Skip to main content

Stop Thought Viruses With Pain Science to Improve Patient Outcomes
By: Nataliya Zlotnikov, MSc, HBSc

Let's Play Jeopardy!

Q: How does a Manual Therapist break up fascia?
You have 30 seconds. 
What's your answer? 


Myth Bustin' Time

If you answered, "manual therapists can't break up fascia," you are corrrect!

Research from recent decades has demonstrated that we can't break up fascia, put something back into place, deform the joint capsule, or even break up scar tissue. 

In fact, it takes thousands of pounds of force to make even a 1% deformation. Unless you aren't humanand I hope that all our readers are, humanlet's agree that it's fairly likely that you cannot generate the necessary force.

Image from Erson Religioso's blog, Moden Manual Therapy, The Eclectic Approach


If no matter how hard we press, squeeze, or mash we're not going to lengthen the connective tissue, maybe we shouldn't be so heavy-handed? Unless of course, you enjoy expending your energy for little to no results.  

Of course, IASTM, needling, manipulation, mobilization, etc. definitely work, however, you don't have to go crazy with the level of force you apply. 

If that's the case, then what works better than manual therapy? Be sure to read to the end of the blog (or scroll down) to find out what works!

Manual Therapy Shouldn't Hurt!

With manual therapy, regardless of your technique of choice, the goal is to change the perception of threat or tightness through modulatory techniques. 

There is no reason to fight fire with fire; the majority of the time you don't need to put your patients through further pain.


Click Here to Learn More About Pain Perception


What Is Pain Science? 

So far, all we've discussed above, falls into the realm of pain science. Let's first remind ourselves what is pain science.

It is the conglomeration of numerous and diverse scientific fields – including neurology, immunology, endocrinology, epigenetics, psychology and physiology – among others, that when integrated, help to clarify what causes and influences human pain (Parker & Madden, 2020). 

Pain science emerged from the observation that the pain people report frequently does not match up with the condition of the bodily tissue.  Therefore, the assumption that pain reflects tissue state had to be reconsidered (Parker & Madden, 2020). 

A shocking example supporting this understanding comes from a recent study. This study stated the following results:

87% of males and females as early as 20-30 years old have disc herniations but are asymptomatic. 

To learn more about Pain Science, take a look at our blog, Yoga and Science in Pain Care: The Book Club Webinar Series.

Stop Scaring Your Patients!

If based on research in the pain sciences we understand that pathoanatomy does not predict pain, why do so many manual therapists and other clinicians continue to exacerbate their clients' kinesiophobia?

Telling your patients things such as, "you should never bend forward," or "if you bend forward you will blow out a disc," is scary and confirms their maladaptive beliefs.

Such word choices only continue to infect your patients with...thought viruses. As healthcare practitioners, infecting patients with anything is simply unethical, be it biological viruses, or those of the thought kind. 

Not exactly sure of what thought viruses are? Take a look at this video from the Neuro Orthopaedic Institute (NOI)


Dad, What's a Thought Virus?

What Is NOI?

Dr. Erson Religioso, the instructor on whose course this blog is based, credits David Butler and Lorimer Moseley as the modern fathers of pain science. David Butler is the founder and director of NOI. While both David Butler and Lorimer Moseley are the groups' key authors. 

If you would like to learn more about pain education and the pain science schools of thought, get an introduction to Dr. Erson's Eclectic Approach and Modern Manual Therapy, learn the benefits and effectiveness of repeated end range loading and much more, we invite you to join us in this wonderful pain science online healthcare course, Integrating Manual Therapy and Patient Education: Transform Passive Care into Active Care, by following the button below. 

How to Innoculate Against Thought Viruses 

Here is a preview from the course in which Dr. E. discusses how to inoculate against thought viruses and provides us with a wonderful anecdote from his clinical experience. 


In This Course You Will Learn 

  1. Why the effects of manual therapy are neurophysiologic rather than mechanical.
  2. Use of the Recovery Timeline Concept to help a patient understand their role in recovery.
  3. To simplify the home exercise program and use repeated motions at the correct therapeutic dose.
  4. To add 2 simple things to the home program to further enhance recovery.

How Long Do Your Treatment Effects Last?

What else have we learned from pain science? Well, research has shown that the analgesic effects of manual therapy practices (regardless of the practice) can last up to 4 hours tops. 

That doesn't sound like a whole lot of pain relief. So, how can you help your patients achieve long-lasting pain relief? Using more than one modality has been shown to be most effective!

What Work's Better Than Manual Therapy? Multi-Modal Is King

It has been shown that:

  • Manual therapy alone does not work as well as exercise alone or education alone.
  • Exercise alone and education both work better than manual therapy alone. 
  • Manual therapy together with education and exercise works best.

Learn More Secrets to Improve Patient Outcomes

More From Dr. E

If you found this topic interesting and would like to learn from Dr. Erson Religioso, please register for his full courses on Modern Manual Therapy and The Eclectic Approach, which can be found here:

We also invite you to take a look at some of our other pain education courses on Embodia by following clicking the button below:


Pain Science Courses on Embodia



  1. Parker, R. and Madden, V. J. (2020). State of the art: What have the pain sciences brought to physiotherapy?. The South African Journal of Physiotherapy76(1), 1390.
Dr. Erson Religioso III

Dr. Erson Religioso III, DPT, MS, MTC, CertMDT, CFC, FMS, FMT, FAAOMPT, is a fellowship trained cash based PT practice owner, entrepreneur, blogger, and sought after lecturer in the topic of Modern Manual Therapy. He has a #CashPT Practice in the Buffalo, NY area, EDGE Rehab and Sports Science, where he specializes in TMD, headaches, spinal care, runners, gymnasts, and chronic pain. His focus is seeing the patient as little as possible, and empowering them with education, self assessment and treatment strategies.

Dr. Religioso is adjunct faculty of SUNY at Buffalo, where he teaches orthopaedic manual physical therapy in the DPT program. He also developed a line of manual therapy, mobility, fitness, strength, and rehab products along with pain science education materials at The EDGE Mobility System.

Modern Manual Therapy - The Eclectic Approach is Dr. Religioso’s line of seminars for clinicians that are taught online and in live venues around the world. The Eclectic Approach started with Modern Manual Therapy, and has expanded to include Modern Strength Training, and Modern Patient Education.

Dr. E is now offering his services as both an online clinical mentor to clinicians at Modern Rehab Mastery, travelling OMPT Fellowship mentor, online patient consultations, and online business and social media consultation, #CashPT start up with LeBauer Consulting. He also is part of media company, UpDoc Media, with 2 podcasts, Therapy Insiders and Untold Physio Stories.

Erson is a family man, married to the best woman in the world, and currently has 5 beautiful children. He enjoys running with them, watching them in competitive gymnastics and watching Disney/Pixar movies. He is also a huge tech geek and loves all things Marvel, Star Wars, and Star Trek. If you see Dr. E out and about, or at a seminar, ask him to grab a beer or coffee and talk about shop or anything!

Subscribe to Our Blog

* indicates required
What kind of emails are you interested in?
© 2024 Embodia