Speaker 1: 0:43

Hello, hello everybody. We are live with another Beauty of Breathing podcast recording. Today we have a very special guest. I'm going to introduce him to you guys, presenting Walt Fritz. He's a physical therapist and international educator specializing in manual therapy for voice, swallowing, oral, motor and airway disorders. Teaching since the mid-1990s, he launched Foundations in Manual Therapy Voice and Swallowing Disorders in 2013, a course taught worldwide that reframes manual therapy as an active, patient-centered and movement-based process. His approach emphasizes shared decision making and multifactorial perspectives, encouraging clinicians to move beyond traditional models of care. Walt also serves as a research supervisor with the Voice Study Center in the UK and maintains a clinical practice in upstate New York. Welcome to the Beauty of Breathing.

Speaker 2: 1:47

Gosh, thank you very much. It's almost like I wrote that whole intro myself. Thanks for having me here again. I think I was with you a bunch of years ago, right?

Speaker 1: 1:58

Yes, you spoke for us on Airway Circle. So we have a couple of different resources for our listeners out there. One of them is Airway Circle. Airway Circle is a little bit more aimed toward professionals, with PowerPoint presentations, so we have, you know, webinars or lectures, and over here on Beauty of Breathing is more for the common population, where we kind of break things down in a way that it's really easy for them to digest and understand. However, we do have many listeners who are also professionals. So thank you everybody for following the beauty of breathing and for being over here today. We do these live. So manual therapy and its place in airway disorders was our topic that we chose today. Can you explain to us how manual therapy differs from traditional approaches to treating airway disorders?

Speaker 2: 2:54

Well, okay. So, renata, I got to be honest the traditional ways of treating. I guess I'm not as up on because I'm not an airway-specific clinician. I'm coming at it from the lens of the physical therapist.

Speaker 2: 3:09

Manual therapy is traditionally viewed as there's something wrong with the tissue right here and we need to, with our skilled intervention, fix that tissue. But it's almost like exercise is often seen as well. This person's weak. We need to make them stronger in order for them to function better. And while exercise does make a person stronger, manual therapy often makes a person looser.

Speaker 2: 3:32

The whys of that, the mechanism of actions, are really really nuanced and complex. To say that the reason a person is breathing better is because they're stronger, I think it's not that it's wrong, but it's so incomplete. And I think the same thing applies to when we use manual therapy. With an airway disorder we would say, well, if we're working with the tongue, doing manual therapy and then some exercises with the tongue, it's like, well, it must have been tight because when we stretched it they can now breathe easier.

Speaker 2: 3:59

But I love some of the new science, the new evidence coming out for both manual therapy and exercise, new science, the new evidence coming out for both maniotherapy and exercise, seeing as it's so much more than what we think is happening here at the peripheral, local level. And that's the way I approach my classes. It's about sure we're using touch, we're using touch for maniotherapy, we're using touch for exercise, but let's take a look at the person we're working with, not just the tissue that we think we're engaging. I probably gave you too much that we were looking for in that brief little intro there.

Speaker 1: 4:32

No, not at all. I think it's important for people to understand. You know, many times I have patients come to me. First of all, most people call myofunctional therapy myofascial release and it is so different. Can you explain just a little bit for the general public? What does it mean myofascial? How is myofascial release different from myofunctional therapy?

Speaker 2: 4:57

Okay. So I can only explain the myofascial side of it because, again, even though in my workshops around the world I get a lot of myofunctional trained clinicians, I don't pretend to teach myofunctional work, I teach manual therapy. Now, myofascial release. You're hitting a hot button for me here because about four years, five years ago now, I finally decided it was time to let go of those words and there's a real problem with the myofascial release mindset and phrasing. It's almost like Robert Frost. You know, the two road paths divide.

