IFR Testimonials June 2010 London Course

The Course

Very good course, enlightening….definite catalyst for further study

The practical application of the IFR throughout the course & the realization of the importance of light touch & the speed at which release happens.

Practical element, global approach to dysfunction.

Sharing with such an advanced group. Radically different paradigm of treatment.

I feel I”ve gained a real understanding of how applying very little pressure you can get great results with the client. Doing the course has opened my eyes to a whole new area which resonates much more with me than my traditional sports massage. John D.

Very enjoyable course!

Lecturer very enthusiatic, great knowledge, good use of case studies & ””””making it real.””””

Helpful in terms of individuals putting the basics together.

Informal & not too clinical. taking into account responses from the ANS autonomic nervous system.

The course, the content & how Steven was able with his eloquence & simplicity to convey material.  it was both fun & stimulating, challenging and made a lot of sense. Mary C.

The Lecturer

Lecturer very enthusiastic, great knowledge, good use of case studies & ””””making it real.””””

Helpful in terms of individuals putting the basics together.

Very interesting, friendly & accessible. Able to adapt to all levels. Very tuned to class in maintaining concentration & not overloading (unless on purpose!)

Was fantastic! depth of knowledge was extensive, very approachable, passionate about the subject & took me to a new place in learning & understanding.  I am bewildered, unsure & very excited about what I have to learn. Trevor S

Exciting teaching style & delivery!

An ability to mix serious & fun, making a good learning environment. Peter C.

Teaches in an interesting & entertaining way that kept us engaged. Plenty of humor & clarity

Enjoyed watching integration of humor & visual images to explain complicated theories. Observing that “play” with tissues is very individualized & Steven is very accepting of that. Wendy H.

Dynamic, fun, exciting, loves what he does. Gets across the information in a simple understandable way. Peter M

Knowledgable, full of insight, very informative.

Brilliant & friendly…takes time to explain individually as well as the group.

The joy of learning this weekend and was in the ease & flow of how Steven conveyed his information-even the heavy-duty scientific knowledge & background. Mary C.

2011 Schedule-London & Edinburgh in March 2011

New Dates Confirmed for UK!

Bodywork Professional Development of the UK Presents

IFR Foundations Workshop-London, England

March 19-21st, 2011 Saturday to Monday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Fibromyalgia Workshop-Edinburgh, Scotland

March 26-27th, 2011

Venue: Scottish Massage Organization Conference Location TBA

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Intermediate Workshop-London, England

April 1st-3rd, 2011 Friday to Sunday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

NEW! Fascial Articulation Workshop NEW!

Fascial Articulations Concepts & Information

Fascial Articulations will be presented as a AAMT sponsored workshop for  AAMT Sydney-Post National Conference Workshop Monday May 24th, Cairns- Sunday July 25th,  Adelaide- Sunday August 8th & Hobart Sunday September 12th, 2010

A window of alternatives to the prevailing approach

This workshop has come about due to my attempt to present how I currently treat clients in my clinical practice.  As any practitioner can attest, the development of their skill and skill set evolves over time.  This process of learning takes the therapist along many avenues in their attempt to refine how to assess and deliver a consistent and quality outcome of manual therapy care.

The approach and style, the orientation of their understanding, and their passion for particular modalities, all create and embody the uniqueness and manner through which the artistic expression of the therapist shines forth.  My manner and expression has changed over time, and now the hybrid of my understanding allows me to enjoy and find playfulness in pursuit of passion and intuitiveness for soft-tissue dysfunction through the delivery of a variety of applications.

These applications consist of direct and indirect myofascial release, with an emphasis on autonomic expression that manipulates the sensory receptors of soft-tissue. I also learned from my studies and practice, that targeting muscles alone as the source of soft-tissue dysfunction will yield less than satisfactory results. This led me on a journey of investigating the nature of myofascial and from that, I now recognize clinically, as researchers have scientifically, that the myofascia is a dynamic partner in the tonality of the musculature.

