The Eclectic Approach to Spinal Manipulation: Chilean Style! | Modern Manual Therapy Blog

The Eclectic Approach to Spinal Manipulation: Chilean Style!


My first international course in Chile was just this past weekend! Excluding Canada, America's hat! Sorry Canada, living in Buffalo, it just felt like driving to teach there wasn't the same as teaching in a completely different country!


With the minds behind TherAdvance, Nelson Adrian Serrano and Hernav√°n Salinas Verdugo


What an honor to be invited and to be faculty for TheraAdvance, a group of educators with a very diverse and naturally eclectic background. Plus it's nice to be introduced by someone who can pronounce my last name correctly, because I'm NOT Italian... the "g" makes an "h" sound!


I want one engraved like this!

Disclaimer! I am definitely not opposed to chiropractic, just bad clinicians, passive treatment, and straight subluxation based theory. I feel like the PTs who are doing all the modality slinging and seeing 4-6 people an hour are just as bad... plenty of patients to go around for the good guys.

Differences

I learned that Physiotherapy in South America has it's differences and similarities to the US. In regard to spinal manipulation, there are still chiropractors who tried to get this course banned. However, unlike the US, chiropractic here is not well known at all, as it is not a regulated/licensed profession. In fact, the "chiropractors" are actually physiotherapists who went through a diplomat program, and now call themselves chiropractors. The same goes for osteopathy. So the majority of the licensed manual therapy in Chile is performed by physiotherapists. Naturally, when the only opposing group is actually the SAME profession as the group hosting the course, the Chilean Physiotherapy Association was in full support of the seminar. There was also some jerk who learned I was going over some Mulligan Concept techniques and also asked if I was "allowed." The official Mulligan Concept instructors for South America also had no issue... of course this guy is a soma simpleton, so that's not really a surprise now is it... Eat that Nicolas!

other differences

  • lack of chiropractors mean the population is not used to maintenance adjustments
  • manipulation is not taught in ANY entry level physiotherapy program
  • there 20 physiotherapy schools in Santiago alone, 15 popping up in the last 15 years, and I thought Buffalo had too many at 3!

Similarities

The similarities to what is going on in the US are unfortunate. Many of the participants have either recently taken diplomat programs or advanced Masters in OMPT. They were or are currently still being taught that

  • palpation for position
  • palpation for motion
  • specificity is possible 
  • specificity is needed
  • pathoanatomy, inflammation and the typical medical model for pain
  • emphasis on special tests, and not classification
One of the TherAdvance instructors told me the Physiotherapy program he teaches for just dropped their 1 year of OMPT in the curriculum, for yoga therapy and more modalities! WHHAAAAAAT????

deep squat pwned!

A Chilean Teapot

Mini case to be posted on OMPT Channel, physiotherapist in MVA two years ago, had been treated by co-workers with no relief. However, like many was really doing nothing about it (co-worker Tx were just here and there, no HEP). Right sided neck pain with left cervical sidebending. Cervical retraction with SB and overpressure decreased the pain, remained better as a result. A little IASTM t the right cervical patterns and a right lower cervical downglide thrust significantly decreased the discomfort for HEP. He was very happy.

Language Barrier, what language barrier?
All interpretation was expertly handled by Nelson and some by Hernavan. It was strange having to wait for a joke to be laughed at until the interpretation was finished! Also, try explaining to someone who does not speak or understand English that the Multisegmental rotation test should be observed from behind, he just kept performing the test instead of turning and facing the other way!


The reception to the course has been great and everyone is had a blast learning the new techniques. It's nice to know that the audible "gasp" I often observe by females after a cervical thrust manipulation (cavitation or no) still happens here.

Rocabado's co-workers, they told me he wanted to visit me but was out of the country!
Still flabbergasted he remembers me from taking his courses 8 years ago!


Let's play find the Filipino!
Here are some vids for your viewing and listening pleasure




Keeping it Eclectic and Spreading the Ease...

16 comments:

  1. The top physical therapy specializations include cardiovascular/pulmonary, geriatric, pediatric, orthopedic and sports therapy. These are far from the only physical therapy specializations, but they are probably the most sought-after services in this field. These five specializations are listed in further detail below.

