Thursday Thoughts: Even More Less is More | Modern Manual Therapy Blog

Thursday Thoughts: Even More Less is More

For those of you who do not follow me on facebook, I recently posted a course participant's comment regarding the amount of force I was using during an IASTM demonstration.

I often post how lightly I use the EDGE during #IASTM, and even regular blog readers who attend my courses are surprised at the complete lack of force. When I was treating Thoracic Patterns, another course participant asked my patient, "What does that feel like?" She replied, "Like a kitten licking my back."

Yes, that is no exaggeration. At this point in my career, 5 years into using IASTM, I barely leave even any redness. Redness when it occurs is mainly due to a lack of lubricant, or using too little. In order to stimulate the skin's mechanoreceptors, the patient just has to perceive it, and even then, what they do not perceive does not mean it is not affecting the PNS and the CNS.

Even More Less is More

  •  the simpler the HEP, the more compliant the patient will be = better outcomes
  • if I can give the patient 1-2 exercises to do at any given time between visits, that's all I will give
  • few patients need actual strengthening exercises (rapid responders typically do not)
  • sometimes a neck patient is only a neck patient
  • treat the proximal DP first, then look at least one joint or area away proximally and distally
  • if the patient has more than one asymmetry, treat the painful/non-painful one first, or the more limited DN/DP and FN next, but do not address all at once
As an example, the triathlete I have been blogging about recently still has not followed up, yet he just texted me over the weekend with "I don't know what's happening, but I had another PR...." That makes 2 PRs and one first place age group trophy just after restoring upper quarter symmetry and proximal DP (shoulder patterns). His chronic knee pain he had for years is gone and I have not addressed his striking pattern or cadence yet. Perhaps I do not have to. 

Sample Shoulder Patient HEP
  • cervical retraction and SB to the involved side
  • repeated shoulder extension or thoracic whips, whichever is more limited
  • lumbar roll to avoid excessive cervical unloading
Sample Lumbar Patient HEP
  • REIS or SGIS
  • lumbar roll to avoid excessive lumbar unloading
  • neurodynamic tensioner/slider if LE neurodynamics still positive after lumbar loading
The repeated motions and lumbar roll are instructed on the first visit, and on the third visit, the repeated loading strategies for the shoulder/thoracic spine or neurodynamic mobility exercises are prescribed on the third visit or so. If there were no more glaring asymmetries in true motion dysfunction or motor control, that may be it for their HEP.

Don't Forget to Remember!
  • rapid and positive outcomes stem from patient education and compliance
  • different ways to engage and positive interactions will enhance each visit
  • prescribe as little repeated motions or corrective exercises as needed 1-2 at most until those are cleared up
  • self assessment further enhances self treatment

Keeping it Eclectic...


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