Andrew Mannino, LCMT BCSI, is a bodywork practitioner with 13 years of experience. He originally found his way to bodywork while studying guitar and music theory at the Berklee College of Music. In his final year there, he started to develop a repetitive strain injury and was feeling the effects of long-term stress and tension manifest on a more systemic level. A friend recommended massage, and he soon became a regular recipient of bodywork. This inspired him to get trained and pursue it further.
He finds bodywork to be a fun balance of science and art that keeps him curious, engaged, and inspired to continually explore on a deeper level. In addition to his private practice, Andrew is an Associate Teacher for Anatomy Trains short courses and the flagship 500 hour KMI Structural Integration course through Kinesis, Inc. When not working, Andrew enjoys exploring projects related to music and art. He produces music under the name, The Other Verses, and you can listen to his music here. Andrew lives with his wife in the Boston area.
Freelap USA: Some neuroscience is creating confusion about what actually happens to tissue in the long term when manual therapy, specifically soft tissue therapy, is performed. From a clinical perspective, many biological variables such as stiffness, tone, viscoelasticity, and responsiveness can be measured with imaging and medical devices to validate manual therapy. While certain responses like thixotropy are fleeting, some long-term changes happen when exercise is added. Can you share some ideas about long-term changes and how this works?
Andrew Mannino: Some of my ideas about long-term change are that the body builds itself around the way you use it; around the demand you put on it. This use or demand consists of the habits and preferences in the way in which you use, carry, and inhibit your body.
Manual therapy helps promote change by offering new options in posture and movement. It does this by reorganizing the connective tissue network, which, in turn, offers a new somatic experience (which has a psychological and emotional component, in my experience). This can then result in long-term or permanent change if new habits and preferences are built around the reorganized connective tissue landscape.Manual therapy offers new options in posture and movement that can lead to long-term body changes. Click To Tweet
If you haven’t done so already, check out Amy Cuddy’s TED Talk. It’s about the way that changing your posture can achieve measurable biological changes, which then alter behavior and habits—changing the demand you put on your body. Of course, manual therapy alone isn’t a tonic, but it helps. Exercise, diet, sleep habits, and emotional and psychological attitudes also all play a role.
Freelap USA: Posture is another area of controversy. Could you share how some athletes have improved function by making postural changes and restoring original form? Some changes to the body may be helpful adaptations, but some changes may cause mechanical injury to tissue. Recent scientific literature has shown that pelvic position is extremely unique to the individual: Some people are fine with changes, while some struggle. In light of these mixed findings in the research, how do you address injury and re-injury with clients, besides trial and error?
Andrew Mannino: Athletes that I have worked with have improved function by bringing their posture into a more efficient balance. In general, a more efficient balance in static posture will lead to a more efficient movement repertoire. So, for example, if an athlete has limited extension in a hip or limited dorsiflexion in an ankle, it will potentially slow them down when running. They will have less power during the push-off phase of running on the affected side. It will be beneficial to balance the tissues in that hip so that they can more easily allow proper extension (or balancing the tissues around the heel/low leg to allow for more dorsiflexion, etc.).Typically, more efficient balance in static posture leads to a more efficient movement repertoire. Click To Tweet
In my experience, pelvic balance is extremely unique to the individual, based on their movement and postural habits, prior injury, and the anatomy with which they were born. For example, someone who has slight hip dysplasia because of the shape of the head of their femur may be more balanced functionally, with a little bit of a torque in their pelvis, than if they had a completely straight/even/true/symmetrical pelvis.
I’ve had the experience of facilitating more symmetry in someone’s pelvis and low back, and it threw them into a pain pattern—they had less pain when they had a little more imbalance. Although experience teaches us the likely outcomes of bodywork, it is impossible to predict with certainty the way that an individual will react after a session. This was humbling for me, and it keeps me mindful during sessions.
