Manual Therapy

Does manual therapy have a place? Manual therapy is one of the more polarizing topics in the movement world, and no doubt you might wonder if this modality is efficacious for improving pain and/or movement. The evidence on manual therapy in isolation is mixed, but perhaps the modality itself is not the problem. Perhaps the problem is not having a model that can explain the utility of manual therapy, when to use it, and why. With a decision-making model, manual therapy is something that can most definitely fit within the interventions you like. Ready to see how manual therapy can be best applied for your supreme clientele? Then check out Movement Debrief Episode 139 below!

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Wrist Pain, Dry Needling & Taping, and Should I Become a PT? – Movement Debrief Episode 90

Movement Debrief Episode 90 is in the books. Below is a copy of the video for your viewing pleasure, and audio if you can’t stand looking at me. Here is the set list: Why does wrist discomfort occur with weight bearing? What limitations could contribute to wrist discomfort? What modifications can I make to improve wrist discomfort? What regressions are useful for wrist discomfort? Do I use dry needling or taping? If and when do I find these modalities useful? Is it worthwhile becoming a physical therapist? What is it really like being a PT?

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Overhead vs Quadruped, Hypersensitivity, and Frozen Shoulder – Movement Debrief Episode 35

Movement Debrief Episode 35 is in the books. Here is a copy of the video and audio for your listening pleasure. Here is the set list: How do the overhead and quadruped positions affect infrasternal angles? How does one reduce hypersensitivity in a focal area of longstanding pain? How does one perform treatment on someone with frozen shoulder? How often are there cervicocranial components to frozen shoulder? What other things do we need to be looking at with frozen shoulder? If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 7:30pm CST. Enjoy!                  Here were the links I mentioned: Infrasternal Angles NOI Recognise apps CRAFTA – A con ed course on craniocervicalmandibular region Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain. Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment “Why Are My Nerves So Sensitive?” By Adriaan Louw Oxygen Advantage  “Unconventional Medicine: Join the Revolution to Reinvent Healthcare, Reverse Chronic Disease, and Create a Practice You Love” by Chris Kresser Here’s a signup for my newsletter to get nearly 3 hours and 50 pages of content, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:   Overhead vs Quadruped Hypersensitivity Frozen Shoulder

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Knee Pain & Modalities – Movement Debrief Episode 24

Movement Debrief Episode 24 is in the books. Here is a copy of the video and audio for your listening pleasure. Here were all the topics: What ACL graft should you get? What does the systemic process look like for knee pain? What local factors are important for knee pain? the importance of plyometrics for knee pain Is there a place for modalities? What modalities I incorporate into my practice If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 7:30pm CST. Enjoy.                    Here were the links I mentioned tonight Enhancing Life Darkside Strength Adam Bryant PRI Impingement and Instability Course Notes Here is the Active Midstance Test Here’s the Copenhagen Adduction Test Bill Hartman A Randomised Controlled Trial of ‘Clockwise’ Ultrasound for Low Back Pain E-Stim and BFR Perioperative Pain and Swelling Control in Anterior Cruciate Ligament Reconstruction Dry Needling 1 Course Notes Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:   Knee Pain Modalities

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Stress Response, Proximal First, Sensation Loss, and Your Health – Movement Debrief Episode 12

Let me guess, you are devastated you missed last night’s Movement Debrief. You should be. It was by far the most interactive debrief we had yet. Loved how active everyone was, and definitely some people help me get better. Kudos to Steve, Jo, Yonnie-Pooh, and the many others who commented on today’s Debrief. Here’s what we talked about: How the stress response impacts many areas Treatment hierarchies How to restore sensation loss post-surgery Functional Medicine Why taking care of your health helps others If you want to watch these live, add me on Facebook, Instagram, or Twitter. (occasionally) They air every Wednesday at 8:30pm CST. Enjoy. Stress Response Proximal First Sensation Loss Your Health

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Manual Therapy Musings

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: Spinal Manipulation Institute’s Dry Needling 1

You Mean Zac Didn’t go to a PRI Course? Yes. From time to time I occasionally take a gander at what else is out there in PT land. It was probably about time I check out this whole dry needling thing and see what the fuss is about. I took the Spinal Manipulation Institute’s version based on some recommendations from a few colleagues I trust. Ray Butts was MC’ing for the weekend. I know needling is quite the controversial topic, but I was amazed at the sheer quantity of evidence supporting this modality. Like, an insane amount. I am not sure what the “haterz” found their criticisms on, so please comment if you have some ammo (I am a noob to this after all). And Ray’s lecture on dry needling mechanisms? Oooohhh lawwwwd. Easily one of the best foundational science lectures I have ever heard. Period. The passion this group has not only for science but the physical therapy profession is inspiring. They made me excited to be a PT. Perhaps even inspired me to contemplate the PhD route. All that said, I am unsure as to where needling will fit into my practice. The assessment that would point you toward needling someone was sorely lacking. I’ve noticed this problem to be quite common in manual therapy courses. It’s pretty much you hurt here/have this diagnosis, then use this protocol.

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The Sensitive Nervous System Chapter IV: Central Sensitivity, Response, and Homeostatic Systems

This is a summary of Chapter IV of David Butler’s “The Sensitive Nervous System.” Intro Central sensitization is a phenomenon that occurs in the dorsal horn, which can be best described via 4 different states: 1)      Normal: Inputs = outputs; innocuous sensations are perceived as such. 2)      Suppressed: Inputs that would hurt do not; think an athlete who injures himself but finishes the game. 3)      Increased sensitivity: Pain system has lower activation threshold, leading to pain spreading and pain with light touch and gentle movement. This change occurs because A beta fibers begin taking over C fiber locations in the dorsal horn. 4)      Maintained afferent barrage, CNS influences, and morphological changes: Long lasting changes in the dorsal horn from a persistent driver, such as… A fiber phenotype changes. Persistent DRG discharge. Persistent inflammation. Supraspinal influences Gene transcription change in dorsal horn neurons. Inflamed dorsal horn or DRG Maladaptive beliefs, fears, and attitudes. Dorsal horn sprouting; A Beta fibers take over C fiber space. Persistent glutamate activity. Descending Control The CNS has an endogenous pain control system which activates during injury threat, noxious cutaneous input, or expectations and learning. Such an example of this is when you go to a healthcare practitioner’s office and no longer hurt. Another example of when this system is activated is during aggressive manual therapy. Think about how good your body may feel after sustained pressure or even a needle to a trigger point. Central Sensitization Patterns Areas/descriptors Symptoms not in neat anatomical/dermatomal boundaries. Original pain

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