Speaker 2: 5:31

When you talk about myofascial release, are we talking about something that we feel selectively influences fascia, or are we talking about myofascial release as an intervention that we call myofascial release? Right, because a lot of people believe the former, that it's all about your fascia, and we see that in that graphic that makes its way around social media all the time, from the tongue to the toes, right? Yeah, I always like to ask people well, what's your purpose in posting that If you're a myofascial release clinician? A lot of them are saying see, we need to release the fascia throughout the body, but yet the evidence doesn't yet support that. I think and this is my personal and professional view the only folks who really have any credence using that graphic are the ones that are talking about tongue tie releases, because that's right now, believe it or not, the only way that we know with credibility that we're impacting any sort of fascial problem. All right, so myofascial release is seen as a way to address that fascia when in reality we're using a pretty generic form of manual therapy, touch, massage, all these different modalities, but somehow myofascial release and cranios sacral therapy have become really really niche work and niche concepts in that myofunctional community. Are we really changing cranial sacral dynamics et cetera, or are we providing a contextually safe, calming, parasympathetic, inducing type of touch to this person? And I make a lot of enemies when I start what people feel is criticizing the craniosacral and the myofascial sort of narratives, and I'm not discounting the benefits of them. I'm just questioning the underlying narrative, the underlying mechanism of action that all of those claim.

Speaker 1: 7:21

Well, we need people like us. I'm the same way. I don't make a lot of friends, because I say as it is and I tell my patients all the time. You know, well, from now on, you became my patient. So, even though I'm referring you to a really good friend of mine who I know, if they, you know, recommend something, we're going to sit down and we're going to talk about it. If it's not something that I think would be great for you, I'm going to say it. I'm going to say it. So it's very important for us to have these types of discussions because, even though we understand what we do, we still need to follow evidence-based treatment and we still, you know, need way more research than we have nowadays to transfer what we're seeing clinically with our patients to research. What are some common airway disorders where manual therapy has shown significant benefits?

Speaker 2: 8:13

Oh, I think one of the biggest ones that we've seen it with and this is both through, you know, some of the myofunctional evidence, sort of translating that over into the manual therapy but definitely with in terms of apnea and you know, snoring, various grades of apnea, et cetera in terms of just providing that person with a sense of option. Right, are they having apnea because they're weak? Are they having apnea because they're tight? It's so much more nuanced than that. But using manual therapy as one of the tools to help with those patient populations, not the tool, one of the tools to help with those patient populations, not the tool. Right, nothing is the holy grail. They all build this sense of buy-in because some people really feel that, well, if you're not touching me, you're not doing anything, and I hear that in PT all the time. Right, all they did was wanted to put me on an exercise machine. You know that helps some people, but a lot of times there's a contextual connection that people make with touch, with these sorts of works. So, definitely with apnea and snoring issues. But we see it a lot with some of the more subtle things, including with performers, in terms of vocal performers, you know, in terms of the ability to maintain that airway as well as the whole health and regulation of the entire respiratory system.

Speaker 2: 9:25

Because you know, we work the diaphragm region, we work the chest region, the whole laryngeal region. It's so important. But I think most of it is probably more commonly seen when we do a lot of the different tongue work. And it's interesting too, renata, because if you had taken my class, well, even two years ago, my class would still have been about manual therapy. Now, even though the class is called manual therapy for voice and swallowing, we spend probably almost as much time on exercise, not in ways that traditionally people think of it, but some of the tongue exercises that we do, resistive work with the tongue. It's blended really easily with the exercise-based work, with the training type of work. What's cool is we're even having people taking tools like the IOP right, you're familiar with that, yeah.

Speaker 2: 10:14

And instead of using them as the therapeutic device. They're using them as a pre and post-test measurement, taking the pre-test, doing some of the resistive work and then doing post-tests. Now one might say, well, we do resistive work with tongue depressors or other tools and I mean those are fantastic. But there is something about the immediate feedback that I can get when I put my thumb on a patient's tongue and ask them to begin moving portions of it, for me to say, okay, that part of the tongue isn't working real well and simply tapping that part. That goes from sensory input right up here and often translates into a new modified motor output. Wow, that's the stuff that I'm just so excited about, that sort of breaking down that wall between exercises, stretching, strengthening and manual therapy and saying you know what these are all working with higher centers of our patient's central nervous system, not out here solely in the periphery, like I think a lot of us have been taught in the past and maybe even inferred from the present.

Speaker 1: 11:19

Oh my gosh, how do I follow that this is so good? How does it look like for a patient when they first come to see you?

Speaker 2: 11:30

Oh well, that depends on the diagnosis, the problem set, etc. So ask your question again.

