Top 5 Fridays! 5 Ways to Get More Out of Your Manual Techniques | Modern Manual Therapy Blog

Top 5 Fridays! 5 Ways to Get More Out of Your Manual Techniques

Here are 5 ways to maximize your manual/physical therapy.

1) Educate the patient about the technique

  • indications/contraindications
    • patients are more likely to tolerate a manual technique if it's uncomfortable (different than painful) if they know why you are doing it
  • their options
    • what may happen if they choose not to have a certain treatment
      • i.e. thrust manip vs mob, manip may improve ROM and pain faster for a few visits but in the long term will have the same effects 
2) Always take pre-test and post-test measurements of motion/function
  • one of my most important points during OMPT teaching is: if you're going to cause a patient some discomfort, there better be a demonstrable improvement afterward
  • motion/function is easily measured, just choose one thing to focus on improving
3) Give 1-2 home exercises maximum to lock in the corrected and improved movement/function
  • less = more, the patient is more likely to be compliant if they're only doing cervical retractions, or lower body rolling patterns until the next visit
  • if they get worse, and you gave them 2-3 things to do, which exercise was it? Was it a combination? You may not know until you remove 2 of those things and that was a visit that rings negative in the patient's mind
4) Think outside of the box
  • too much tone to make headway with STM/IASTM? Use reciprocal inhibition of the antagonists to quickly decrease it (vids coming up for OMPT channel subscribers sometime next week)
  • alternatives to traditional joint mobs
    • stabilize the part you normally mobilize and mobilize the other (mob scap on stab humerus, or mob cranium on stabilized mandible)
    • perform STM in a tissue folded position to make it more tolerable
    • perform STM in a tissue lengthened position as a force progression
  • combine techniques
    • perform JM while in neural load
5) Be interested, not interesting!
  • Some patients like participating in conversation around the clinic, others are very egocentric and only want the visit centered around themselves
  • learn to recognize this and focus on and listen to the patient actively
  • ask them occasionally how they are feeling, especially as the technique progresses
  • even if they come in acutely painful, be very positive and explain the acute phase is the BEST time to treat, "As quick as you flared up, we can just as quickly find some relief."
  • ask them about their family, job, etc... remember these things and personalize the visit
I hope everyone has a great holiday weekend (in the states), be sure to sign up for forum when you get a chance!


  1. Great post Erson!

    Just a question related to your assess-reassess point. After you do say a T-spine roll down manip or lumbar side posture oblique gap manip, what do you do to reassess motion? I know you're not a big fan of using PIVMS to determine joint restrictions, so how do you objectively assess and reassess intervertebral movement? I only ask because this is something I want to do more of and would love some ideas that make it clear to the patient what has improved post treatment....It's nice when clients get off the bed and say they "feel looser" but I would love something objective to show them.

    Thanks for the great post!


  2. Thanks Jesse, are you going to IFOMPT? Anyway, for thoracic, it could be anything from shoulder elevation to gross trunk rotation either in sitting or something like the SFMA's multisegmental rotation. After lumbar, it is most likely something like lumbar flexion or extension. Essentially I pick an osteokinematic deficit or functional movement that is limited and/or painful, treat, then remeasure. Think osteokinematic for reassessment, not arthrokinematic, makes it more reliable because it's simple.

  3. I figured I would make a comment here too Jesse and I would say I agree with E about osteotomatic vs arthrokinematic as the latter can be very one sided from the clinician and the patient may not 'see' the change like we do. Just an example on Friday, patient had peripherlization to distal posterior thigh with standing lumbar flexion (sciatica as laymen term) and after treatment, just simply got her up to retest it. She was amazed at the no 'pulling' sensation and could even flex further. No bias from me there, it's all about her and this is what she will go back and tell family/friends. Me telling pt that I feel more motion is like a Cairo putting back up an x ray after months of treatment and saying see here, it's more aligned (and pt sits there having no idea what to look for and agrees...furthering the paternalistic approach of treatment vs pt taking it into their own hands).

    Sorry, got on a soap box but good stuff E. I will share this will have current student. Well put and seeing in words from an established OM PT means even more ( at least of what I am teaching is credible and not just from a small town boy haha).


  4. Thanks HV! You're already ahead of the game as when I was only a few years out I had the approach that we were talking about giving up above. Great job.