    ReplyDelete
  2. Dr. E,
    Sounds like you were welcomed well! Good to see the knowledge spreading overseas too. I always thought we were behind in regards to OMPT, but doesn't seem so in Chile.

    Keep up good work for our profession.
    Best
    Harrison

    ReplyDelete
  3. Pablo Neira StegmaierSeptember 16, 2013 at 8:47 AM

    Thumb up for Dr. Erson and the TherAdvance Group for this course, really happy and a complete mind blow with the simplicity and efectivity of the approach, just very very happy, can wait to finish "The Eclectic Approach" courses and another visit of Dr E in Chile, now it's time to try the Edge Mobility Band, courtesy of the TherAdvance Group

    ReplyDelete
  4. Thanks! Let me know your results with the band! Also, can you upload the vid of me using the band on the guy with limited/painful hip flexion and internal rotation? Message me at

    ReplyDelete
  5. It was fascinating to see they have similar problems with using physical agents and many physio's there seeing 4-6 people an hour. i thought that may be unique to the USA

    ReplyDelete
  6. "... of course this guy is a soma simpleton, so that's not really a surprise now is it... Eat that Nicolas!"


    Soma simpleton? Wow. Stay classy, Dr Religioso.
    www.somasimple.com

    ReplyDelete
  7. Yeah sure, says the teapot to the kettle. Nicolas Sepultiva tried to get my coursed banned from Chile for teaching Mulligan MWM. Go back to bickering among your forum where all the top posters agree with each other.

    ReplyDelete
  8. Just because you do not agree with one's position on who should be teaching Mulligan( and with baseless accusations), that does not mean that you get to insult those who post @Somasimple the way you did. What makes you think that's OK?

    ReplyDelete
  9. It's not baseless. The TherAdvance instructor, Nelson, told me Nicolas "reported" my course content to the official Mulligan concept instructor in Chile, who had no issues with me teaching it, and was happy that I was doing so. Love it how it's ok in your forum and on others to be argumentative and rude, but once it's thrown back in your face, you can't handle it...

    ReplyDelete
  10. Hi Erson (DPT)
    I wonder if you ever worry about hubris?
    This MD did. A very thoughtful opinion piece. I reckon it is very easily applied to PT.

    http://www.drjohnm.org/2013/07/changing-the-culture-of-american-medicine-start-by-removing-hubris/

    I applaud your wish to be at the peak of your skills, but your confidence in some of these techniques makes me worry that you are teaching Experience Based Practice...rather than...well, you know...being a DPT and all.

    Many thanks
    Wynn

    ReplyDelete
  11. Hi Erson,
    I also take exception to the "soma simpleton" crack. I think- I hope- you're above that kind of broad brush insult. The person you referred to as a "soma simpleton" and "jerk" has in fact only posted 14 times in over 3 years, so he's not a "regular" by any measure.

    Also, I think Dr. Jason Silvernail, a published PT researcher, peer reviewer, post-graduate doctor of science and Lt. Colonel in the US Army with service in combat zones, has earned a higher order of respect from you as well. To scold him like you did was very unbecoming. Jason is one of the most even-handed and thoughtful therapists that I know, and I don't doubt that he's destined for making very significant and important contributions to our profession. Having said that, Jason and I have both been around SomaSimple for nearly the same amount of time, and I can assure you that we have had many disagreements over the years in discussions there, so your echo chamber charge is not only insulting, it's inaccurate.

    ReplyDelete
  12. Erson,

    Yes, manipulation is well researched. Ultimately it proves to be no more effective (I feel sure that you know how to find the Cochrane Library). A recent review for SMT and chronic low back pain suggested (quote):

    "High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain."

    And similarly for acute low back pain:

    "SMT is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies."



    You may not do it to be showy, yet you acknowledge that there is much theatricality. Does it not remind you of close up magic, sleight of hand? Is that ethical?


    Where is the high quality evidence for scraping the skin with instruments?


    Where is the high quality evidence for poking people with needles?


    With all due reverence, Erson, this is what I am talking about. Experience is a form of evidence; but is it good quality?


    Wynn.

