It's always refreshing to see a former patient from even 2 years ago noting that I practice differently, explain things differently and expect more of them. I hope you have similar experiences with former patients, after all, we should be moving forward and not stagnating. Here is a list of 5 Things I Have Abandoned (or at least nearly given up) Over the Years.
1) Special Tests
- The first post I wrote on this blog a little over 2 years ago was that Special Tests are not that special
- other than provocation, which just makes the patient not like you, what use are they?
- they often do not guide treatment, and more tell you what not to do, rather than classify a patient and guide your treatment and enhance your clinical decision making
- apparently Tinel was some guy who like to poke people where it hurt, do you want to be that guy/girl?
- a system like MDT or the SFMA guides your treatment in a systematic way by classifying the patient and tells you what do to immediately to help them
2) joint mobilization
- yes, I barely ever do mobilization
- by mob, I mean, uncomfortable or painful grade 3-4 oscillations in AP, PA glides, etc
- when I got into STM after taking IPA courses over 10 years ago, I noticed greater changes in my patients with better gains between visits
- after I adopted #IASTM 7 years ago, and started working on broad patterns instead of specific glides or nonspecific distractions, I again noticed better changes
- for me, joint mobilizations are less comfortable for the patient, work on a smaller area, and take longer to make the same gains you can make with either a manipulation, or light soft tissue work
- most of the patients you see out there will be rapid responders, and any number of techniques you do will get rapid results, why not choose one that is more comfortable and faster?
- I still do MWM and similar techniques, but they are pain free, as a rule
- in my experience, 1-2 fast manipulations (which I also do rarely), or 30-60 seconds of IASTM or Cupping will accomplish the same thing 3-4 minutes of mobilization will do
3) neurodynamics - as a Tx
- I mainly use neurodynamics as a pre and post test these days, and this is coming from a nerve head!
- it's the same reason as above, these techniques can be VERY uncomfortable, after all, who likes lightning shot of pain/paraesthesia with oscillations?
- if I find a limited and/or painful neurodynamic test, I then do IASTM or cupping along a the nerve pattern, then retest
- another option is to wrap the limb with an EDGE Mobility Band and then retest, often after either of these options or both, the previous painful/limited test is now nearly pain free with full motion
- both the above techniques work well as alternate comfortable and non-threatening inputs
- you know they will work and you should be able to modulate pain rapidly if the patient has full motion in all of the components of the test
- i.e. if a patient has full shoulder ER, 60 degrees of abduction, full elbow extension, full supination, and full wrist and finger extension, but the test is limited and painful, they already have the motion, you just have to modulate the pain to make the CNS release it's lockdown
- yes, stabilization
- as in, I haven't taught a side plank, bird dog, or a deep cervical flexor protocol over a cuff that the patient does not have at home in a few years
- I prefer HEP the patient can easily perform at home that are both proactive and reactive
- MDT has a built in assessment and treatment, with rapid results
- if someone flares up, but is already doing perfect bird dogs, then ends up with a huge lumbar lateral shift after lifting a piano, can they do more bird dogs to straighten up?
- much of what happens with stabilization is restoration of motor control and timing, and between MDT eliminating pain rapidly - often restoring motor control, or using a SFMA approach to restoring symmetry and motor control, I find very little use for static movements or movements that require perfect motor control and a lot of verbal and tactile cuing
5) a tie between: piriformis release, and suboccipital release
- ok, I'm getting tired and couldn't think of another broad category so I'll go with two of my previous favorite things to do
- for the first 4 years of my career, I instructed students that they have to be able to do 5 separate 5 minute suboccipital releases without having their hands hurt, and they will be able to by the end of their internship
- while I admit this is a great feeling technique for the patient and a great prep for subcranial shear distractions, so is IASTM to the occiput, and your hands don't hurt doing that!
- piriformis release: anyone with a hip issue used to dread - or maybe not, the good ol' wooden knuckle, my earlier rendition of an EDGE Tool
- now, I'd rather find out what is causing the extra tone and tenderness in the piriformis, plus, I just as much as possible try not to fight pain with pain
- even when patients ask me to do these things - usually former patients from a long time ago, I just tell them there are better, more comfortable ways for either them or me to get the same things done.
I'm sure I will be able to update this list in a few years! Maybe I'll go back to some of them, use them more than rarely, or abandon them completely. By no means is this a request that you do the same, because if these things are working for you, run with them! They were working for me as well, but I moved away from the things that were hard on both my patients and myself.
Keeping it Eclectic...