Guiding Principle III: Cross-fibre manipulation

In this article I explain that I have found cross-fibre manipulation to be, by far, the most efficient and effective technique for assessing and treating myofascial dysfunction.

I am a Geelong boy.

I studied Myotherapy back in the mid ’90s, not long after Myotherapy had evolved out of RMIT’s Remedial Massage Diploma. When I came home from the big smoke (Melbourne) to Geelong to practise I was only one of two ‘Myotherapists’ in my hometown. As I commenced seeing patients and getting some good results (to my delight!), I observed that Geelong people often referred to Tom Bowen. Tom Bowen was a Geelong man, a body worker, who got some amazing results. Commencing with volunteer work in local football clubs, Tom eventually became too busy with his body work and left his job at the Geelong Cement Works to treat patients full time.

 

In his heyday Tom Bowen provided about 300 treatments a week or about 13,500 treatments per year.

 

When I started practising in Geelong, Tom had been dead about 25 years. Nonetheless, older patients would often say to me ‘I used to see Tommy Bowen’.

What on Earth was this guy doing?

My rational mind dispelled several of the fables that I had heard from patients. Yet no one ends up seeing 300 people per week, via only word of mouth, if they are not getting something right. As I started to experience the great results that could be derived from Myotherapy manipulation, I became more and more intrigued with stories about Tom. Why couldn’t I be like him?

He performed soft tissue manipulation. So did I.

He treated headaches and back pain. So did I.

He got lasting results in just a handful of treatments. So did I.

But I wasn’t like him….

…his treatments were often only minutes. People would complain that he ‘didn’t do enough’, only to find out the next day that they were ‘cured’?

…he didn’t use oils and do traditional massage techniques.

…he worked through clothing.

His ‘soft tissue work’ looked nothing like the soft tissue massage techniques I had learned at university. What on Earth was this guy doing?

My reasonable mind told me that Tom was not a magician, he was a normal guy. He had great hands and an enquiring mind. His results came from his ‘feel’ and a willingness to experiment until he got results. So my quest became ‘What did he feel?’ and ‘What did he do?’ and I prepared myself to experiment until I got results. I went and trained in a module of ‘Bowen Therapy’ to see what he did because I simply had to know! I also read every skerrick of information I could find about ‘What he felt’, ‘What he said’ and ‘How he worked’.

Bowen Therapy . . .

Now I have not become a Bowen therapist. I do not advertise as one, and I don’t claim to perform the Bowen technique. After all the Bowen technique is bottled and wrapped in trademarks and registrations.

Tom’s technique has been enshrined in a formula. It is taught with slight variations by a number of different organisations today and has become popular worldwide. Despite this, most of the six young men who had the privilege of observing Tom and emulating his technique would argue that Tom did not have a formula. That he did things differently all the time. Again, being a Geelong boy, I have been lucky enough to chat with some of these men directly and observe their version of Tom’s technique.

Cross-fibre manipulation . . .

In my quest to understand how Tom achieved the results he did, I distilled the difference between what I was doing and what he was doing to three ideas.

1. He always performed cross-fibre manipulation.
2. What he felt for was not what I had been taught to feel for.
3. He assessed continually.

I want to mention here the ‘cross-fibre’ idea. As for feel, that is what he felt and what I now feel for, that will be another article.

I had been taught in uni about many massage/soft tissue techniques and generalising I would have to say that most techniques follow the direction of the muscle fibres longitudinally. Effleurages, deep stripping and even myofascial release or Rolfing techniques all follow the logical inclination that to lengthen, release or stretch muscle you should work ‘along the fibres’ in the direction they are going. This is conventional wisdom.

But Tom did not do this.

All of Tom’s moves were cross-fibre moves. Now the only cross-fibre form of manipulation that I had learned was a deep cross-fibre friction kind of manipulation that is supposedly meant to break up adhesions. (This technique lacks scientific evidence of efficacy, but is common nonetheless). But Tom wasn’t doing this either. His manipulation was much more superficial.

Now having a good knowledge of musculoskeletal anatomy I could see that wherever the manipulation was performed it was perpendicular (90 degrees) to the direction of the underlying muscle fibres.

So I started.

Rather than practising the Bowen routine, I applied the cross-fibre concept only. Being a soft tissue therapist with a good understanding of anatomy and biomechanics who was getting results already, I did not need to mimic the Bowen formula. I used my usual processes of assessment and testing to determine the problem areas, but when it came to treating said areas, I started using a cross-fibre technique exclusively.

What does the cross-fibre manipulation look like?

The form of manipulation looks like rolling a muscle under your finger without your fingers sliding on the skin. The technique is most easily demonstrated on long rope-like muscles such as sternocleidomastoid or one of the paraspinal muscles.

An example:

Rest your left forearm, elbow at 90 degrees, in front of you. Place your right thumb on brachioradialis an inch or two from the crease of the elbow. Now lock your thumb onto the skin and roll back and forth over the belly of brachioradialis without your thumb sliding across the skin at all. You should be able to feel most of the three-dimensional shape of brachioradialis roll back and forth under your thumb.

So in other words, this manipulation involves ‘locking’ your thumb or fingers onto the skin and firmly and slowly gliding across the perpendicular fibres of the muscle beneath. In my opinion what you are really ‘affecting’ is the fascia between the skin and the underlying muscle. You are affecting this fascia both via downward pressure and cross-fibre stretch, so to speak. The amazing thing is that stimulating the fascia in this way will release its longitudinal range of movement. So rather than subscribing to conventional logic, that suggests in order to restore length to a muscle we should strip along the fibres, myofascially release in the direction of the fibres or stretch …

…  instead …

… a brief cross-fibre manipulation or series of cross-fibre manipulations somehow stimulates the muscle to ‘release’ and restores the full range of movement to the muscle. Counterintuitive but far more effective.

My observations . . .

As I began to employ this concept in conjunction with my knowledge of anatomy and myofascial referred pain patterns, here is what I found:

• That this type of ‘skin/cross-fibre’ manipulation over the site of a trigger point would release that trigger point more quickly than any other method I had employed. Often in only seconds.
• That as a result of this, treatment was less painful and manipulation was for a shorter period, leaving little or no residual tenderness.
• That range of movement could, in many cases, be tested and retested seconds after manipulation enabling a much quicker ‘treat-assess-treat’ method.
• That treatment through clothing was possible, and often even better, as the clothing and skin become one, and ‘feel’ for the fascia between the skin and muscle is clearer! (It was only after I had concluded that working through a layer of material gave me a better feel for the fascia, that I learned that Tom always worked through a sheet! Cool, perhaps I was on the right track.)

As a Myotherapist you can just begin to imagine how working through clothing, being able to release trigger points in seconds and employing an efficient treat-assess-treat method could revolutionise your craft. Well it did mine.

I will use the next article to discuss what might be going on physiologically that makes this form of manipulation so effective.