147: Palpating Fibrosis, Easing Inflammation (with Geoffrey Bove & Holly McMillan)
šWhat can trained hands feel in irradiated tissueāand 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 āoff-micā bonus segment where Holly describes her hands-on work in surgical oncology settings.
ā±ļø Key Topics:
ā¢āÆ00:01:31 ā Introductions: Cathy Ryan, Geoffrey Bove, Holly McMillan
ā¢āÆ00:03:09 ā Why this study was exciting to manual therapists
ā¢āÆ00:04:18 ā Geoffrey Bove on inflammation, nerves, and fibrosis research
ā¢āÆ00:08:14 ā Holly: how findings might apply beyond radiation cases
ā¢āÆ00:13:20 ā Holly explains what she was feeling for in irradiated limbs
ā¢āÆ00:14:23 ā āBuoyancyā and the difficulty of articulating touch-based findings
ā¢āÆ00:18:25 ā How palpation findings relate to pathology and imaging
ā¢āÆ00:20:59 ā Fibrosis and lymphedema as a clinical continuum
ā¢āÆ00:23:36 ā Timing differences in fibrosis between surgery and radiation
ā¢āÆ00:24:52 ā Study limitations: assay sensitivity vs. palpation sensitivity
ā¢āÆ00:27:00 ā Movementās role in mitigating radiation effects
ā¢āÆ00:29:00 ā The importance of community, alliance, and social touch
ā¢āÆ00:33:27 ā Timing of manual therapy before and after radiation
ā¢āÆ00:35:00 ā Prevention vs. treatment of fibrosis
ā¢āÆ00:37:18 ā What kind of touch is most helpful, and when
ā¢āÆ00:40:00 ā Oncology-specific timing considerations for manual therapy
ā¢āÆ00:42:29 ā Manual therapy goals in early vs. late stages post-surgery
ā¢āÆ00:44:09 ā What practitioners are really touching: inflammation, edema, fibrosis
ā¢āÆ00:45:49 ā Apprenticeship vs. protocol-driven training in touch therapy
ā¢āÆ00:47:34 ā Final thoughts from Geoffrey and Holly
ā¢āÆ00:50:56 ā Bonus: āOff-micā conversationāHollyās stories from surgical manual therapy work
ā¢āÆ00:51:09 ā Holly describes doing manual therapy in open surgical fields
ā¢āÆ00:52:13 ā Avoiding surgery or enabling access through touch
ā¢āÆ00:53:27 ā āSun-dried tomatoā vs. ābeef jerkyā: metaphors for tissue change
ā¢āÆ00:54:15 ā Scar tissue, fibrosis, nociceptors, and innervation
ā¢āÆ00:55:57 ā The gap between pain-focused and function-focused care
ā¢āÆ00:57:08 ā āThe Diary of Hollyā and the value of descriptive clinical cases
Resources discussed in this episode:Ā
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/10.1080/15384047.2024.2436694Ā
https://www.tandfonline.com/doi/10.1080/15384047.2024.2436694Ā and supplemental file https://advanced-trainings.com/materials_ttp/147_bove_supplemental_kcbt_a_2436694_sm2290.pdfĀ
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.Ā JAMA otolaryngology-- head & neck surgery,Ā 148(5), 418ā425. 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.Ā BMJ open,Ā 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.Ā JAMA otolaryngology-- head & neck surgery,Ā 151(4), 319ā327. https://doi.org/10.1001/jamaoto.2024.5157
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(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)