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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🎙In this special mini-episode, Til Luchau previews his upcoming Leg, Knee & Foot Masterclass (August 17–19, 2025 in Walpole, Maine) while catching up with his longtime friend and colleague Thomas Myers, founder of Anatomy Trains and host of the Anatomy Trains Summer Program. 

Together, they reflect on:

• How their teaching—and their excitement for it—has evolved

• Why the leg, knee, and foot deserve more focused attention

• The meaning of mastery after decades in the field

• The value of proprioception and embodied experience in our work

• How hands-on practice helps restore a felt sense of connection in uncertain times

🗓️ Til’s Leg, Knee & Foot Masterclass takes place August 17–19, 2025 in Walpole, Maine, as part of the Anatomy Trains Summer Program.

Learn more and register at:

• https://advanced-trainings.com/workshops/ 
• https://www.anatomytrains.com/product/leg-knee-foot-masterclass-advanced-myofascial-techniques-with-til-luchau 

Sponsor Offers: 

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🎙Grief is not just an emotion—it’s a full-body experience. In this episode, Til Luchau talks with neuroscientist and psychologist Mary-Frances O’Connor, author of The Grieving Body, about how grief changes the brain, affects inflammation, and alters our physiology. They explore how attachment loss rewires the brain, how inflammatory responses shape behavior and mood, and how the body experiences grief via physical sensations.

They also discuss the role of touch, bodywork, and therapeutic presence in supporting people through grief, and together they reflect on the profound connections between grief, the body, and the healing power of human connection.

🔍 Key Topics:

• 04:30 – Grief and the brain: What happens in the mind-body connection
• 10:45 – Grief is not toxic: A new understanding of pain and loss
• 16:00 – How inflammation shapes behavior and mood in grief
• 24:00 – Attachment loss and the nervous system: Polyvagal insights
• 32:45 – The physical sensations of grief: aches, tension, and holding patterns
• 38:00 – Touch as co-regulation: What bodywork can offer in grief
• 44:15 – Grief as a lifelong, embodied process, not something to get over
• 50:10 – Practical insights for bodyworkers supporting grieving clients
• 55:30 – How understanding the body’s role in grief can transform our approach

💡 Join the Conversation: Share your thoughts with us! info@thethinkingpractitioner.com 

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🎙 World-renowned spine expert Dr. Stuart McGill returns for a deep dive into the complexities of disc healing and adaptation, back pain mechanics, and what manual and movement therapists need to understand about spinal loading, adaptation, and practitioner longevity. In this rich and wide-ranging conversation with Til Luchau and Whitney Lowe, Dr. McGill offers both cutting-edge science and practical insights for helping clients—and ourselves—move with more strength, resilience, and less pain.

🔍 Key Topics:

• (04:43) Can Discs Heal or Adapt? – What the science says about disc recovery and tissue response.

• (09:47) Posture vs. Load-Driven Pain – Simple tests to differentiate pain sources.

• (14:12) Disc Architecture & Adaptation – Why discs don’t respond like tendons.

• (19:38) Mobility vs. Load Capacity – The trade-offs between flexibility and strength.

• (25:41) Disc Bulges, Schmorl’s Nodes & End Plate Damage – How structure influences symptoms.

• (32:10) McKenzie Techniques: When They Work & When They Don’t – What recent studies reveal.

• (41:19) Grooving New Movement Patterns – Lasting change requires more than mobility.

• (45:57) The Biological Spectrum – Why not all bodies adapt the same.

• (52:55) Long Fascial Chains & Functional Release – Lessons from the fascia world.

• (59:00) Chronic vs. Repeated Acute Pain – Empowering clients through precision assessment.

• (1:00:13) Bodyworker Longevity & Spinal Mechanics – How therapists can protect their own backs.

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🎙In this thought-provoking episode, Til and Whitney welcome back fascia researcher Robert Schleip to explore the evolving science behind fascia’s role in emotional regulation, inflammation, and sensory experience. They dive into Schleip’s keynote for the upcoming 7th International Fascia Research Congress and discuss emerging research on fascia as a dynamic neuro-immune interface.

Robert shares his updates on fascinating insights into attention, depression, touch, circadian rhythms, and how fascia may bridge body and mind in ways we’re only beginning to understand.

🕑 Key Topics

• 04:15 – Schleip’s keynote preview: fascia, emotion, and immune interaction

• 06:09 – The new direction of the 2025 Fascia Research Congress

• 07:55 – Polyvagal theory and fascia: Schleip on Porges and the vagus nerve

• 12:15 – Fascia and depression: new findings on thickened epimysium

• 20:47 – Foam rolling, mindful attention, and emotional filtering in depression

• 26:12 – Reticular formation, attention, and touch outcomes

• 32:07 – Therapist vs client attention: new data on treatment impact

• 37:12 – The history and evolution of the Fascia Research Congress

• 44:04 – Fascia, safety, and perceptual context

• 48:00 – Sliding fascia and emotional stress: 48-hour delay and resilience

• 51:40 – New paradigm: from force transmission to circadian rhythms and synthesis

• 56:21 – Schleip’s takeaway: return to wonder and curiosity under the stars

💡 Join the Conversation:  Share your thoughts with us!

📌 Sponsored by: ABMP and Books of Discovery, with in-kind support from the Fascia Research Society

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