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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Recognizing and Changing Nonverbal Communication Disorders: An Interaction Approach

I was at my local coffee shop the other day chatting with my barista as she prepared my drink. Once it was all said and done and I paid, she wished that I had a glorious day. Glorious is not a word you hear often and definitely caught me ear. You might even say it was salient! I have this thing when someone uses an uncommon descriptor. When this occurs, I typically try to use an even more ridiculous descriptor. I especially like to apply this method to wish someone a better day than I. For example: Joe Blow: “You have a good day.” Me: “You have an even better day.” Glorious is a bit more difficult to top, but in the blink of an eye I was able to respond: “You have a splendiferous day.” Stupid? Yes. Did I get a laugh and a smile? Absolutely. Me doing this silly little thing with people is irrelevant. What is relevant is the speed that I was able to apply this quip. I spouted this word quickly because it fit a common pattern. Pattern recognition is huge in athleticism, medicine, and a multitude of other life facets. But how often do we think of pattern recognition when we interact with individuals? Being able to differentiate what both verbal and nonverbal communication one uses is critical in ensuring a favorable interaction with someone. And if your patient or client doesn’t like you? Fugetaboutit. Let’s look at a very common pattern that if you allow

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It’s the Salient Detection System, Stupid

 Can you tell the difference among pain, depression, and pleasure? From a neurotransmitter perspective, the answer is no (see here and here). How is it that three very different states can be so neurologically similar? I feel the commonality that the nervous system purports reflects a system that responds to stimuli that are deviations from the norm. We call these instances by this word: Salient. Doesn’t that make your loins quiver? Let’s discuss how it works. Here’s your recommended reading. 1. The pain matrix reloaded: a salience detection system for the body (Thanks Sigurd) 2. Stress signalling pathways that impair prefrontal cortex structure and function (Thanks Son) 3. From the neuromatrix to the pain matrix (and back) [Note: Most of this article is an amalgamation of the three articles that I cited above and my own thoughts. Rather then cite every sentence AMA-style, I’ll give the credit to these guys above. Read ‘em and figure out how I put this together. For those who are sticklers for proper reference formatting, the type I am using is KMA-style citation.*] The Pain Neuromatrix Myth Hate to break it to you, but pain ain’t so special. Here’s why. If you follow modern pain science, you may often hear the term pain neurosignature or neurotag. This phrase is meant to describe a cluster of brain areas that are active during a pain experience. Information that can contribute to a pain experience travels to several areas. Some of the big players are the primary and secondary somatosensory cortices (all the

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