Speaker 1: 11:38

Since we mentioned snoring, let's say with that. I am a 41-year-old who started snoring in the last few months and I'm coming to see Walt Fritz Gotcha.

Speaker 2: 11:54

I ask really, really difficult questions, ones that sometimes really throw my patients off and throw clinicians off when they come to my seminars. Because I will ask them well, renato, what does it feel like when you snore? What does it feel like when you lay back to go to sleep and you're starting to drop off? What does that feel like? What does it feel like when apnea wakes you? Right, and often it's like I don't know I'm sleeping, but it's like, okay, let's discuss this. What is that felt sense within you? And, whether it's something here or up here or out here, what does it feel like?

Speaker 2: 12:31

Because my model is all about connecting to patients' lived experience and often we have to try and get a hold of a feeling and, by the way, a feeling can be it hurts I'm just making something up or a feeling could be I'm scared, right, I'm a physical therapist. Or feelings would be I'm scared, right, I'm a physical therapist, not a psychotherapist. But we all know the psychosocial ramifications of these mechanical problems. So that's one of the first things I would do to you, with you, renata, is to sort of talk about this. Certainly, background history, medications, all those things we need to know, but I need to know what does it feel like?

Speaker 2: 13:05

Because when we do our work whether it's the manual therapy, stretching, the resistive exercises, even some of the cognitive behavior work that we'll do, I want to know are we connecting with, are we replicating, are we doing something to make you feel like whatever you just did there? Walt? That's part of that feeling of my snoring, of my apnea, part of that feeling of my snoring of my apnea, and it's a wild sort of experience and some patients get it immediately and some just leave here thinking that guy was weird. He was asking me questions which I have no idea what he was asking me, which is it's frustrating for me and my patients sometimes, but that's part of the art of what we do is trying to connect them with their issue. Traditional physical therapy is about okay, patient's got a weakness, patient's got a tightness, and I know what to do because I'm fully trained.

Speaker 2: 13:54

And I am fully trained, I'm experienced and all blah, blah, blah, but I don't know your lived experience, so I try to balance those out. That's what I use shared decision-making for Feeling that your input is as important to this intervention as my input, and that's. That's a tough sell sometimes.

Speaker 1: 14:13

I think my patients would agree that I'm a little weird also, and I you talked about, what would you do with you when you walked in?

Speaker 2: 14:21

It's first of all, let's have the discussion, because I would tell you that while we're working I'm looking to do something which brings us into sort of a connection to that feeling, and I need to know when we start to encounter it. There's some really interesting parallels in the psychological research when it comes to priors, prior events with psychological past and present, to priors, prior events with psychological past and present. There's actually a study that looks at the parallels between the psychology concept of a prior and the touch-based experience of priors, and I think we can learn so much if we sort of go beyond that rabbit hole of our own native research as a PT. If I only look at PT literature, I am missing the boat on so much understanding the behavioral aspects of this person who I'm working with right now and that's where I've gone over the past five years. It's really drifted, you know, sort of off the beaten path into understanding how touch can be impactful, not just from the tissue-based perspective but from the human perspective.

Speaker 1: 15:26

So I have an interesting question. Sleep apnea is extremely complex, right, and every day we're learning something new about it. Do you think it would be possible, or do you think there's any correlation of somebody's maybe physical or emotional trauma around sleep that could create the body to react a certain way to cause ethnic events?

Speaker 2: 15:56

As a contributor, absolutely, absolutely. I think that's where things are really fuzzy there. You know we can look in the literature and understand how trauma can influence us, but I think all of us have to sort of like sort of roll over the uncertain piece of that to make a claim that, yes, trauma can be part of this whole sleep apnea or any kind of negative experience that patients might see us. For I just I come from a background where a lot of unsubstantiated claims were allowed and accepted and you know I don't want to get too political here, but it almost aligns really well with what's happening in our country today and the disagreement with science et cetera, right and research. But that was my native introduction to myofascial release.

Speaker 2: 16:44

Originally that seeing people said things like well, emotions are trapped in your fascia and until you release the fascia the person will never truly heal. And then classic post hoc fallacy we treated people with fascia work, they had emotions and they felt better. So we said, well, it must have been trapped in the fascia. No, it doesn't work that way, right? So is it possible? Absolutely, how do we prove it with 100% certainty? Good luck with that one.

