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.
- “If you don’t have a system, you are lost in an evaluation.”
- The SFMA reasons why people get hurt.
- “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.
- 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.
- “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
- “Posture is a reflection of your attitude toward life.” ~ Stanley Paris
- Posture is a risk factor, not a causative factor.
- 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.