What’s more interesting to my clinical experience is that the other main soft-tissue constituents; tendon, ligament and joint capsule, are all main contributors to the dynamic interplay of fibrosis, adhesion, congestion and excess tonality surrounding the musculature.

I tend to treat from a differing perspective. Whereas, most therapists assess and treat muscles at the beginning of a treatment, I employ most of my muscle applications towards the end of a treatment.  I’ll begin with assessment of the cardinal lines of myofascial tension (Myers 2000) and the high leverage points that anchor myofascial within the myofascial net (Schleip 2003).

The three main lines that correspond to main muscular and habitual patterns of motion that we all employ are:  sagittal which mediates flexion/extension, coronal/frontal which mediates abduction/adduction and horizontal/transverse which mediates rotation. Myers named these lines as SBL Superficial Back Line, SFL Superficial Front Line and LL lateral Line. The assessment of three cardinal lines ensure you a more global relaxation in the fascial tension and restoration of increase mobility corresponds along these lines.

Once I have assessed myofascial tension, I assess joint ROM from a fascial perspective. You may ask how can one assess from a myofascial perspective for ROM?  Essentially the distinct difference is not moving into the limit of anatomical integrity, instead the assessment of joint motion is confined to the level of first resistance. That is, where you feel the first tug, snag or glitch to the smoothness and quality of this motion. The reason is this will usually indicate the congestion of the connective tissue in the form of superficial fascia or fibrous connective tissue component as capsular or ligament restriction.

Remember myofascial surrounds each and every muscle group as a unit, muscle fibres and even muscle fascicles have a connective tissue wrapping. Therefore when you feel the first level of resistance you are keying into the first level of myofascial restriction that prohibits smooth joint motion.

I then move the joint through its muscular range but again feel the first level of restriction as it nears end feel.  Again the rationale is autonomic and neurological. When a therapist moves a muscle into its end range, and if restriction is present, the client will feel the pull or strain. When they feel the strain, they cannot help but to unconsciously guard or the very least, respond by flinching.

The guard response is what I’m attempting to avoid. Again if I can avoid any reactive distress by my passive range of motion assessment, I avoid moving the client back into a sympathetic state.  Micheal Shea (1995) is found of stating, and I quote; “all soft-tissue release is predicated on how the autonomic nervous system is discharging its impulses.”

The nervous system discharges, soft-tissue releases. You cannot accomplish soft-tissue change without a compliant nervous system.  That said, of course, if you are strategically deciding to assess ROM and need to employ a special test, say for example an anterior drawer test of the knee joint, you would use excessive force provocatively, as it is necessary to assess if anterior cruciate  ligaments are damaged.  This is referred to as a provocative test.  However, there is always a price to be paid from an autonomic or neurologic standpoint regarding excessive compressive force.  The body will always respond whether the practitioner is aware or unaware of this. You have chosen to over ride the ANS, by re-producing pain to substantiate your assessment or diagnosis. Once pain is provoked, the ability for the soft-tissue to change is diminished.  This is nervous system  Cause and Effect.  The sophistication of the central and autonomic nervous systems is a wonder to behold.

The other forgotten component in changing persistent and stubborn soft-tissue dysfunction is change to joint capsule and ligamentous structures. Although once considered inert and non-contractile structures, they are major contributors to the holding of tensional and tonal states of the muscles.  The sooner you understand that all the soft-tissue is in dynamic interplay, the better it is for you regarding your clinical outcomes.

Once assessment is complete, I initiate technique with the ANS autonomic nervous system in mind, to ‘settle the system’ by use of the gentle ‘Two Point’, this facilitates the ANS to enter into a parasympathetic state, with the lowering of high sympathetic tone (Shea 1995). The Two Point is applied either to transverse planes or the major peripheral joints, i.e. knee, ankle, shoulder, elbow or wrist.