Speaker 1: 17:13

Yeah.

Speaker 2: 17:14

Yeah, the thing I think is important, renata, is that if my patient comes in to see me feeling that their issues are trauma based, I think it's hugely important for me not to question that I've not lived your life Right.

Speaker 2: 17:32

You said earlier that you know there's times when we really do tell people our opinions, but I also think we need to learn. I need to learn to temper them right, because I might say to you well, that's a bunch of crap, the evidence doesn't support that, but yet everything in your being feels that that's relevant and I don't know that that's a positive therapeutic dynamic. To repeat, what I like to do is I'll take your story, which might be off the wall, and I'll say it absolutely could be that piece, but it also could be this, and I might insert a more, what I view as a more evidence-based approach. But I allow both of those to be out here saying it could be this and it could be this, but let's turn it around now and say it could be those. But what do you feel right now when I do this with you? Does it feel like we're connecting? Does it feel positive? Does it feel like it might be helpful, like not invalidating a person's core beliefs?

Speaker 1: 18:29

You mentioned earlier about, whenever you do manual therapy, you are releasing rather than the exercises will be more of an exercise and contract and increase strength. How is this manual therapy related to somebody possibly snoring? How can you explain to the general population that these can help each other?

Speaker 2: 18:51

Yeah, I just want to jump back because I didn't, I don't, I didn't quite agree with what you said about encapsulating what I had said previously, please rephrase that Right.

Speaker 2: 19:01

In terms of the exercise piece, it is strengthening. But okay, have you ever done an exercise with a client? And within session, within that one session, they demonstrate more functional ability. I think most of us have right when we do something and the patient can then generate more power. That is not classic muscle weakness, because if it was, it would have taken multiple sessions, taken the person to full fatigue, allowing recovery to build strength over time. But so frequently we do things and whether it's stretching or strengthening, we do things with them that instantaneously translates into improved functional strength. That's a very different kind of a strengthening process, other than classic muscle weakness. To strengthen right.

Speaker 1: 19:50

Yeah.

Speaker 2: 19:50

That's what we're using with the manual therapy model too. That sure we might have actually impacted something within that. You know that one individual muscle that was too short. But more likely we're producing this cascade of influence of sensory input to the central nervous system which then can come back down to the periphery with a different motor output.

Speaker 2: 20:11

So if I get a patient coming in with apnea and we talk about some of these things, we might say you know, there could be some weakness where you know your resting self, sleeping self, can't support that area and maybe some strengthening will help. There might be tightness, tension, scar tissue, adhesions, whatever word you like that are contributing to the laxity there, right, and those are simple ways to sort of enter the conversation and often I'll stop there If the patient's like, if that's enough, I'll stop there. But a lot of my patients say can you tell me a little bit more about that, the transition from the five second elevator speech to the 30 second one, and they really want to know. Then we sit them down for the five minute elevator speech, right, because the complexities of why a person snores, I mean, it's so multifactorial there is no one simple explanation nor solution.

Speaker 2: 21:01

And that's what we're talking about here. We're talking about maybe sprinkling in a little bit of this manual therapy work with the work, the really good work that you're doing, to say, okay, we're kind of throwing things at the wall to see what sticks, not to be unethical about it, but I don't know how this person's going to respond. Maybe they would respond initially to my stretch and that's all we need. Maybe they need education, training, they need other support, et cetera.

Speaker 1: 21:27

Very good. And going back to what we talked about earlier of the manual therapy versus myofunctional therapy, I like to explain to my patients, of course, that the myofascial and all of those releases you have to touch the patient Myofunctional. We're working mainly on the function of the muscles, so I don't necessarily need to touch the patient to treat them. But they complement each other very well and they are used differently. I like to explain that, if you you know my functional therapy is like you're going to the gym and you're given an exercise specifically for you, for whatever. After we evaluate the muscles, see exactly what is not responding as well as it should. However, all the exercises that we give are perfectly aimed into improving the function of that muscle.

