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A fundamental critique of the fascial distortion model and its application in clinical practice


Tags: fascia, controversy, debunkery, etiology, pro, massage, manual therapy, treatment

Two articles on PainSci cite Thalhamer 2017: (1) Complete Guide to Low Back Pain(2) Does Fascia Matter?

PainSci notes on Thalhamer 2017:

This is an critical analysis of fascial therapy that hits all the obvious skeptical talking points on the topic. but the most important is that professional excitement about fascial therapy and how it works is all premature because there is still no evidence that it has any effect on fascia whatsoever, beneficial or otherwise. “A literature review found no clinical trials or basic research studies to support the empirical foundations of the FDM contentions.“

Unfortunately, I don’t think this paper is rhetorically effective, even though I agree with it. It is too obviously just a formally stated opinion that fascial therapy is bullshit based solely on speculation with many obvious flaws. It doesn’t offer much information that most skeptics aren’t already well aware of, and it is unlikely to persuade anyone else.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

INTRODUCTION: The therapeutic techniques used in the fascial distortion model (FDM) have become increasingly popular among manual therapists and physical therapists. The reasons for this trend remain to be empirically explored. Therefore this paper pursues two goals: first, to investigate the historical and theoretical background of FDM, and second, to discuss seven problems associated with the theory and practice of FDM.

MATERIALS AND METHODS: The objectives of this paper are based on a review of the literature. The research mainly focuses on clinical proofs of concept for FDM treatment techniques in musculoskeletal medicine.

RESULTS: FDM as a treatment method was founded and developed in the early 1990s by Stephen Typaldos. It is based on the concept that all musculoskeletal complaints can be traced back to three-dimensional deformations or distortions of the fasciae. The concept is that these distortions can be undone through direct application of certain manual techniques. A literature review found no clinical trials or basic research studies to support the empirical foundations of the FDM contentions.

DISCUSSION: Based on the absence of proof of concept for FDM treatment techniques along with certain theoretical considerations, seven problems emerge, the most striking of which include (1) diagnostic criteria for FDM, (2) the biological implausibility of the model, (3) the reduction of all such disorders to a single common denominator: the fasciae, (4) the role of FDM research, and (5) potentially harmful consequences related to FDM treatment.

CONCLUSION: The above problems can only be invalidated through high-quality clinical trials. Allegations that clinical experience is sufficient to validate therapeutic results have been abundantly refuted in the literature.

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