you made the muscle more elastic.
But if it can't pass over it,
the neighboring muscles,
then it still acts like it's stuck or short.
So I like to use some soft tissue manipulation for tennis,
(20:25):
elbow and golfer's elbow to get that added level of flexibility that's gonna help take tension off the joint and tendons to improve the,
the uh elbow pain.
And um I,
I highly recommend you try that.
Um You can do some really good,
(20:46):
nice FASA work on the plantar surface of the foot as well.
Um So,
you know,
if you're thinking about a plant or fasciitis or foot pain and you think there's some stuck fas and come on,
like most of us as we age,
everything's stuck.
So you can get some really good,
(21:09):
good release uh working on the plantar surface of the foot.
Some people might be a little ticklish,
but um you'll find a way you can find a way to make it um less ticklish like by touching next to where your tool is,
it can help desensitize um that,
(21:29):
that ticklishness.
But um you know,
working on planter fas is great.
You know,
we,
we're trying to restore proprioception and that's one of the 1st 1st areas of proprioception that we lose with age is the,
is the feat.
So working on the plantar surface of the foot can be awesome.
(21:52):
Um And you gotta do it gently.
Uh what Robert Schlep's research showed was that going too heavy on soft tissue manipulation and creating pettier was actually doing the opposite of what the goal was,
which was to,
to relax the fas when you're,
(22:13):
when you're stimulating to the level of creating peti,
you're actually,
you're actually introducing a noxious um stimulate and that,
that will stimulate the pain sensors,
the that the discomfort will make the area want to tighten up.
(22:36):
So we don't want to create pet a,
we don't want to create too much uh pink in the skin because then we're probably pushing a little too hard.
It should be so light and that it feels good and it should,
you'll know you're doing it right.
If you're doubting that what you're doing could possibly work.
(23:00):
It's,
it's a,
it's a weird paradox.
You're,
you're running your tool just with the weight of the tool over the area and you're thinking this is so useless.
There's no way this is helping.
Um And you do that for 3 to 5 minutes and you're really trying to get to where you don't feel that vibration of,
(23:20):
of stuck FASA and you start feeling smooth uh underneath your tool.
You know,
you've accomplished what you were trying to do and the proof is in having the patient actually move that limb and see and feel for themselves.
The improvement and,
and it's often quite significant.
(23:43):
Um So that is soft tissue manipulation.
That is not,
is the,
is the,
that's what you're doing with Guha.
You want the pink and you want the red and you want the stripes.
Um because you're,
you're trying to work on the muscles,
you're trying to break up tight muscles and,
(24:06):
and make the area re uh heal itself.
Um So there's,
there very likely is a role for Guha for people who especially people who don't do much with motor points and trigger points.
Guha can probably be a really helpful uh addition to the treatment you um I think it was C Chan Gunn who hypothesized that um that acupuncture that was not orthopedic could still be helpful because it would create um some breaking of capillaries and the blood that was um escaping to touch the muscles was,
(24:59):
was similar to like a prolotherapy,
you know,
where,
where the the exposure of tissue to the blood and the stem cells could help to reheal the area.
So the hypothesis is that when you're breaking up the little vessels like that,
you're causing an exposure of blood on the muscle in the area that needs healing.
(25:26):
It's sort of like the,
the poor man's version of prolotherapy.
I guess it's,
uh you know,
you don't need a doctor to expose the area to blood.
So if you're breaking up those capillaries,
perhaps there's a stem cell sort of healing that you would get from something like prolotherapy.
(25:48):
Um So there probably is a,
an argument to be made that there that in there is a time and place for the more aggressive uh treatment.
Um I personally just don't feel the need to do it because I feel like I,
like I said,
I can,
(26:08):
I can free up the muscles and top bands with dry needling and then I can use uh the,
the soft tissue manipulation when necessary to get better,
even better flexibility and better mobility of the muscles,
the muscles passing over each other.
Uh the muscles not hitting nerves,
the muscles,
not irritating nerves uh causing edema.
(26:33):
So,
um that's just,
you know,
that's just me and my interpretation of how things need to work and,
and what I feel gets the best result.
Um Because when,
you know,
when people ask me,
do you do copping or do you,
my answer is,
is,
is,
(26:53):
is most of the time.
No,
I do not.
Um But that is not the same as me saying they're not effective or that they're,
they're not useful.
Um,
I just think that what I'm doing is more effective.
So,
you know,
and,
(27:13):
and if you do cupping in,
you know,
how much work it is,
there's a lot of clean up too.
So,
um,
for efficiency,
time management.
And because I think what I'm already doing,
if I'm already getting someone to 100% pain free,
do I really need to add another modality?
(27:34):
No,
in my opinion,
I don't need it.
Um However,
if you do like to do it and your patients love it,
then I'm all for it,
I think,
you know,
we should always do what we love and we should do.
You know,
and you,
(27:54):
you want to do what your patients love and if you have patients who love cupping,
then then and you're already doing cupping,
then keep doing cupping.
I'm all about it.
Um But my explanation was more an answer to someone from our uh mentoring a pod group who had asked me about the differences.
(28:17):
And so I wanted to explain my take on the difference between and the way I do soft tissue manipulation.
And,
and just to be clear,
there are plenty of people who do soft tissue manipulation and do it aggressively enough to be considered.
(28:43):
Some,
you know,
there are plenty,
plenty of people doing soft tissue manipulation for pet A for the red Streep streaks and the and you know,
digging in really hard aggressively.
I would I would bet most of the people who do that if they were trained and licensed to do acupuncture in the motor points and could do dry needling would cease doing aggressive soft tissue manipulation because they would have a much more comfortable and much more effective,
(29:24):
fast way to get the get to the goal that they're trying to achieve with soft tissue manipulation,
with aggressive soft tissue manipulation.
So,
ok,
I've talked enough.
Um But that's uh that's my take on the difference between and working with the FAA to release the FASA.
(29:50):
All right,
have a great week and I will talk to you soon.
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