Speaker 1: 22:23

So, just like the physical therapist does for the body, we usually do which you guys also work here but we usually do for airway muscles, tongue and lips, during sleep, apnea or snoring, a lot of times these muscles here of the oropharynx, they will collapse, especially if there's resistance in the nose. So, yes, we're looking at all of this. Myofunctional therapy is not just the exercises but looking at the airway, looking at the nose, looking at psychological things, not psychology, but I'm asking my patients if there's any trauma or anything like that that could be possibly related. But looking at the whole picture and then knowing exactly, okay, you need to go to this professional, this professional can help you, this professional here. So I was just trying to understand a little bit more. When would I refer my patient to you? What am I looking for exactly?

Speaker 2: 23:13

So, without getting too silly here, why would you refer them to me? If you could do it too right, I don't.

Speaker 1: 23:21

I don't do what you do.

Speaker 2: 23:22

No, right, okay, Gotcha, because I know a lot of my functional therapists are now, you know, kind of taking these sorts of trainings and seeing ways to blend. I don't know. I think that it's a really good question what you asked, and to me I make a referral out if the person isn't reacting, responding the way I'd hope they would from my intervention. Right, and it's not because I don't know what I'm doing. It's like we can't hit everybody, we can't meet everybody's needs, right, but understanding that maybe this person would benefit from a more, you know, a multi-centered type of approach, which is kind of what you're talking about. And I would say, if they're not changing in the way that you expect it, if maybe they're dealing with more physical injury, right, post-surgical scarring.

Speaker 2: 24:09

I had such a cool patient about two years ago, mid-30s woman, who prior to her surgery, her only problem was chronic tonsillitis. After the surgery at mid-30s for tonsil removal, airway issues she had she developed apnea, horrible snoring. She developed something that she called pre-snoring. When she laid down to go to sleep she'd start to snore before she fell asleep. But she also developed it's like every single thing that I that we cover in some of my classes she just discovered a voice disorder and some dysphagia. Right, you know that's not a common type of patient.

Speaker 2: 24:47

But when we started doing both the tongue work as well as some upper cervical retrolaryngo type work, almost in the upper pharyngeal region, she said you just touched my scar right there, right, obviously that when we hit that, when we touched it, then she allowed the process to sort of happen and then, going back to that concept of prior, she's like that's that feeling I get right there, you've just touched that Right. That doesn't necessarily answer your question when would you refer? But you know, because I don't think there's a really great decision-making tree to say, well, if they can't do this, this or this, send them to a PT or an SLP or an RDH who are trained in this sort of work, that sort of thing. Right, I think it's really complicated. Some of us like to keep our patients, we don't like to share, and others are real sharing individuals, and you know people on both sides of that spectrum, right, yeah, I know, oh gosh, patients are so complex.

Speaker 1: 25:50

Myofunctional therapy is great. I always say this. Myofunctional therapy is incredible because it is not done alone. There's no way that I can do what I do without the help of an ENT, of an orthodontist, sometimes a physical therapist, occupational therapist, chiropractor. I mean, I need my people to be looking at reflex integration, to be looking at sensory processing. Otherwise, what I'm doing is not going to be successful if we do not look yeah, yeah.

Speaker 2: 26:25

Yeah, the work that I teach is not exactly complex. It really isn't. It's just a basic grounding in understanding the dynamics of touch, the dynamics of manual therapy, the dynamics of shared decision-making, so much so that I don't know percentage-wise, but a large number of malfunctional clinicians are now using these sorts of work under a permissible license, right. Yeah, using these sorts of work under a permissible license, right, in order to do it, instead of needing to think, well, should I refer this person out when it's like, well, how about if we just add another variable right here to the dynamic of what's happening in the session you're working with? And I would love, you know, I'll take referrals, you know, any day of the week here at my clinic, but it's, you know, if we're looking for that greater good. It's so easy to incorporate some of these principles into the, into the framework that you guys are really good at.

Speaker 1: 27:23

Yes, I usually ask my patients, you know, do you want to get a tooth taken out by an oral surgeon who does it all day long, or do you want to go to a dentist that does them, you know, twice a year?

Speaker 2: 27:31

Yeah, it's a good point. It's a. It is a good point. It's a. It is a good point, you know, in terms of seeing an expert. I just I think sometimes OK, here's where I'm unpopular again I think sometimes people who sell us certifications and courses make it seem so complex that you have to come to me for a full training in order to safely treat others, come to me for a full training in order to safely treat others, and certainly a lot of work is like that. But I think there's a lot of like sort of selfishness with that, so much that we, you and I, in our shared communities, can share with each other. That's not acting out of scope of practice. It's not acting out of, you know, inexperience. It's saying you know, I already know the basics of this. Let's just add a little bit here and see what happens.