This then leads me to address the quality and quantity of range regarding any involved joint by utilizing indirect technique approaches that are osteopathic in nature.  Among them is joint play, that is, combining accessory motion (anterior/posterior, lateral translation, distraction or rotational movements of approximated positions (close pack)), with crowding or approximation to the joint mechanoreceptors that facilitate a neurologic response of relaxation.

The other assessment component employed is the use of the assessment of ease or bind motion of the crowded joint by assessing the three planes of distortion within an ease or bind position.  This in osteopathic parlance is called stacking. Stacking is the engagement of two or more planes of distortion simultaneously to re-organize and transform congested soft-tissue.  It is a highly effective approach for changing proprioceptive mechanoreceptors in the joint capsule and surrounding ligamentous structures.

I address the musculature & joint restrictions by utilizing low load resistive (modified MET’s). This is directionally based rather than muscle specific. My intent is to target joint capsule, fibrous connective tissue responds well to low load resistives, thus joint capsule & ligaments respond to this type of technique.  Upon conclusion of all the above, I then address musculature. Clearly there are very appropriate times to address and release muscular hypertonicity straight way. My point is that when muscles are not responding or releasing, then you need to change your strategy and orientation.

FASCIAL PLANES OF DISTORTION

When palpating to distinguish the direction of a myofascial distortion, it is recommended that the therapist palpate the surface of the skin to determine the plane(s) of restriction. This method was first noted in osteopathic literature and is commonly held throughout all manual therapy disciplines.

The osteopathic concepts of ‘ease’ and ‘bind’ are assessed in two ways: either the direction of the restriction or barrier is palpated or the direction of the motion barrier or restriction is assess by PROM passive range of motion as a motion restriction. Ease is always away from the barrier or the greatest degree of movement. Bind is the barrier or where movement has the greatest degree of restriction

HOW TO LOCATE SUPERFICIAL FASCIA

Palpate the skin with your palm or fingertips in a manner that forms to the shape of the skin over the area you are palpating.  Do not tense your hand or forearm and your shoulders should be relaxed as you perform this assessment.

Next engage through the skin by increasing the depth of your pressure to the first layer of muscle, then back off. You should be between skin and muscle.  This is the space where superficial fascia resides. Palpation is to the first level or layer of restriction.

The skin should be assessed for its mobility.  Place your hands flat upon the surface of their skin and move the skin in all directions.  Ideally, the skin should move equally in all directions, except around tendinous insertions into osseous structures.  If it does not move well in a particular direction, this will indicate the underlying fascia is restricted.

If the skin does move in one particular plane of movement, say in a cephalic or sagittal direction, a myofascial technique can be applied in the direction of the restriction.

Skin adhesion is an indication of the ease or bind of the superficial fascia below it. You can easily assess fascial restriction by moving the skin over superficial fascial tissue. Assess the four cardinal directions by moving the skin proximal/distal medial/lateral or inferior/superior

DIRECT & INDIRECT TECHNIQUE: CONCEPTS OF EASE & BIND

The direction(s) the skin moves easily is called ‘ease’. The direction(s) that the skin resists moving is called ‘bind’. This is the method to assess planes of fascial distortion.

You engage bind by using a static compression of the skin into the superficial fascia and you will release the current assessed bind and create both a new ease and bind position.   If the skin moves easily in the area you are assessing, then you are probably able to use techniques that are more muscular oriented.  If however, the skin does not move easily, then in a general sense you are dealing with myofascial that needs to be released before you can achieve desired results from your muscular approaches.
This simple assessment can be utilized to assess superficial back and front line restrictions or lateral line restrictions. (Myers 2000) “Manual therapy comprises direct & indirect techniques.  Direct techniques load or bind tissue and structure. The tissue is moved towards a barrier on one or more planes.  The direction of displacement of the soft-tissue is in the least mobile, most restricted & most limited direction. Techniques are performed at or just before the barrier. The result is a change of the position of the barrier which will move closer to what would be the end of a more normal range of motion. For example, a direct approach might be employed to treat elbow flexion contracture with shortened and contracted biceps that limits elbow extension, a direct technique would be to move the elbow into extension. At the barrier, or just before the barrier at the interbarrier zone, a technique is performed with the result an increase in range of extension motion.

