Thanks to Physio Answers Contributor Dr. Aaron Swanson for this idea.
I notice (as well as my former patients) that my practice, interactions, education, and techniques change every few years, often dramatically. Here are 5 Texts or Articles That Changed My Practice.
1) Fascial Plasticity: A New Neurobiological Explanation
- for those of us firmly entrenched in PT Peer reviewed literature, there is a lot of other literature out there done by tissue researchers, one of the foremost being Robert Schleip
- in this two part must read article, Dr. Schleip goes over many modern theories of what tissue work is (mostly neurological) and what it is not (deformation)
2) The neurophysiological effects of a single session of spinal joint mobilization: does the effect last?
- this and a similar study on manipulation are ones I often cite
- The neurophysiologic (i.e. rapid changes) last minutes at best and up to 24 hours for analgesia
- what's the solution? Give the patient homework to keep the reset going
- this is why MDT based HEPs, or at least a mode of prescription that keeps the window of improvement open work so well
- after reading this article 3+ years ago, and then believing it, I started using lighter and lighter forces with tissue work and IASTM
- essentially, it states using hundreds of pounds of force deforms fascia 1%, and even that 1% is transient
- I explain the use of excessive force in manual therapy by thinking of very athletic functional events like running, plyometrics, etc...
- if you think your directed force is "breaking up scar tissue," "deforming fascia," or "stretching joint capsule," then running and especially plyometrics would literally tear us up!
- many of you have expressed interest in Capnography and the Capnotrainer that I use
- the researcher who founded Better Physiology wrote this
- it gives a basis for why capnography and a patient centered approach to learning improved breathing patterns is important
Lastly, and most importantly.... drum roll....
- this sums up all the modern theories along with a great research review to back up why modern manual therapy approaches need to be viewed as neurophysiological and not just mechanical as is still taught in programs not only in entry level but also in accredited fellowships
- take time to read it, and realize it's the best current way we have of describing the effects of what we do
These are 5 articles that changed the way I thought, or practiced or both. Some were hard to swallow coming from a traditional manual therapy background. Once you get over yourself, and the fact that you were probably too aggressive with many patients, and that what you were taught was woefully incomplete, or just plain incorrect, it's liberating!
Keeping it Eclectic...