Speaker 1: 28:19

Yes, I feel like the more knowledge we gain as clinicians, the better we're going to be able to treat our patients, not because we're going to be practicing that, but because we know other possibilities and we know other opportunities of treatment that this patient may have, that it could benefit them. But if I don't have you in front of me asking these questions, I'm never going to know when this patient could benefit from what you do. So types of conversations are so, so, so important.

Speaker 2: 28:47

Yeah, you know I get ENTs coming to my class once in a while and I'll say, well, why are you here? You know not to be rude, but like what brought you here? And some of them are saying you know, I want to understand this better so I can make appropriate referrals. Well, what is also really cool is I want to understand this better so that I can start applying this or try a little bit of it to see if there's benefit, then I can make the referral. And I just think that we can hit people at so many different areas and I've met ENTs who actually that we can hit people at so many different areas. And I've met ENTs who actually most of them are in the UK, who actually are allowed. But this one fellow from Wales is allowed one day of the week where he can do what he wants with his voice patients and as an ENT he does manual therapy and I thought, wow, what a cool just sort of crossing of boundaries and borders, of professions and everything.

Speaker 2: 29:36

So you know again, I'm not trying to over-empower somebody who doesn't feel sufficiently trained, but on the other hand, you know there's not, there's danger in everything you and I do, period. Knowing this danger is important, but let's try this. Let's see what happens, and if we need to make a referral, we can always do that.

Speaker 1: 29:54

I love that. How does your patient-centered and movement-based approach improve outcomes in manual therapy for voice and swallowing issues?

Speaker 2: 30:06

I thought you were reading me a statement. What's the question?

Speaker 1: 30:09

How does your patient-centered and movement-based approach improve the outcomes? We're going into voice and swallowing now.

Speaker 2: 30:22

Okay, so I'm going to go into the underlying theory of patient-centered, which is a parallel to shared decision-making. Right, it's very shared decision-making. Instead of clinician is expert, biomedical model is based on the clinician is expert model which, let's face it, it works right. But so much of the newer literature on shared decision-making is saying first, we need to give patient choice, and to me, that's the ultimate aspect of shared decision-making that they very easily give up to us. Oh, you decide, you're the expert, you decide what's best for me and I will if I have to, but I don't want to do it that way. I want to include you and I don't want to do it that way. I want to include you.

Speaker 2: 30:58

And I don't know whether you've read any of Leah Halou's work on metatherapy. Leah is a speech pathologist who specializes in voice, but she talks about metatherapy. Metatherapy being the meta is essentially the therapy that surrounds our technique. Right that we think it's the technique that's instrumental in creating change, but it's actually the environment that we build around the technique.

Speaker 2: 31:23

And I had the pleasure of having a conversation with Leah about her concepts of metatherapy in the research and my concepts of shared decision-making, because I tell people when they come to a class. You think you're coming to learn some nifty hands-on skills, which you will, but what I really hope you leave here is an understanding of what surrounds that and how we envelop the therapy right. So I believe, to get back to your question, I finally can work my way back. I believe that's what makes maybe this I don't want to say better than traditional clinicians as expert manual therapy for voice swallowing related issues, but I think it offers a different approach. It gives the person more of a sense of feeling validated and that they have worth in a biomedical model where traditionally they're not given a lot of worth and power.

Speaker 1: 32:13

Mm-hmm, wow, as our last question now, how do you see the role of manual therapy evolving in the future of airway disorder treatment and rehabilitation?

Speaker 2: 32:37

techniques, manual techniques by themselves, not without the malfunction inclusion within the apnea and sleep disorder type community. There's really a really poor lack of evidence there. So you know what am I doing? Sitting here with you claiming that, yeah, this can help with airway? I'm going to the lowest form of evidence, right Below case studies. I'm going from antidotes right, we can't totally rely on antidotes in an evidence based model but I don't know. It's also give us some of that fuel to say, you know what? That's where it starts. Let's, let's see what happens, right, and I don't believe that I'm operating unethical from that perspective. I'm an annoying. My glasses three quarters full person. If you come in to see me, it's like let's try this. If within a session or two it's not making a difference, move on.