Indirect techniques unload or ease the tissue or structure.  The tissue is moved away from the barrier on one or more planes. The direction of movement of the tissue is the most mobile, least restricted, least limited direction. The distortion is thereby exacerbated.  The problem is exaggerated. For example, with limited extension, there is relatively too much flexion. The problem could be described as excessive flexion. The treatment would be towards flexion.  The result is a ‘release’ phenomenon: the soft-tissues “let go” of tension in a tissue tension release.” (Giammatteo & Kain, Integrative Manual Therapy 2005 Vol.4, p70 North Atlantic Books)

MYOFASCIAL SLEEVE RESTRICTIONS

Myofascia behaves as a superficial wrapping as seen from Serge Paoletti’s anterior fascia of the low extremity.
Which brings me to assessment & palpation of fascial sleeves. Most practitioners are used to assessing rotation of the humerus or femur which determines movement at the shoulder or hip.
Another assessment that can be included is assessment of restriction of upper or lower extremity fascial sleeves. This is assessment is crucial to improving motion at the joint and for allowing the smoother movement of the muscle through its fascial sheath.

When addressing the scapular complex (GH joint, AC joint, SC joint & scapula-thoracic joints, humeral ulnar, radial ulnar, radial carpal), sleeve restrictions often will be the first restriction to release.  Since myofascial loves to be encased through fascial ‘grasps’, this simple static compressive technique can clear fascial tissue quite quickly.

• Assess which direction of rotational restriction is ease and which direction is bind.
• Engage myofascial by using a grasp and apply the twist in the direction of ease to unload the tissue, or bind to load the tissue.
• Usually the engagement of the superficial myofascial wrapping is enough to create a myofascial glide, usually within 10-30 seconds. However if this isn’t successful, then here are some points to consider:
• From a palpation standpoint you are pressing too hard
• You will need to engage a second plane of fascial distortion, which is to put a direction or vector on the myofascial by creating a ‘lateral shear’. Osteopaths call this ‘stacking’
• You may ask the client to use slight movement as you engage the myofascial, usually in a rotational direction.
• Micheal Stansborough and other direct myofascial release authors call this Active Movement Participation AMP.
• You will find once you’ve cleared a rotational distortion or restriction you will increase ROM at the joint and the clarity of the restriction will become more focal.
• Myofascial restrictions & distortions will obscure the ability to distinctly palpate the muscular structure beneath it.

Costings and Policies

As of January 1st, 2010, the local Australian price structure for IFR Foundations, Levels or Advanced classes in Australian Dollars are as follows:

Costing Structure

IFR Foundations 3 Day	$575 Melbourne	$625 Interstate
IFR Intermediate 3 Day	$575 Melbourne	$625 Interstate
IFR Advanced 3 Day	$575 Melbourne	$625 Interstate
IFR Intensive 4 Day	$725 Melbourne	$795 Interstate
IFR Levels One thru Four 2 Day Workshop Fibromyalgia Workshop with DVD	$425 Melbourne $425 Melbourne	$450 Interstate $475 Interstate
IFR Introductory One Day Workshop	$225 Melbourne	$270 Interstate

Discounts are available based on a guaranteed size of group, student or association affiliation.

This would be negotiated with Steven and the organizers.

In Melbourne

USA Prices differ than Australian prices.

Please Contact Steven for details

2010-2011 Schedule

NHP Canada National Conference

Presentation at the 21st NHP Canada National Conference
October 25th, 2009
Saskatoon, Saskatchewan, Canada

http://nhpcanada.org/pages/home/default.aspx

Clinical Approaches for the Manual Therapists

Sunday September 20th, 2009
One Day Workshop
Fibromyalgia: Clinical Approaches for the Manual Therapists

http://www.comphs.ca/