Active Myofascial Therapy – An integrated Alternative to Passive Rehabilitation to Promote Physical Recovery

The "INSIDE-OUT" Approach:

The science and anecdotal responses from patients and clients who've received Active Myofascial Therapy-The Diamond Method approach, (AMT), supports our belief that The Diamond Method is dramatically more effective than client-passive modalities of traditional physical therapy, chiropractic treatments, massage therapy and other therapies where the patient passively receives their treatment.

Due to the client/patient being an active partner in their care, and mentally and physically active throughout their therapy session, The Diamond Method  provides long-lasting, fast, comprehensive relief and positive clinical outcomes.

The Diamond Method considers their interactive approach an "INSIDE-OUT" approach where the client's active involvement incorporates their internal engagement of muscles and joint movement, stemming from their brain. During The Diamond Method, the practitioner is applies the treatment WITH the client, so it is a partnership where they co-create the therapeutic experience.

This  "INSIDE-OUT" approach is the exact opposite of the traditional  "OUTSIDE-OUT" approach where the client is a passive recipient, where the practitioner is doing the treatment TO them, not WITH them.

Staying Current:

Although the name, Active Myofascial Therapy, might seem to indicate an adherence to earlier tissue-based explanatory mechanisms that the modern pain science community has moved past, it is instead a link to the history and the style of the work which officially began in 1988 — retaining the name, while replacing the underlying ideas with scientifically plausible theory as the knowledge progressed (1). The retention of the name AMT also provides continuity for clients to base their treatment decisions on, in light of the track record that it has amassed over decades of practice. 

The Diamond Method continues to evolve with scientific knowledge about therapeutic mechanisms and outcomes, incorporating more factors than just a simple tissue-based orientation, and it is consistent with modern anatomy, physiology, pathology, psychology, neuroscience, and pain science (2).

During the Session the Client Partners With the Practitioner:

• The client and practitioner work together to communicate clearly throughout the continuum of care so they are both aware of the expectations and responsibilities of each other as therapy progresses, to reach the determined clinical goal.
•  The client is directed to move in prescribed ways, while the practitioner is applying the manual manipulation and is always in control of their perceived level of comfort/discomfort. The Diamond Method  uses a client-subjective scale of 0-10, where the client should never experience anything they would consider 'painful'. This means the manual pressure applied to their body will always be less than or equal to an 8/10 on their subjective scale. (We believe this level to be the therapeutic, appropriate manually-applied pressure).
•  The client is guided to be aware of and observe any changes they notice throughout receiving the therapy as well as after the therapy session.
• The client will have Home Exercises suggested for development and improvement of strength, flexibility, stability and neurophysiology. (The Diamond Method refers to the corrective exercises as "Actions")
  
  

Demonstrated Effectiveness:

Manual manipulation has repeatedly and reliably demonstrated strong effectiveness in reducing pain and its associated anxiety and depression, both in the short term and in the long term (3-23).

Movement therapy similarly has demonstrated promising results that are consistent with emergent neuroscience findings regarding rehabilitation and recovery, motor learning, brain plasticity, and the effects of self-efficacy and resilience on activities of daily living and quality of life (24-30).

The Diamond Method integrates these therapies in a systemic way, utilizing multiple physical and neurophysiological mechanisms. Drawing upon the strengths of both therapies, The Diamond Method offers clients individualized care and lasting results based on the non-invasive and low-risk methods of skilled manual therapists and interactive exercises, as well as health education to help them maintain their clinical progress.

Interactor Model of Interactivity:

Adding the client-active component of interactive movement therapy, and practicing manual manipulation in a way that is less passive for the client than the way typical manual therapies are generally practiced, means that The Diamond Method  is closer to Jacobs' and Silvernail's more client-centered "interactor" model than to the "operator" model on a passive client, that had been a previous understanding of clinical roles (31, 32).

