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 1% of the population needs surgery, yet insurance still covers it.”
• “Patients who underwent surgery did not see a good PT.” ~Stanley Paris

On Posture

• “Posture is a reflection of your attitude toward life.” ~ Stanley Paris
• Posture is a risk factor, not a causative factor.

On Treatments

• Kinesiotape provides a constant stimulus to the nervous system. May allow for better superficial fascia movement.

On Home Exercise Programs (HEP)

• “We can only help someone if they can help themselves.”
• Manual therapy effects last 5-45 minutes. The HEP keeps this longer.
• “If you walk out of here feeling better, you make it last.”
• Keep the HEP simple so patients are more likely to do it.
• Nice cue for cervical retraction: Pretend your chin is on a table and an ugly guy is trying to kiss you.
• If something stops working, something changed with the exercise. Make sure they are doing it right.

On Manual Therapy

• Everything we do is neurophysiologic. Otherwise huge range of motion changes in quick timeframe would likely rupture muscle.
• End range is key to creating rapid change. This is due to increased mechanoreceptor firing. It is easier to get to end range with closing patterns.
• Posterior to anterior intervertebral motion (PAIVM) at one level moves two adjacent levels above and below. So don’t even think you can be specific.
• Manual therapy is unplugging and plugging in the router.
• We cannot change bone position, but we can change how people move.
• “If I don’t have to cause pain, I won’t.”
• “I don’t document levels anymore. We cannot be specific.”

On Soft Tissue Mobilization

• We can only change superficial fascial fibrosis, as it takes 100-200# of force to deform deep fascia 1%.
• Ultrasound research shows greatest tissue changes occur within 2 minutes.
• Restrictions are the superficial grit and fibrosis and require quick light strokes with a tool.
• To change tone use slow, light strokes with a tool.

On McKenzie MDT

• Stoplight rule
  • Red light: Pain increases and remains worse, then change direction.
  • Yellow light: Pain increases, but does not remain worse. Not hurting, so keep going.
  • Green light: Pain decreases, so continue with direction.
  • HEP performed 10 times per hour to reinforce gains.
  • Classify your patients into two types.
    • Fast responder: insidious onset. Contrary motion and closing pattern is key.
    • Slow responder: Multidirectional ROM limitations. Likely will not make major changes in 6 visit timeframe. These people need tissue to adapt, and work best in mid-range.
    • A slow responding area is usually adjacent to a fast responding area.
    • The disk reducing explanation is not correct with McKenzie, because the end range principle works at joints that do not have a disk.
    • Operator vs. instructor.
      • An operator has magic hands to help the patient.
      • An instructor teaches the patient how to get better on their own.
      • McKenzie is not for pansies.