Anatomy Trains

In the aftermath… (uh, sorry, afterglow) of the FRC, here are a few thoughts on the context of the event and the development for the future:

The most publicly heartfelt moment was when Jim Oschman, fascial prophet and energy medicine guru (http://www.energyresearch.bizland.com/index.html), was honored by Tom Findlay and Helene Langevin at the end of the first day. You could feel their bubble and squeaky joy in giving him an honor, and his bark and woof of joy in receiving it. A somewhat odd choice, in that Jim has done no research, and his literature search has sometimes been out in the left field of unsupported speculation. But he has been so right on concerning several major points, and he held the lamp up for research for many, many years when no one else could seem to coalesce around its value – so I am glad my old friend got the honor.

This conference was not as electric as the first conference in 2007, and in some ways not as ‘good’. But it was very much in the directly unfolding line of this fascinating process of investigating fascial properties. It will take a number of conferences over a decade, I should think, to get the balance right, and even then it should be dynamically changing over time.

In the last conference, the gulf between the clinicians and the researchers was mountainous, and though it was clear that we were climbing the same mountain by the end of the conference, it was also clear that it would take some time to meet at the top. Perhaps the most important part of the 2007 conference was simply getting the scientists, many of whom were working on fascia from many different fields and thus did not know of each other, together to see each others’ work.

By this conference, major issues emerged:

• The architecture of fascia: particularly what is made to stick and what is made to slide, and how and why does that happen, and how does one switch to the other in pathology?

• Epi- and intra-muscular fascial force transmission is another big area of exploration that will have practical consequences to assessment and treatment.

• In terms of machinery, ultrasound imaging and computer modeling of fascial forces and remodeling shows great promise.

• The exact role of inflammation in fascial repair – when is it doing good, when does it go too far and over-correct – looks a good avenue for further study.

• And I personally am over the moon about van der Wal’s concept of the ‘dynament’, though I am not sure I can get many of my colleagues to jump so high in its favor – but I plan to champion it in an article or two.

A few suggestions for the next time:

1) One symptom of ‘second conference-itis’ was too much of too little. While clearly every effort was being made to be inclusive of the many professional as well as scientific approaches, the review committee could perhaps be seen this time as being just a little too inclusive, It would be good next time if the short presentations could be a bit fewer but of higher quality research.

2) I suppose it is too much to ask that good scientists also be good presenters, and how would you screen for this anyway? but when we can read the slides that they are bent into the mike repeating word for word in a monotone of heavily accented English, perhaps these folks (and certainly the attendees) are better served by appearing as a poster presentation.

A word to the researchers: You have been given a short time to present your work. We know it’s short; you know in advance it is short. Practice. Leave out those 40 supporting slides, and get us to the conclusion before the last 15 seconds! The number of presenters arriving at this congress, for which we have all paid substantial money, who were confused about Power Point, and who allowed minute descriptions of their lab methods to overtake the presentation of their findings was disappointing.

3) We need discussion. So far the emphasis has been on ‘discussion’ between the scientists and clinicians, so that we find out about what each other do. This discussion is fairly fruitless, with a few exceptions, because of the gulf I mentioned above. There are three areas for discussion that I think would be more fruitful:

• A time at the end of the conference for digestion and synthesis of the conference’s main themes, but in terms of the science and the implications. I imagine questions along the line of: “If I put these findings over here up against that line of research there, does this mean…?”

• I would love to hear a discussion among the scientists as to what constitutes good research and where the holes are. Unarmed with the experienced inner skeptic of a Solomonow, I have instead an ‘inner gull’. Everything presented seems very sound and well-done when I hear it, and I am inclined to believe it, even though I know by now that I cannot take what happens to pig fascia in a petri dish and immediately apply it to my practice.

My common experience in this conference, however, was that in the break following a presentation, I could run across someone who had an equally convincing story of why the research I had just heard was weak, flawed, or simply not what shows up in the experienced practitioner’s common results.

Therefore I could use some critical review of what we have heard – not to ad hominem attacks, but asking the senior scientists to have the courage to correct the younger, and the courage of the younger to be willing to be wrong.

• Finally, it would be good to have some education for the clinicians. If the scientists need to talk to each other, then the clinicians need to learn to listen with a more practiced ear. This is not the time, my dear friends and fellow practitioners, to grandstand for your method. This is not a political movement manning the barricades of the resistance to our arts in the health care system, or a professional convention where touting your wares is more par for the course. This is certainly not the time to hog the bully pulpit. Mr Dommerholt, in the service of your small contribution to the whole, no matter how important you think you are to the healing of the world.

The fundamental ticket to enter this hall – be you researcher of clinician or both – is the willingness to fall, willingness to be wrong in the search for reliable truth. Evidence-based research, even good evidence-based research, even established findings – they all get overturned in the course of time, so the researchers, though understandably wedded to the results they obtained with so much perspiration, must come in open to a better method, turning toward the unexpected by being shown a salient factor they missed, or given an alternative explanation that fits more facts.

My experience was that the scientists are more imbued in that attitude, while (some) clinicians arrived in a more stuck place. Clinicians – be they rolfers, acupuncturists, myofascial release therapists or Bowenites – sometimes present more strongly held views on the rightness of their cause than they have any cause to. The scientists indulged the clinicians touching but naive faith in the ability of their particular method to invariably sort out intractable problems, based on no more than their unavoidably self-interested results in a self-selecting practice and a large body of healing lore’ that we all carry around with us in place of the science we do not yet have.

I am not willing to be so generous with my own group: Practitioners: shut up, sit down, listen, and if you don’t like what you hear, then put up some money or do the sweat work to get some answering research done. Don’t kvetch, and please don’t embarrass us further by kvetching from the place of such extreme ignorance of the special method of sharing that science is.

So I say to my fellow clinicians: Come humbly to the temple of science. No one is questioning that you do good in the world, that your work is worthwhile, that you are part of the solution not the problem. But likewise, however much you know it works, you (we, all of us) know so little about how it works. So these conferences become searches for clues, clues which may lead to established facts that fly in the face of some of our dearly-held beliefs, but will ultimately, I am sure, confirm the healing power of the structured touch we are so enthusiastic about. Coming in with a political agenda, an ego drive, or an unshakable conviction based solely on anecdote only slows the process of discovery, for you and everyone else. A little of the dispassion the Buddha showed would drape well over some of these angry and self-interested shoulders.

“Can you show me why I failed with this patient?” is a much more interesting question than “Can you confirm my prejudice about why I am succeeding with these patients?”

So some guided discussion among the clinicians would result in more precise questions for the researchers, to take some of some of the discrepancies I heard in the corridors and elevators, over a coffee or an outside break. The importance of these moments was mentioned in the last hour by the organizer Peter Huijing, but I believe much more use could be made of this process by bringing it inside toward the end of the conference, and organizing it into more incisive questions for what research would actually serve to answer clinicians’ questions and disputes.

The next conference will be early in 2012 in Vancouver. I plan to be there. There is enough discovery in these events, enough ‘being confused at a higher level’, to make the visit worthwhile, despite the frustrations I feel from both sides.