One of the 5 E's of the Eclectic Approach is Easy. After going to school for 6-7 years or more, we tend to want to complicate things. What we do, it's not rocket science.
Here are 5 (Easy) Difficult to Grasp Concepts of the Eclectic Approach
1) Do not treat pain with pain
- not sure where fighting fire with fire came from, but treating pain with pain = not that effective
- sure we all got people better by cranking on them, hell, I used to tell patients to suck it up because it they'd move better afterward!
- with what modern pain science tells us about central sensitization, pain thresholds and perceived threat, if someone comes to you in pain, does it make any sense at all to hurt a patient to improve their pain?
- discomfort to tolerance may be unavoidable, but pain, is a no-no
- you still make rapid changes with very light forces
- experience tells me that changes will be even more rapid when the interaction is positive, educational, and the techniques are comfortable
2) End range is the END of the physiologic range
- go FARther, not harder
- it is often surprising and scary for patients and even clinicians to take get to end range
- education on the stoplight rule is key
- a patient's physiologic end range is just that, their own built in limit, THAT is where the magic happens
- by "magic" I mean bombarding the CNS with healthy and novel proprioceptive information that is non-threatening
- when a patient says "I do not think my back/neck is supposed to bend that way" - my reply "That's like saying my elbow bends this way, but not the other. It's motion you're supposed to have"
- you cannot abandon MDT or looking for a directional preference unless end range is reached, repeatedly, or held sustained
- a few weeks ago, my vidcast was called treating the ipsilateral side, that was misleading, it should have been called, treating the agonist
- I wanted to convey we're not treating "muscles" per se, only enhancing movement
- however, when doing IASTM to the quadriceps to enhance ASLR, that's not really the ipsilateral side, but the muscles that need to be activated, rather than "stretched"
- loss of cervical SB to the left, simple, start with treating the left side, NOT the right
- I sometimes treat the antagonist, just not that often these days
- 1-2 minutes of treatment per pattern, if no changes are made, change the pattern or technique
4) Less is more
- COTW for next Monday, a grandmother of a current intern
- she was scheduled for disc replacement and her grandson could not convince her to avoid this
- she tried other clinicians, but nothing helped
- after much education, we found DPs for both her cervical spine and lumbar spine, showed her how to do it at home, never touched her other than light cuing
- the result, left completely pain free after 30+ years of lumbar and cervical pain, surgery = cancelled!
5) Manual therapy is to enhance movement
- wait, that's not so hard to grasp!??!
- the difficult part is letting go of the "magic hands" and control of your patients and using manual therapy to enhance the natural movement most patients already have
- rapid responders can improve with MDT, motor control, manual therapy, etc... manual therapy just makes the first two work
- it's like a cheat to help the patient gain the movement they innately have, but are not using
- IASTM along some patterns, maybe a manip or two if needed
- now movements are pain free to end range = compliance increased and increased chance for successful outcome
- movement patterning restore to the GH joint, scapula becomes a bit more stable, now they can perform KB carries overhead, but prior to manual therapy, they had impingement in elevation
- these examples are limitless, but the main point is the HEP is EVERYTHING!
- without home exercise and education, what we do lasts a short time, patients have to lock in the improvements we make as clinicians themselves!