The Thinking Practitioner

🎙What can trained hands feel in irradiated tissue—and how might that inform both research and practice?

In this episode, Til Luchau and guest cohost Cathy Ryan, RMT, talk with neurobiologist Dr. Geoffrey Bove and manual therapist/speech pathologist Holly McMillan about their collaborative animal study. They explore how massage therapy may influence radiation-induced fibrosis, the use of palpation as a formal outcome, and the challenges of correlating what we feel with what science can measure. This wide-ranging discussion offers practical takeaways for manual therapists working with inflammation, scarring, or post-radiation clients.

Stick around after the outro for a candid “off-mic” bonus segment where Holly describes her hands-on work in surgical oncology settings.

⏱️ Key Topics:
• 00:01:31 – Introductions: Cathy Ryan, Geoffrey Bove, Holly McMillan
• 00:03:09 – Why this study was exciting to manual therapists
• 00:04:18 – Geoffrey Bove on inflammation, nerves, and fibrosis research
• 00:08:14 – Holly: how findings might apply beyond radiation cases
• 00:13:20 – Holly explains what she was feeling for in irradiated limbs
• 00:14:23 – “Buoyancy” and the difficulty of articulating touch-based findings
• 00:18:25 – How palpation findings relate to pathology and imaging
• 00:20:59 – Fibrosis and lymphedema as a clinical continuum
• 00:23:36 – Timing differences in fibrosis between surgery and radiation
• 00:24:52 – Study limitations: assay sensitivity vs. palpation sensitivity
• 00:27:00 – Movement’s role in mitigating radiation effects
• 00:29:00 – The importance of community, alliance, and social touch
• 00:33:27 – Timing of manual therapy before and after radiation
• 00:35:00 – Prevention vs. treatment of fibrosis
• 00:37:18 – What kind of touch is most helpful, and when
• 00:40:00 – Oncology-specific timing considerations for manual therapy
• 00:42:29 – Manual therapy goals in early vs. late stages post-surgery
• 00:44:09 – What practitioners are really touching: inflammation, edema, fibrosis
• 00:45:49 – Apprenticeship vs. protocol-driven training in touch therapy
• 00:47:34 – Final thoughts from Geoffrey and Holly
• 00:50:56 – Bonus: “Off-mic” conversation—Holly’s stories from surgical manual therapy work
• 00:51:09 – Holly describes doing manual therapy in open surgical fields
• 00:52:13 – Avoiding surgery or enabling access through touch
• 00:53:27 – “Sun-dried tomato” vs. “beef jerky”: metaphors for tissue change
• 00:54:15 – Scar tissue, fibrosis, nociceptors, and innervation
• 00:55:57 – The gap between pain-focused and function-focused care
• 00:57:08 – “The Diary of Holly” and the value of descriptive clinical cases

Resources discussed in this episode: 

• Study:
  • Bove, G. M., McMillan, H., & Barbe, M. F. (2024). Evaluating massage therapy for radiation-induced fibrosis in rats: preliminary findings and palpation results. Cancer Biology & Therapy, 25(1). https://doi.org/10.1080/15384047.2024.2436694 
    https://www.tandfonline.com/doi/10.1080/15384047.2024.2436694  and supplemental file https://advanced-trainings.com/materials_ttp/147_bove_supplemental_kcbt_a_2436694_sm2290.pdf 
• Also mentioned in this episode:

  • McMillan, H., Barbon, C. E. A., Cardoso, R., Sedory, A., Buoy, S., Porsche, C., Savage, K., Mayo, L., & Hutcheson, K. A. (2022). Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer. JAMA otolaryngology-- head & neck surgery, 148(5), 418–425. https://doi.org/10.1001/jamaoto.2022.0082

  • Hutcheson, K., McMillan, H., Warneke, C., Porsche, C., Savage, K., Buoy, S., Wang, J., Woodman, K., Lai, S., & Fuller, C. (2021). Manual Therapy for Fibrosis-Related Late Effect Dysphagia in head and neck cancer survivors: the pilot MANTLE trial. BMJ open, 11(8), e047830. https://doi.org/10.1136/bmjopen-2020-047830

  • McMillan, H., Warneke, C. L., Buoy, S., Porsche, C., Savage, K., Lai, S. Y., Fuller, C. D., & Hutcheson, K. A. (2025). Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial. JAMA otolaryngology-- head & neck surgery, 151(4), 319–327. https://doi.org/10.1001/jamaoto.2024.5157

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