0:00

Welcome , Dr Ruhm . Thank you so much for

0:02

being here . It's actually a really big

0:04

honor to have you on my show because

0:07

myself I've seen so

0:09

much release and

0:11

also benefits from myofacial

0:14

release , so I'd love if you could introduce

0:16

yourself and tell me how you got started

0:18

with myofacial release .

0:20

Yeah , sure , with pleasure . So

0:22

I am a family

0:24

practitioner from South Africa and

0:27

I was working in a full

0:29

service family practice in Parksville

0:31

and I had a locum come in who did trigger

0:34

point in myofascial release and my patient

0:36

started demanding that I learn what

0:39

this doc had learned , and so initially

0:41

I thought this can't be anything because

0:43

it's with saline . But the more

0:45

I delved into it and the more persistent my patients

0:48

got , the more I ended up doing some

0:50

research and then realized no , there's something

0:52

to this , and ended

0:54

up becoming more and more passionate about it because

0:57

of how instantaneous the

1:00

effect is and how much difference

1:02

you can make , which , in medicine , is something

1:04

you don't often see yeah

1:07

, it's incredible .

1:09

I'm seven years into my concussion and

1:12

I noticed when I came in

1:14

for this treatment I wasn't sure what to expect

1:16

and , like today , I

1:18

saw you today actually for treatment because my back had like

1:20

seized up and I walked out of there and

1:22

I was like , oh my god , I actually feel like a full release

1:25

, which is incredible because

1:27

I haven't had that for so many years . So

1:31

can you , can you explain

1:33

what myofascial release is and how it works

1:35

?

1:37

Sure , um it's

1:40

, it's a modality where you're using a needle

1:42

to release tissues . Um it's

1:44

, it's focused on the soft tissue . So

1:46

you are releasing muscles that are too tight

1:48

, scar tissue and

1:51

fascial lines that have also

1:53

tethered and become too tight and are not functioning

1:55

well , and you are

1:57

looking for the areas that are causing

2:00

the restriction and pain and the

2:02

true source . So often , if , for example , a person

2:04

does come in with back pain , often the origin is not and the true source . So often , if , for example , a person does come in with back pain , often

2:07

the origin is not in the back itself

2:09

. It's in muscles that are antagonistic

2:12

to the back muscles and

2:14

to the normal alignment

2:17

of where the back should be . So

2:19

, for example , if a hip flexor is too tight

2:21

on one side , it will kind of twist you down

2:23

, it will bring you forward , which

2:26

will make the back

2:28

start to ache , and so having

2:30

treatment in the back can give temporary relief

2:32

, but most of the time the problem

2:35

is not really coming from there , so you have to

2:37

, or you find then that

2:39

it keeps on coming back .

2:42

Yeah , I was actually quite shocked when I came in to

2:44

get treatment with you because I told

2:46

you about my migraines going on in my forehead

2:48

and then I believe

2:50

you were treating my stomach at the time and

2:52

I was kind of nervous because you're coming at me with

2:54

needles in my stomach and I'm not used to that . But

2:56

I definitely felt the release afterwards

2:59

. So

3:02

yeah sorry if

3:04

somebody is not familiar with what

3:06

fascia sorry , I'm not sure if I'm

3:08

saying it right what fascia is . Can

3:10

you explain a little bit more about what

3:12

that is ?

3:14

Sure . So fascia is like

3:16

the connective tissue that binds

3:18

everything in your body together . If

3:21

you take another example , like an orange , you've got

3:23

the peel and then you've got the segments , and then

3:25

you've got the tiny segments

3:27

inside the segments when you open them , and

3:29

those white bits or

3:32

the pith that would be seen as fascia

3:34

. So around your muscles

3:36

and flowing into the tendons

3:39

and then flowing over the bone and

3:41

then into the next muscle . These fascial

3:43

lines are continuous , so

3:46

it basically puts you in a onesie and

3:48

if it gets distorted somewhere

3:50

then that onesie doesn't move right

3:52

and it doesn't allow other

3:54

areas to move right .

