It Does Not Have to be Rocket Science! | Modern Manual Therapy Blog

It Does Not Have to be Rocket Science!

I find many of my students are nervous to start interning at my clinic whether they have ortho experience or not. By the end of the first week, they are often surprised at how simple the "Eclectic" approach can be.

This post was inspired when I was speaking with Dr. Don Reagan last week. After congratulating him on what a great opportunity Gray Cook has to work with him, we talked shop for a bit. Part of our conversation was the approach we learned to evaluation at the University of St. Augustine. He remembers it better than I do, as it was a handful of years ago for him, and many more hands ago for me! Movement assessment is something like step 13 in the evaluation. That seems.... excessive... but I'm sure Dr. Paris made it work.

After taking a good history, and actually listening to the patient on what movement/positions improve and worsen their complaints, plus functional limitations, it's on to movement assessment. You could look at structure, but do not spend too much time on it, as it may not affect your treatment.

This seems like a reiteration of You Need a System, and it is in a way, but it's something I cannot stress enough. I recommend this order of movement assessment

  • AROM
  • PROM/overpressure
  • repeated/positional alleviation
  • functional movement testing
After finding limits, you then look for things to treat. I look for areas at least in the same upper or lower chain for sedentary individuals, and more for the more active ones. I look for
  • soft tissue restrictions
  • neurodynamic limits
  • junctional zone joint limits
    • OA, AA, CT, TL, LS, more likely to be restricted 
Do not stress out if you missed anything, each visit/treatment/movement is an evaluation!

Rarely on the first visit do I look for "joint" restrictions, as the mobs/manips I choose are based on symptoms and movement loss, not where I palpate the restrictions to be. Research does back up the use of general techniques vs specific, but we all have our go to techniques we find the most useful. That affects outcomes just as much; the techniques you have confidence in and are well practiced will have the greatest effects.

On each treatment, I will do a bit of IASTM, functional release, movement based mobs, maybe a manip, some neurodynamics if warranted; I then instruct on 1-2 exercise strategies to keep the gains made in treatment. I choose strategies that I can hopefully back up with a combination of what works, experience/expertise, and then what is supported by evidence.

So yes, most students find it to be very easy compared to history, AROM, PROM, passive testing, accessory testing, special tests including provocations tests "Ow, quit it!", alleviation tests, quadrant tests, spring tests, PIVMs, and the list goes on. It even gets easier with experience!

Of course, I still believe we need a strong basic science background, and the doctoral education helps us learn many different aspects of PT. We do need to be able to rule in/out different competing Dx and red flags. My exam still takes 30-45 minutes depending on the patient, with time always left for Tx at the end. This also includes my explanation of what I am finding, what to do and avoid, and why compliance is important. My education is also meant to decreased the perceived threat/fear avoidance.

In the end, it does not have to be rocket science, after all, I only graduated at the bottom of the top of my class!


  1. Great post on a systematic system for evaluations. Do you perform any strength testing?

  2. Yes, I do, just only of certain muscle groups that I find to often be inhibited or weak depending on the pattern.

  3. I am curious about how many repeated motions you use initially to discover if one is a fast or slow responder. Of course it varies per case, but it goes back to identifying when the pt is not going to reduce their derangement quickly and to improve outcomes by lightening up a bit or going with a different strategy of MDT (different plane, less over-pressure, different sequence of closing the facets, hold times).

    1. Generally 10-20 if they respond. If not, I immediately start manual to make them reach end range faster.