Freelap USA: Anatomy Trains exploded in popularity a few years ago, but had some backlash from a few therapists who had evidence that connections are not always clear or strong with some lines of the body. Thanks to motion capture, new studies with EMG are now seeing connections that show that, while connections with tissue may not be as “wired,” tissue and joint dysfunction has some merit from foot mechanics and motion. You teach for Dr. Myers, and he is open to any patterns that therapists may find: Do you see your own injury pattern types with clients? If so, how hard is it to make changes to movement patterns that may mechanically destroy biomaterial (joint and tissue), and when do you assume it’s more psychological?
Andrew Mannino: What’s important to remember about Anatomy Trains (AT) is that it is “A” map of integrated anatomy, not “THE” map of integrated anatomy. For me, the beauty of the AT myofascial meridians is that they help me make sense of a very complicated system by providing a framework to devise strategies for efficient bodywork. Is it perfect? Nope, and Tom will agree. But it is a very useful way of mapping the body for therapists.
I agree that tissue and joint function or dysfunction is greatly affected by foot mechanics and motion. With every step we take, force transmission travels first through the foot, and then on upwards through the system. If the foot isn’t balanced, if the individual simply has inefficient habits with their gait, or if the individual is wearing improper footwear, it will have systemic effects on their body.
As far as making changes to movement patterns (or posture for that matter), I don’t try to facilitate changes that would cause more stress on joints and tissues. I always work to bring more ease into the system. There can often be some “exercise” type of soreness involved when changing posture or movement, but this is more about muscles working in a new way than a destruction of biomaterial. Whenever someone is trying to change posture or movement (or anything!), there is a psychological component, in my opinion. There is no separating mind and body.
Freelap USA: Nerves are now thought of as the new trail for therapists, with electroaccupuncture moving from meridians to anatomical areas and physiological data (fMRI, blood, autonomic nervous system). When dealing with pain, desensitizing athletes is sometimes the wise thing to do. This is because much of an injury is not necessarily structural but neurological, due to the athlete’s unique anatomy, thus forcing therapists to move from manual therapy to more nerve-specific treatments. Where do you see this going for education for therapists wanting to help clients with nerve gliding problems?
Andrew Mannino: It is important for everyone doing bodywork in any modality to work with and be aware of the neurofascial system. Nerve work can be very helpful, particularly for high-performing athletes that have a very high physical demand on their bodies. Being able to assess and treat inflamed neurofascia is a valuable asset, and it has helped my practice tremendously. I’ve found that “deep” work can be done at a very superficial layer—at the subcutaneous nerve level. Working this layer first, before going for deeper fascial structures, has made my work easier (for me and the client) and more efficient. I would strongly recommend that massage and bodywork practitioners study the nerves and how to engage with them.
Freelap USA: You have done a lot with helping athletes breath better when contact injuries cause altered functions to muscle groups. When doing sEMG and blood panels, I saw a trend where athletes that got a lot of abdominal work received benefits to stress hormones due to the removal of excessive hypotonia. The elastography readings showed markedly significant changes to muscle groups. How does therapy allow athletes to work with pain and soft tissue changes (guarding of joint motion) so they can mentally reduce stress and fear? Is it as simple as walking into the water and going deeper as time goes on, or something more complicated?
Andrew Mannino: Manual therapy can help athletes work with the pain, guarding of joint motion, and fear/stress surrounding old injuries by re-educating the mind/body system around such areas. Physically reorganizing the neuromyofascial territory to take strain off of areas that are overcompensating and burning out is part of it. But also, something I’m interested in more and more is bringing new, efficient, functional movement to those areas in a way that is safe and digestible for the individual. This is tricky, because what works for one person won’t work for another. It is usually a process of experimentation, but the end result can really help to unlearn old patterns and create new ones.
It is a little like walking into the water and going deeper as time goes on. That’s a good analogy because, just as it takes time to acclimate to the cold water you are walking into, changing an old pattern (whether it be physical, mental, emotional, etc.) takes time and acclimation. The whole system has to adapt, and even more, the whole system has to adapt within the context of “XYZ,” whether it be a sport, work, the daily activities of life, or anything else that people spend their lives doing. Only then does it become the new habit/pattern.
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