3:57

That's incredible . Yeah , I've

3:59

felt it too with all the different treatments . You know

4:02

you

4:04

, I tell you I have neck pain and then you're treating me

4:06

in a completely different area of my body , and you

4:08

know it's . It kind of made

4:10

me like realize how much we're

4:12

connected very much

4:14

so . I know

4:16

migraines can be a big problem

4:18

as well after concussion . Do you see

4:20

a lot of people come in that have had concussion

4:23

?

4:25

Yeah , it's one of the common things

4:27

that end up having people

4:29

send in , as well as whiplash

4:32

, shoulders , the backs , concussion

4:35

, though there's a number of components

4:37

. There's not only the brain injury but

4:39

there's also the musculature , often

4:41

that got really strained , often

4:43

there's whiplash components to

4:46

it and there's also the core strain . That

4:48

happens because the body's trying to protect

4:50

its vital organs and when the core

4:52

strains then it pulls on these

4:54

fascial lines that go up and over

4:56

the head . They

4:59

go into the neck , into the shoulders

5:01

. So you find often addressing

5:04

these core muscular areas

5:06

will release large

5:08

tracts that go all

5:10

the way up into the head and around the neck and

5:12

so on .

5:14

It's incredible . So many people need this . Honestly

5:16

, we need to speak

5:18

more about this . I'm curious

5:21

too , like how often would someone need to come in for

5:23

treatments if they were to ? You know , never

5:25

try this before , and what is the maintaining

5:27

treatments ?

5:30

So it can vary a lot and I would

5:32

say that there isn't a have to kind

5:34

of protocol that we follow . Generally

5:38

we try and especially if someone is really

5:40

debilitated to try and get them in

5:42

once a week for three weeks that we start

5:44

to really just get them moving and

5:46

and and release to a degree

5:48

that they have some functionality back , and

5:51

then we start shifting the appointments about a month

5:53

apart because in the initial time

5:55

we're asking them please don't do a lot

5:57

, don't overexert

5:59

yourself , don't get the muscles tired

6:02

while they're trying to recover and your body's

6:04

trying to reorganize and

6:06

not to do strengthening . But once

6:09

they've got some functionality and symmetry back

6:11

, then they can start to strengthen again

6:13

. And then we see them about once a month and then try and

6:15

catch what's got snagged along the

6:18

way . Do have patients coming up

6:20

from from quite far

6:22

up island , from Campbell River in Port Alberni

6:24

, and some , some of them can only come in

6:26

once a month and so then we just

6:28

adapt to whatever their

6:30

their ability is to come in

6:32

and there's some clinics on the mainland that

6:35

have different kind of scheduling

6:37

protocols that they follow

6:39

. So it would also just depend on where people are located

6:42

and what the clinics around them can offer .

6:45

Okay , amazing . And I'm

6:47

curious too , because in the beginning

6:49

I actually thought that myofacial

6:51

release was IMS and

6:53

I'm just wondering how it's different from IMS .

6:57

And I'm just wondering how it's different from

6:59

IMS . So

7:05

the way of identifying where to treat is very different from IMS , because we

7:07

use a postural assessment , a specific postural assessment and also movement tests

7:09

that we call base tests , and

7:12

these tests

7:14

are designed to help us identify

7:17

the true source of where things

7:19

are not functioning right , where IMS is

7:21

very often used in an area

7:23

that's painful and

7:25

so for something that's pretty simple

7:28

and the

7:30

origin of the problem is really where

7:33

it's being felt , then IMS will be highly

7:35

effective . But if , for example

7:37

, a shoulder is aching

7:39

because of an

7:44

external oblique muscle , for example , that's pulling

7:46

too tight into the fascial lines that run all

7:48

the way up , then just releasing

7:51

the shoulder or working on the shoulder is not

7:53

going to give them any relief . So this is really

7:55

about trying to identify where the

7:57

true source of pain is coming from

7:59

I .

