Top 5 Fridays! 5 Things I Am Glad I Learned This Year | Modern Manual Therapy Blog

Top 5 Fridays! 5 Things I Am Glad I Learned This Year


The learning never stops, the more I learn, the less I know. This is very humbling from a self professed know it all earlier in my career. Here are 5 things I am glad I learned this year.

1) Kinesiotaping using the FMT or RockTape Model

What's FMT mean? It's Fascial Movement Taping. Their slogan of taping movements, not muscles fits in very well to a modern manual therapy approach. Since it's "just tape on skin" how could it matter if you taped proximal to distal, origin to insertion or vice versa? It reminds me of a study I read years ago on McConnell taping helping knee pain equally whether or not the patella was taped medially, laterally, or in neutral. It's proprioceptive or neural.

The advantages are
  • a patient/athlete can wear it all day for several days
    • record holder is a cervical/HA patient leaving it on for 19 days - showering daily and washing her hair every other day
    • this was in cervical and upper trap patterns (not gonna happen with traditional KT Tape brand) 
  • any improvement you get from light skin scraping remains as the mild skin lift mobilizes superficial fascia (possibly) and provides continuous input to the CNS perceptible or not
  • in other words, I use it for those who may not be as compliant with their HEP or need a bit of help in their motor control strategies
2) The Value of Blowing Up a Balloon

The summary is here of PRI's model for breathing using a balloon



Having no formal training in instructing breathing, but realizing it's value after repeatedly hearing it in chronic cervical/HA and lumbar research, I knew it was time to get some training. Enter PRI's approach. I am finished with two of their home study courses now and while it is decidedly heavy on the pathoanatomy, there is definite value in a predictable (but not sure why) test-retest model that emphasizes minimal manual techniques and patient centered HEP that can make big changes.

Just this week, I had 4 patients with severe HA exacerbation, and simple hooklying with feet up on a 2" bolster with the right UE overhead in flexion and emphasizing balloon breathing. Many had difficulty at first, but after getting the balloon inflated, thus getting the diaphragm actively descending, tone noticeably decreases in the cervical, upper trap, scalenes, and SCMs. In other words, all the areas manual therapists tend to attack first. Two patients improved about 50% with my traditional OMPT techniques combined with MDT. The other two did not at all. All four completely abolished HA with just the balloon breathing. It's the cheapest, most effective tool I have come across so far.

3) Compression Wrapping

Plug time! I use my EDGE Mobility Bands on anyone from runners with knee pain to little old ladies with frozen shoulders. Why? They often and effectively enable pain free movement or neurodynamic movement without symptoms. Why do they work? Who knows! What I think is that the compression of the skin and tissues feels very comfortable. Compression often increases stability and reduces the perceived threat of a stretch, pain, or paraesthesia. It's like an advanced form of gaiting. Perhaps it also redefines a cortically smudged limb in the CNS, also allowing for improved motion by shutting off the alarm of the nervous system lockdown.

Advantages over taping
  • it's reusable
  • you can compress the circumference of a limb instead of taping only a pattern
disadvantages
  • you can't wear them during an event or longer than a several minutes
  • no research for pain/motion (I'm working on it) - there is some on for strength training with positive results that Dr. Don Reagan sent me, but I only glossed over them 
4) Getting upset at patient compliance is not productive

See this previous post where I got schooled on compliance. Nuff said.

5) People are willing to go out of network for a good service

My goal is to be a cash based practice in two years. I am starting this on the side as I have a concierge option where I travel to your house (or work place) and do the entire eval and treatment out of my car. I travel with a portable table, EDGEility tool, RockTape, EDGE Solution, balloons, a small ball, and a Jungle Gym XT. What more do you need for most treatments? So far I've only had two clients out of a local TrX gym, but am working on doing the same for a running shop and Buffalo's new Crunch Fitness. Wish me luck!

8 comments:

  1. Erson, let us know how the cash business unfolds. Coming from a personal training background I've always thought it would be a good option.

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  2. very interesting on the balloon breathing...look forward to reading up on it some more!

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  3. It is interesting and very easy to implement. It seemingly makes large changes in tone, ROM, and pain perception most likely due to autonomic changes.

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  4. I will! I have officially stopped taking Medicare primary as the first step since I was only getting 2-4/year anyway. Just not worth all the extra paperwork only to still most likely not pass an audit.

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  5. Big Step doing cash based practice. I'm about 70/30 cash/insurance, the 30 % insurance adds so much paperwork it is sometimes so frustrating. Good Luck E. Do you charge extra for the concierge service? In the UK, there are a few physios who do this exclusively, but do not charge any extra...

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  6. I don't charge extra for the concierge service, just the same I charge for an hourly visit. Most of my visits are 30 minutes for follow up, so in a way they are more, because it always takes a bit longer than when in clinic due to setup, etc.

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  7. Your PRI paper was written by 2 Elon professors and 1 student/graduate of the DPT program. Just a little love for my PT program!
    Also, what's up with a 2" bolster vs 90/90 positioning for the balloon? Just the position I am used to, sure their training has been modified since I took it. And do you have review of the respiration course soon?

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  8. I'll work on a review for Respiration soon, definitely helped in addition to Myokin. the 2" bolster is just another position in addition to the 90-90, I think it's emphasized more in Postural Respiration and the 90-90 is more Myokin, either one seems to work well. The 2" is to put the lumbar spine in more neutral to assist with the diaphragm length tension I think

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