Ten years ago, I would have scoffed at this list, yet here I am writing it now. I find that every 2 years on average, I am changing something about my practice, often dramatically, or adding a new assessment and/or treatment to the tool bag.
Here are 5 Modern Ways to Look at Manual Therapy
1) No one has "magic hands"
- years ago if a patient said I had magic hands, I'd puff out my chest in pride, and say, "Thank you!"
- now I realize not only do you not need magic hands, as MDT proves with repeated loading and unloading of gross osteokinematic movements, but you do not really need palpation skills either
- treating patterns or larger areas with soft tissue work as opposed to looking for the minutiae of small restrictions, TrPs, etc
- you do not need to waste your valuable time palpating because
2) You do not need to be specific
- not only do you not need this, you cannot be specific
- you can choose say to mobilize different groups of 5-6 levels of vertebrae, but you certainly cannot move just two
- in the research non specific techniques work just as well as "specific" techniques, and MDT has known this for years as they mainly advocate general osteokinematic patient generated forces
- these days I mainly assess active and passive planar movements and rarely if ever do spring testing or PIVM
3) Bone or Tone?
- this is a question I present often at The Eclectic Approach Seminars
- meaning if you "spring" or "palpate" an elevated first rib, it feels pretty hard, right?
- then you can perform the lightest #IASTM for 1-2 minutes along the cervical paraspinals and upper trap patterns
- re-test the springing.... now the "bone" is gone... bone or tone?
4) The effects of any manual therapy technique you do can be replicated by the patient's HEP
- manipulation or mobilization - replicated by repeated end range loading
- IASTM - either self rolling, wrapping with an EDGE Mobility Band for increased movement/decreased threat, or the improvements are kept with repeated end range loading
- neurodynamics? - the same movements should be prescribed to be performed regularly throughout the day
- I should mention that kinesiotaping is also a great way to keep the tone reduction and mobility improvement effects going after IASTM or a technique like TDN
5) Manual therapy is a shortcut
- despite not being "magic" or "specific" or even difficult to perform, manual therapy is still a very powerful tool
- it's a shortcut those of us who are licensed to perform can use to improve pain and movement, as well as decrease threat to either
- I just make sure to tell the patient that the effects are powerful, and often rapid, but something they must continue to keep up with, if they want at least part of the improvements to remain between visits
- we can enhance the placebo effect with manual therapy, if a patient has a preference for tissue work, manipulation, use that to your advantage
Keeping it Eclectic....