The interactivity involved in The Diamond Method 's engagement among the client, the intervention, the therapist, and the environment builds upon the strengths of its component modalities by engaging, mirroring, and guiding the client, providing an opportunity for increasing the client's self-efficacy, resiliency, well-being, and feelings of empowerment—lasting changes that maintain outcome improvements outside of the clinic, and crucial reasons that the attest research evidence in neuroscience supports the more active approach.

Social Aspects of Pain:

Additionally, while it is very early to claim firm linkages, the work by Mogil and by Koban (33-41) on the social aspects of pain—how pain is experienced and mediated by the presence of trusted and caring others—holds the promise of eventually providing insight on the effectiveness of the interactive aspect of The Diamond Method , and the therapeutic alliance it creates.

For all these reasons, we believe that The Diamond Method  is strongly consistent with the evidence-based and science-based practice of massage, and other manual and movement-based treatments. 

References
(1) Fritz, W. "Myofascial Release, from a science-informed perspective", http://www.waltfritzseminars.com/blog/ Accessed 12 April 2018.
(2) Melzack R. From the gate to the neuromatrix. Pain 1999;Suppl 6:S121–6.
(3) Schachter S, Singer JE. Cognitive, social, and physiological determinants of emotional state. Psychol Rev. 1962;69:379–399.
(4) Weinrich SP, Weinrich MC. The effect of massage on pain in cancer patients. Appl Nurs Res. 1990;3(4):140–145. doi: 10.1016/
S0897-1897(05)80135-1.
(5) Hsieh CY, Phillips RB, Adams AH, Pope MH. Functional outcomes of low back pain: comparison of four treatment groups in a randomized controlled
trial. J Manipulative Physiol Ther. 1992;15(1):4–9.
(6) Ekman P, Davidson RJ. Voluntary smiling changes regional brain activity. Psychol Sci. 1993;4(5):342–345.
(7) Duclos SE, Laird JD. The deliberate control of emotional experience through control of expressions. Cogn Emot. 2001;15(1):27–56.
(8) Schnall S, Laird JD. Keep smiling: enduring effects of facial expressions and postures on emotional experience and memory. Cogn Emot. 2003;17(5):
787–797.
(9) Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine (Phila PA 1976).
2004;29:2593–602.
(10) Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004 Jan;130(1):3-18.
(11) Mook DG. Classic Experiments in Psychology. Westport, CT: Greenwood Press; 2004. Schachter and Singer: cognition and emotion.
(12) Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a
randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85:1301–17.
(13) Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine (Phila Pa 1976). 2006;31:2541–9.
(14) Beider S, Moyer CA. Randomized controlled trials of pediatric massage: a review. Evid Based Complement Alternat Med. 2007;4(1):23–34.
(15) Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/
American College of Physicians clinical practice guideline. Ann Intern Med 2007;147:492–504.
(16) Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA Cancer J
Clin. 2008;58(4):214–230.
(17) Moyer CA. Affective massage therapy. Int J Ther Massage Bodywork. 2008 Dec 15;1(2):3-5.
(18) Sarafino EP. Health Psychology: Biopsychosocial Interactions. 6th ed. Hoboken, NJ: John Wiley and Sons; 2008.
(19) Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low back pain: an updated systematic review within the framework of the Cochrane Back Review Group. Spine (Phila Pa 1976 ) 2009;34:1669–84.
(20) Jane SW, Wilkie DJ, Gallucci BB, Beaton RD, Huang HY. Effects of a full body massage on pain intensity, anxiety, and physiological relaxation in
