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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Why Everything Works (and Doesn’t Work)

A Great Place to Be I was recently at my home away from home, IFAST. Every time I go here the following occurs: I have an amazing time with amazing people. I learn a ton and realize how little I really know. Prolific discussions are had. I end up purchasing WAY too many books as soon as I get home. As many of you know, Bill Hartman and I appreciate a PRI philosophy. When I go to IFAST, we inevitably experiment with many different things. This weekend, Bill and I were playing with how many different ways we could achieve full right shoulder internal rotation on my good friend Lance and the lovely IFAST intern Liz. Here was everything that gave these people full motion. Soft tissue mobilization to the infraspinatus. Manually assisted breathing. Tickling the right side of the face. Tapping the left hamstring. Smacking the right glute max (yes, I spanked someone). Having someone think about contracting their right glute max as hard as possible. Having someone watch me breathe with a left sidebend. Reflex locomotion. Now of course, that does not mean you should be spanking your patients and clients with shoulder issues (but if you do make sure it is the right glute), but we have to ask why did all of these different techniques–even the weird ones– achieve the same outcome we wanted? Why Things Work Joseph Brence, a gentleman whose material I enjoy, recently posted a blog showing several different techniques and polling his

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