When I think About You… Prompted by some mentee questions and blog comments, I wondered where manual therapy fits in the rehab process. To satisfy my curiosity, I calculated how much time I spend performing manual interventions. Looking at last month’s patient numbers to acquire data, I found these numbers based on billing one patient every 45 minutes (subtracting out evals and reassessments): Nonmanual (including exercise and education) = 80% Manual = 20% Modalities = 0%!!!!!!!!!!!! Delving a bit further, here’s my time spent using PRI manual techniques versus my other manual therapy skill-set: PRI manual = 14% Other manual = 6% As you can see, I use manual therapy a ridiculously low amount; skills that I used to employ liberally with decent success There’s a reason for the shift I want my patients to independently improve at all cost and as quickly as possible. The learning process is the critical piece needed to create necessary neuroplastic change; and consequently a successful rehab program. Rarely is learning involved in manual therapy.
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Course Notes: The Eclectic Approach to Upper Quarter Evaluation and Treatment
I recently attended this course with my man Erson Religioso III. It was great connecting with him and learning his approach. Check out his stuff on www.themanualtherapist.com Overall, I thought it was an excellent course and definitely opened my mind to an approach (i.e. McKenzie) that I was not a huge fan of. I highly recommend taking one of his courses. Here were some of the pearls I got from his course. My thoughts will be italicized. On Assessments “If you don’t have a system, you are lost in an evaluation.” The SFMA reasons why people get hurt. #1 cause – previous injury. Asymmetry of quality and quantity. Motor control. Stupidity. Just because you clear something once doesn’t mean it has been cleared forever. If one has knee pain and decreased ankle dorsiflexion, check tibial internal rotation. On Education “Never tell people they are train wrecks.” This goes back to reducing the threat response and explaining pain. We want to maximize the placebo effect. On Neuroscience Nerves move like an arm in a sleeve. A tight sleeve wears down myelin which is replaced with ion channels. This is why nerves become sensitive. Also why you must treat the entire nerve container. Abnormal impulse generating site (AIGS) These fire both ways. Not normally at the sight of symptoms. If symptoms are episodic, then it is not centrally maintained. If you skin your knee 10 times in 10 years, you don’t say I have a chronic skinned-knee problem. On Surgery “Less than
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