    ReplyDelete
  13. You're right Wynn, I guess I better stop teaching it. Oh wait, I'm teaching it RIGHT NOW, for the Pitt Marquette Challenge. The problem with you EB Police is that you only critique with nothing constructive to offer. Why don't you teach a course or blog about what we ALL should be doing. Anything can easily be proven or disproven. Very few studies are repeated or validated and if attempted validation, a good percentage are not found to be statistically significant the second time.

    ReplyDelete
  14. I just wanted to provide a brief list of individuals in the
    PT research and clinical education community who have been interviewed at SomaSimple.com:

    Steven George, PhD, PT- Associate Professor and Assistant Program Chair, University of Florida program in Physical Therapy. Premier clinical PT researcher in the area of spinal manipulation and the role of fear-avoidance beliefs in persistent musculoskeletal pain. Member of editorial boards of both the journals Physical Therapy and JOSPT

    Michael Shacklock, M.App.Sc., Dip.Physio., Author of Clinical Neurodynamics, published researcher, international lecturer and course provider in clinical neurodynamics for treatment of musculoskeletal pain problems.

    Joel Bialosky, PT, PhD, FAAOMPT, OCS- Clinical Assistant Professor at University of Florida program in Physical Therapy. Leading researcher in the area of developing explanatory model for the mechanism of manual therapy. Received “Excellence in Research Award” from JOSPT in 2009 and “Best Paper” award from JMMT in 2011.

    Nicholas Lucas, DO, PhD- manual therapy researcher and published author in peer reviewed publications with emphasis in the area of reliability and validity of clinical testing and myofascial trigger points.

    Adriaan Louw, PT, PhD- Director of International Spine and Pain Institute, published clinical PT researcher, international lecturer on treatment of pain utilizing biopsychosocial approach including “Therapeutic Neuroscience Education”; author of published clinical manual on educating patients about pain pre-lumbar surgery.

    Not bad for a bunch of simpletons.

    ReplyDelete
  15. Wynn, I'm not offended, I just grow weary of those posting links to research without knowing how I practice, or what I am teaching. If you regularly read my blog, and it's clear that you do not, or attended any of my courses, you'd know that I teach and believe that the effects of all manual therapy is transient, and I consider it just a tool to get the patient to perform their MDT based HEP. I'd like to think that using manual therapy to make a well research HEP, even in long term studies, to make movement less painful, or not at all, thus making a patient more compliant, and reducing visits, costs, and making them not reliant on the practitioner is something we should all strive for. However, you wouldn't know that since you're making broad assumptions and not knowing anything about how I practice and teach. Sorry for the run on... but it gets old getting links, but nothing very constructive.

    ReplyDelete
  16. I just wanted to provide a brief list of individuals in the
    PT research community who have been interviewed at SomaSimple.com:

    Steven George, PhD, PT- Associate Professor and Assistant
    Program Chair, University of Florida program in Physical Therapy. Premier clinical PT researcher in the area of spinal manipulation and the role of fear-avoidance beliefs in persistent musculoskeletal pain. Member of editorial boards of both the journals Physical Therapy and JOSPT

    Michael Shacklock, M.App.Sc., Dip.Physio., Author of Clinical Neurodynamics, published researcher, international lecturer and course provider in clinical neurodynamics for treatment of musculoskeletal pain problems.

    Joel Bialosky, PT, PhD, FAAOMPT, OCS- Clinical Assistant
    Professor at University of Florida program in Physical Therapy. Leading researcher in the area of developing explanatory model for the mechanism of manual therapy. Received “Excellence in Research Award” from JOSPT in 2009 and “Best Paper” award from JMMT in 2011.

    Nicholas Lucas, DO, PhD- manual therapy researcher and published author in peer reviewed publications with emphasis in the area of reliability and validity of clinical testing and myofascial trigger points.

    Adriaan Louw, PT, PhD- Director of International Spine and
    Pain Institute, published clinical PT researcher, international lecturer on
    treatment of pain utilizing biopsychosocial approach including “Therapeutic Neuroscience Education”; author of published clinical manual on educating patients about pain pre-lumbar surgery.



    Not bad for a bunch of simpletons who live in an echo chamber.

    ReplyDelete