Taiwanese patients with metastatic bone pain: a pilot study. J Pain Symptom Manage. 2009 Apr;37(4):754-63.
(21) Bialosky JE, Bishop MD, George SZ, Robinson ME. Placebo response to manual therapy: something out of nothing? J Man Manip Ther. 2011 Feb;19(1): 11-9.
(22) Lindquist MA, Krishnan A, López-Solà M, Jepma M, Woo CW, Koban L, Roy M, Atlas LY, Schmidt L, Chang LJ, Reynolds Losin EA, Eisenbarth H, Ashar YK, Delk E, Wager TD. Group-regularized individual prediction: theory and application to pain. Neuroimage. 2017 Jan 15;145(Pt B):274-287.
(23) Lange G, Leonhart R, Gruber H, Koch SC. The Effect of Active Creation on Psychological Health: A Feasibility Study on (Therapeutic) Mechanisms. Behav Sci (Basel). 2018 Feb 12;8(2).
(24) Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000;30:126–37.
(25) Sterr A. Training-based interventions in motor rehabilitation after stroke: theoretical and clinical considerations. Behav Neurol. 2004;15(3-4):55-63.
(26) Butler AJ, Page SJ. Mental practice with motor imagery: evidence for motor recovery and cortical reorganization after stroke. Arch Phys Med
Rehabil. 2006 Dec;87(12 Suppl 2):S2-11.
(27) Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine (Phila Pa 1976). 2008;33:2371–8.
(28) Cleland JA, Abbott JH, Kidd MO, Stockwell S, Cheney S, Gerrard DF, Flynn TW. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2009;39:573–85.
(29) Roth EJ. Trends in stroke rehabilitation. Eur J Phys Rehabil Med. 2009 Jun; 45(2):247-54.
(30) Tsachor RP, Shafir T. A Somatic Movement Approach to Fostering Emotional Resiliency through Laban Movement Analysis. Front Hum Neurosci. 2017 Sep 7;11:410.
(31) Jacobs DF, Silvernail JL. Therapist as operator or interactor? Moving beyond the technique. J Man Manip Ther 2011;19(2):120–21.
(32) Silvernail J. Manual therapy: process or product? J Man Manip Ther. 2012 May;20(2):109-10.
(33) Langford DJ, Crager SE, Shehzad Z, Smith SB, Sotocinal SG, Levenstadt JS, Chanda ML, Levitin DJ, Mogil JS. Social modulation of pain as evidence for empathy in mice. Science. 2006 Jun 30;312(5782):1967-70.
(34) Langford DJ, Tuttle AH, Brown K, Deschenes S, Fischer DB, Mutso A, Root KC, Sotocinal SG, Stern MA, Mogil JS, Sternberg WF. Social approach to pain in laboratory mice. Soc Neurosci. 2010;5(2):163-70.
(35) Hadjistavropoulos T, Craig KD, Duck S, Cano A, Goubert L, Jackson PL, Mogil JS, Rainville P, Sullivan MJL, Williams ACC, Vervoort T, Fitzgerald TD. A
biopsychosocial formulation of pain communication. Psychol Bull. 2011 Nov; 137(6):910-939.
(36) Langford DJ, Tuttle AH, Briscoe C, Harvey-Lewis C, Baran I, Gleeson P, Fischer DB, Buonora M, Sternberg WF, Mogil JS. Varying perceived social threat modulates pain behavior in male mice. J Pain. 2011 Jan;12(1):125-32.
(37) Martin LJ, Tuttle AH, Mogil JS. The interaction between pain and social behavior in humans and rodents. Curr Top Behav Neurosci. 2014;20:233-50.
(38) Koban L, Wager TD. Beyond conformity: Social influences on pain reports and physiology. Emotion. 2016 Feb;16(1):24-32.
(39) Koban L, Jepma M, Geuter S, Wager TD. What's in a word? How instructions, suggestions, and social information change pain and emotion.
Neurosci Biobehav Rev. 2017 Oct;81(Pt A):29-42.
(40) Koban L, Ramamoorthy A, Konvalinka I. Why do we fall into sync with others? Interpersonal synchronization and the brain's optimization principle.
Soc Neurosci. 2017 Nov 8:1-9.
(41) Koban L, Kusko D, Wager TD. Generalization of learned pain modulation depends on explicit learning. Acta Psychol (Amst). 2018 Mar;184:75-84.