Thursday Thoughts: Redefining the Smudge | Modern Manual Therapy Blog

Thursday Thoughts: Redefining the Smudge

A concept that needs to gain more traction in ALL curriculum of movement/fitness/health, is what fMRIs tell us about an area of the body that is in pain and/or has not moved regularly.
Taking a cue from David Butler, I use a pinboard to describe a patient the virtual representation of the body in the brain.
  • pushing out pins with your hand, “This is what your hand would normally look like on a scan”
  • “if you stop moving normally, and/or are in pain for even as short as 48 hours, the other neurons around the hand (pins) start lighting up”
  • “this ‘smudges’ the normal definition of the hand, and it becomes less recognizable by the CNS”
  • this makes sense in lieu of the too often heard complaints - "my hand just does not feel like itself" 

So what can we do about it? Just the normal things we usually do! The main message of The Eclectic Approach has been redefining the why behind what we do with plausible scientific reasoning.

My explanation for why treatments like IASTM or joint mobilizations work is that they are a novel, non-threatening stimulus that helps “redefine” the smudged limb. I envision this, especially with light skin stimulation, as re-drawing the blurred image to make it recognizable again. Fortunately, the body leaves us with the perfect outline to "re-draw" the smudged area in the form of skin, rich with mechanoreceptors, just ready for some novel feel good stimulus.

The same holds true for joint mobilizations, and this is absolutely why you should not be going to town trying to deform capsule. First, you are pressing on skin, fascia, nerves, blood vessels, muscle, etc… This sends info to the CNS, by wiggling the bones around in various oscillations, you are lighting up that area in the CNS, and if comfortable, can reduce the perceived threat. This in turn would raise pain and movement thresholds.

Steps to better explanations and treatment
  • buy a pinboard
  • stop going to town with manual treatments
  • treat as large a portion of the involved area/limb as possible
  • this is most likely why treatments like IASTM or functional release (pin and stretch - involving AROM) seem to work "better" than mobilizations, because they represent a larger area, involving more skin and/or movement

Keeping it Eclectic…


  1. Excellent post, Erson. It makes sense.

    Do you find that some patients still need deeper tissue work on TPs or taut bands of muscle? Can they all improve with light pressure? What if a patient requests deeper work? (I usually deliver, but maybe I need to deliver education instead and stay lighter?)

    Regarding joint mobs, what would you consider "going to town"? Are you talking about pushing well beyond a traditional grade IV mobilization? What grade of mobs do you find yourself using most often on the I-V scale?


  2. Thanks Brian! I tend not to do much in the way of mobilizations, in lieu of IASTM and repeated end range loading after. If I do end range loading, or P/A on lumbar, it is closer to a very slow and gentle grade 3, rarely if ever do grade 4. Still do grade 5 on occasion.

  3. Thank you Erson
    Do you use more pressure with STM or IASTM with some patients? (Please see the first part of my question above.)

    Even light intensity mobs for patients without pain but with capsular pattern limitations, or are you always light with mobs no matter what?


  4. Brian, sorry! I forgot to answer this in your epic Q&A email. More than 9/10 times, I am using the force of a kitten licking you.