8:01

You know I actually noticed that too from having ims

8:03

before , as I noticed a new area

8:05

sometimes would almost pop up when I had ims

8:07

. Um , but I felt like there was only

8:10

about 70 percent release when I

8:12

had ims and I always felt

8:14

like there I needed more . So

8:17

I still always had a little bit of lingering

8:19

pain and

8:21

also the migraines wouldn't completely go away

8:23

as well . So

8:28

I'm curious how long has the treatment been

8:30

available for recognized for ?

8:33

Dr Greg Sirin started this

8:36

methodology and he started two

8:38

clinics in 2010 . One was called

8:40

Change Pain in Vancouver and the other one

8:42

was the Mayo Clinic on Taiyi Road in

8:44

Victoria . So this

8:46

treatment has been around since about then

8:48

it started to become a lot more

8:51

formalized in the sense of

8:53

a training program with actual

8:55

modules and workshops

8:59

. So we have four levels of workshops . Each

9:01

of these focus on different body areas

9:03

. So if a physician comes in and wants to

9:05

do training , in the first session they

9:07

would learn about the needling

9:09

technique and how to treat a back and how

9:11

to treat for knee pain , for

9:14

example . And then we move to more risky

9:16

areas and more finicky areas in the

9:19

next levels up of these workshops

9:21

. Now there are multiple

9:23

faculty members in different

9:25

specialities all involved in

9:27

developing the

9:29

learning material and all kind

9:31

of contributing to

9:34

it , but Dr Greg Surin

9:36

was the star or the innovator

9:38

of this methodology .

9:40

Amazing . Do you have to be a doctor

9:42

to practice this , or can you be a chiropractor

9:44

?

9:47

There are some regulations around who is allowed

9:49

to give needles , so we have

9:51

nurse practitioners that

9:53

are doing myoactivation and

9:56

then , obviously , physicians . Some

9:58

of the physiotherapists will use IMS

10:00

needles but use this methodology to identify

10:03

where to treat . We've

10:05

also had some naturopaths wanting

10:07

to learn and having gone

10:09

through the program and

10:11

some

10:14

acupuncturists , but we haven't had any actually

10:16

come through the program .

10:17

We've also had yeah

10:22

, I think I said physiotherapists

10:25

before yeah .

10:31

Amazing . And so what conditions or issues can

10:33

myofascial release therapy help with ? It's so broad it would take a long time to

10:35

actually mention all of it , but really , from head to toe

10:37

, anything that has to do with how

10:39

things move , any

10:42

ache or pain that you have . So the

10:44

reason why I say that is , for example , people were

10:46

coming with a label say now arthritis . Say

10:49

now it's arthritis in the hip , and

10:51

the reason we can help with this is if the musculature

10:54

has gotten tight around that joint , it compacts

10:57

the joint , it accelerates the degeneration

10:59

, it increases the inflammation

11:02

and the pain around the joint . So if

11:04

we release that , there's more space in the joint

11:06

, it moves more freely and there's less pain

11:08

in it , even though we haven't solved

11:11

the the problem of having had

11:13

degeneration in that joint . Problems

11:17

with neck stiffness or whiplash

11:19

very commonly

11:22

are things that we treat shoulders , frozen

11:24

shoulders , sore

11:27

backs , obviously knees , plantar

11:29

fasciitis . Then

11:32

there's things like anxiety

11:34

, which also gets helped , and also

11:36

respiratory issues , and this

11:39

will make some of my colleagues hair rise

11:41

. But anxiety , for

11:43

example , often there's

11:46

two components there's the emotional component

11:48

and then there's also a muscular component

11:50

with muscles tightening up because

11:52

of that anxiety . It's often

11:54

over the top of the sternum

11:57

and on the chest wall and it makes the chest

11:59

compress and then that

12:01

gives a sensation of suffocation which

12:03

adrenalizes people and makes

12:05

them feel even more anxious wow

12:08

, um , yeah , that's

12:11

incredible .

12:11

Yeah , we're . We're also interconnected and

12:14

, you know , sometimes we can get treated like it's

12:16

just one specific area , when it's , you

12:18

know , our whole body as a whole

12:20

.