Speaker 2: 33:21

But I think that's probably the greatest need right now when it comes to manual therapy and airway type related issues is some really good quality evidence on these disorders and not just the evidence to say when we pull somebody's tongue they snore less, right, but to really dive deeply and this is lacking in so much of our shared research really dive deeply into exploring the mechanism of action, because we rely so easily on historical mechanisms when we're writing a study and I read this all the time and it just drives me crazy.

Speaker 2: 33:53

They're talking, they do a study, an outcome-based study, and they reach back into history and rewrite these really really poorly defined narratives. But because they were published in the past, we accept it and I just think we need to do so much better than that. Year got my first paper ever published and that was taking a look at the traditional mechanism of actions for laryngeal manual therapy versus what the newer evidence is showing us and basically saying it's time to stop using these crusty, dusty historical narratives on. You know what? They have too much muscle tension and when we do this, we break up the tension as if it's the what happens in Vegas stays in Vegas. Perspective Touch manual therapy exercise. They are so multidimensional but we keep reverting back to these simple oh, you're weak, we need to make you stronger, you're tight, we need to make you looser, and really there's just so much more than that and that is a big deficit in the manual therapy community when it comes to airway disorders.

Speaker 1: 35:00

I'm going to ask one more question, if you don't mind. It's absolutely fine. Do you think that tongue ties people's tongue restrictions? Do you think?

Speaker 2: 35:28

the manual therapy can help with some people's symptoms if they have a restricted tongue freedom to the point where they don't need a release. I'm not going to go quite that far to say that they don't need a release. I think that people can be benefited from manual therapies. I get really irritable when it comes to people who talk about we're going to release your fascia through myofascial release, and I think that's one of the primary issues of credibility. Right, you don't need that. We can release that with myofascial release. You don't need surgery, and I just think that's a bald face lie.

Speaker 2: 35:57

I think that exercise, I think the cognitive behavioral work. I think that manual therapies can be beneficial for that person, whether affecting the frenum itself or affecting the area surrounding it. It's really hard to know which. So, to answer your question, yeah, I think it could be beneficial, but sometimes it's just snip that sucker and move on, move on. Let's just progress from there. But it drives me crazy when I hear people talking about saying oh no, we don't need to do those. We can do that with our hands. You need to give me a credible mechanism of action with a lot of evidence to support what you just said. And you can't do that because it's not out there.

Speaker 1: 36:40

Thank you. I think that that's the best way for us to end our podcast today. Do you have any last words before you can share about your course to us?

Speaker 2: 36:51

No, no, I think that I think we've covered a lot of it here. I do make I I I love this work. I love engaging with the public. I love it in both the public as well as therapists. I love answering questions for people, so don't ever hesitate to reach out to me through social media or my website Not that we're going to diagnose you over the internet or something like that that's not what it's about. But I think that for too long we've all been kept in these separate closets, right, and I just think it's time to open the doors and realize there's so much sharing that can be had that's mutually beneficial.

Speaker 1: 37:24

I love it. Well, thank you so much for spending this day with us. Very, very insightful information. If people want to reach out to you, do you know your Instagram handle or would you like to share?

Speaker 2: 37:36

I think it's waltfritzpt. Instagram is waltfritzpt.

Speaker 1: 37:38

Yeah.

Speaker 2: 37:38

Okay, perfect. Yeah, and my website's waltfritzcom. I keep it simple and maybe a little bit too egocentric by calling it waltfritzcom, but there you go. Yeah, lots of courses, us and international. I have lots of online courses, et cetera, and 25% off sale on all my online courses right now, through the end of October. Okay, there I go. I did my little promo sales pitch. Thank you for listening.

Speaker 1: 38:00

Thank you, I appreciate it. You know a lot of people get really uncomfortable selling. But selling is serving. I think we should change the way that we call it. We are serving other people with you know the knowledge that was given to us. We're helping them, so there's nothing wrong with us sharing what we know. But thank you so so much for being here. Everybody, have a wonderful day. We'll see you guys next week. Great Thanks for having me, thank you.