12:23

The whole system .

12:24

Yeah , yeah , exactly Right , that's

12:28

amazing . I love that you're looking at that too with anxiety

12:30

, cause I actually know a lot of people that have had anxiety

12:33

, so I'm going to tell them about this too

12:35

, cause I didn't realize that . I just noticed

12:37

for me when I came in it was mostly for headaches

12:39

and the whiplash pain which is . It's

12:42

incredible , like I just can't believe how

12:44

much release I have , so I

12:46

love it yeah , no

12:49

, that's awesome .

12:50

I'm so happy that we could have able

12:52

to help you yeah , but I needed you

12:54

, like years ago . That's

12:57

. The other thing is people always feel angry

12:59

when they do get a quick

13:01

release with a simple procedure that's

13:03

not very risky , and then

13:06

they often will say why didn't you do

13:08

something 10 years ago ? But it is a new modality

13:11

, not that many people know about

13:13

it . It's really mainly available

13:15

in BC in the world . So

13:17

we're very privileged to be

13:19

where we are .

13:21

Wow , that's incredible . So I'm living

13:23

in a good place then . Are

13:26

there any specific techniques or methods

13:29

used in myofascial release that you find

13:31

more effective ?

13:33

Is more effective than my activation

13:36

. I

13:39

haven't seen any . I mean you

13:41

pressure release and

13:43

myofascial release . Techniques

13:45

with massage are

13:48

also used and I

13:51

haven't seen that

13:53

it delivers the same kind of release

13:55

, because that spinal reflex doesn't fire

13:58

the same as what you get with the hypodermic

14:00

needle .

14:02

And I agree to everything you've just said , because I've tried

14:04

everything under the moon for

14:06

pain relief , you know . Are

14:09

there any misconceptions about myofascial

14:12

release that you'd like to address ?

14:15

Well , I think this fear is the one

14:17

thing people often come in quite , quite

14:19

scared of how painful is it going to be

14:21

and what are the possible side effects ? And

14:24

most of the time people will

14:26

say after a few treatments you know , this is

14:28

, this is pinchy and it can be painful , but

14:31

it's a few seconds and then the release

14:33

is really a huge relief

14:35

and it's worth that

14:38

, just that minute or

14:40

a few seconds if one can get long-term

14:42

relief , because one's coming in with constant pain

14:44

anyway and not

14:46

being able to sleep but not being able

14:49

to function . So it's a small price to pay

14:51

. From a side effect

14:53

profile it's really very low risk

14:55

. We we use a small gauge needle . There's

14:58

a possibility of a bruise and , like

15:00

any procedure , to feel a bit achy . On

15:07

average , about a 24-hour period one can feel you've had a treatment . Things just

15:09

feel a little bit tender and your body can feel tired because

15:11

you've had a procedure . But

15:14

as far as procedures

15:16

go , this is pretty minimal

15:18

and the body does recover pretty quickly

15:20

.

15:21

That's amazing . Yeah , I've noticed . I've been a little bit sore

15:23

afterwards and just had a hot bath and

15:26

that seems to help and I feel more tired

15:28

, but the

15:30

release is worth every bit

15:33

of tiredness . So

15:35

how does myofascial release differ

15:37

? Also from acupuncture ? How is it

15:39

different ?

15:41

So they are coming from two totally different

15:43

philosophies . Acupuncture is

15:46

an Eastern medicine methodology

15:49

based on energy meridians and energy

15:51

flow . The needles are left

15:53

in and sometimes manipulated

15:56

or tweaked or twisted , and sometimes electricity

15:58

is put on them to get energy

16:01

flow to be restored

16:03

, whereas myofascial release is working

16:05

on anatomic trains and physical

16:08

tension lines , so it's more like a type

16:11

of anatomic engineering . So

16:14

it's much more on the on

16:16

the physical side of what's working

16:18

with what and what's working against what , rather

16:20

than the , the energy system in the body

16:22

. And

16:25

yeah , and myofascial release , or my activation

16:27

, is based on western medicine okay

16:30

, amazing .

16:31

And so how can someone find a qualified practitioner

16:34

?

16:35

oh sure , um , if you go

16:37

onto the anatomicmedicineorg

16:39

website , there isa practitioner

16:41

directory . You just click on the

16:43

little button for the practitioner directory .

16:47

Amazing . Is there any self care techniques

16:49

or exercises that individuals can do

16:51

at home to complement the

16:53

therapy ?

16:55

For sure and we try and spend

16:57

enough time on preparing

16:59

people for this . But after

17:01

having release and having a treatment

17:04

like my , activation to move frequently

17:06

, because if we

17:08

stay in a posture for too long our bodies

17:11

stiffen in that posture and after

17:13

release it tends to stiffen easier

17:15

. So one wants to move enough that

17:17

your body's staying supple , but

17:19

not so much that you tire things out and restrain

17:22

them . There's a fragile

17:26

component to the

17:28

releases that we get and if you then

17:31

fully exert that muscle or fully contract

17:33

it , it can go right back into that contracted

17:35

state . So one has to be careful with

17:38

what you do for a few days after the treatment

17:40

and be mindful you know , if you've

17:42

suddenly got a bunch of gardening to go and do

17:45

, to do one little section

17:47

for 15 minutes and then go and sort

17:49

out some things , be in a different position using

17:51

different muscles and then come back to it so

17:53

that you're alternating muscle groups

17:55

and giving them a rest and not just tiring

17:57

things out . So that does become a priority

18:00

after treatment , to try and keep that release

18:02

and get the body to progress

18:04

on recovery .

18:06

Awesome , and then . So I guess , if

18:08

you're a weight trainer , you want to wait . What

18:11

is it ? 24 , 48 hours or ?

18:14

At least 48 hours and then , when you

18:16

start again , to start at about 30%

18:18

. So to understand that when muscles

18:20

are in the state of constant

18:23

contracture they're

18:25

working all the time , so they get tired

18:27

, but they also are weakened because they

18:29

haven't been working with you . They've

18:32

been stuck , so now you release it

18:34

and those muscles are actually not

18:36

as conditioned as you think they are . So

18:38

one has to then start lower so that you

18:40

get those parts of the

18:42

muscles that have been really stuck and are now

18:45

released to start working with you and build up some

18:47

stamina without restraining them .

18:51

What are some ongoing research that's

18:53

happening on myofascial release ?

18:56

We have quite a bit . Also , if you

18:58

look at the anatomicmedicineorg

19:00

website , there are research papers

19:03

on there . There's a study

19:05

from the GATE lab with Dr Gillian

19:07

Lauder . She works at BC Children's

19:10

and so they measured

19:12

movements before and after treatment and you could

19:14

see the changes in ranges of motion , which was

19:16

really lovely to see . As it's measured

19:19

. Um , there is a quantitative

19:21

and qualitative study in process and

19:23

they're going to be published this year . Then

19:26

there is a chapter in a book that's also . You can

19:28

click on the link on on the on

19:30

that website and you can read the

19:32

chapter um and

19:34

and the papers that we have are already in

19:37

there . The other thing to realize is

19:39

that there's been decades of research

19:41

on trigger point injections in

19:43

general , as well as on myofascial

19:46

release techniques and the outcomes

19:48

that they have , and this puts those two modalities

19:51

together . So when looking at

19:53

a modality that incorporates the

19:56

research that we know of what works with

19:58

trigger point and with myofascial release and

20:00

how it affects the body but

20:02

this is just more powerful using a needle

20:05

.

20:07

This is incredible . I really value

20:09

being here and sharing this information because I really

20:11

feel like so many people really need this

20:13

and so if

20:20

you want to give it a try , go check

20:22

out the website and take a look at

20:24

this , because I know that you

20:26

know myself is suffering with pain for

20:28

so many years . It's just , it's

20:30

like a dream come true , honestly , having this

20:32

type of treatment . So thank

20:34

you so much . It's been a pleasure to have

20:37

you absolute pleasure

20:39

.

20:39

Happy we could help .