Top 5 Fridays! 5 Commonly Believed Myths in PT | Modern Manual Therapy Blog

Top 5 Fridays! 5 Commonly Believed Myths in PT

Another Friday, another difficult time coming up with a list. The more you teach, the more you get asked the same questions over and over, even from regular blog readers!

Here are 5 Commonly Believed Myths in PT

1) McKenzie practitioners are afraid of flexion

  • back when MDT was disc centric (is it still? - I haven't taken a course in a while), it made sense to avoid flexion and promote extension
  • however, even McKenzie had an anterior derangement, with the directional preference of extension, that was typically blocked by extension, and improved with repeated flexion
  • even if extension of the cervical spine or lumbar spine is what centralized and abolished a patient's pain, the recovery of function phase made sure the patient was able to flex without blocking extension or reproducing complaints
  • in other words, it was always part of MDT to restore flexion, and make the patient realize it was important not to be afraid of it, and that pain free function in all planes was necessary to be ready for discharge

2) It makes a difference when you tape origin to insertion vs insertion to origin
  • seriously? SERIOUSLY? Deforming capsule and fascia, yeah that made sense before it was debunked, but this... really people?
  • when someone asks me that at almost every STM course I teach, my reply is would putting on your pants right leg first, then left leg would make a difference in your hip ROM
  • or a woman putting on a dress over her head or pulling it up from her feet would make a difference
  • it's tape on skin, there is a big proprioceptive effect, and it's non specific, so sure sham taping works as well as the actual "patterns"
  • take a RockTape course if you want to hear updated mechanisms and research on power and endurance that has significant effects

3) SFMA says (or Gray Cook says, or I've even heard Erson says) treat the distal DN before the proximal DP
  • I even asked Gray when I met him, at IFOMPT
  • during his keynote, he did state going after a distal DN, you are very unlikely not to flare up the proximal DP, but at some point, you are going to tackle the proximal DP
  • that's why I advocate IASTM then repeated motions to treat the proximal DP, then go after the distal DNs for prevention or overall movement pattern improvement

4) "Adverse Neural Tension" needs to be stretched out
  • this is an outdated term, because it implies the peripheral nervous system scars down, or loses motion due to adherence
    • while peripheral nerves may be tethered (see Bove's research), leading to an AIGs this is far from an entire nerve that is somehow bound down, needing plastic deformation
  • performing neurodynamic tests and mobilizations may bias a certain nerve, but there are so many other tissues you are affecting
  • plus, just like any other tissue, the rapid changes are neurophysiologic, which is why I only use neurodynamics as pre-test, post-test movements and use IASTM or EDGE Mobility Bands to decrease the threat and improve the movement tolerance
  • If I do use neurodynamics as mobilizations, maybe the pt does not prefer light scraping or has a latex allergy, I would still start with sliders and make the techniques as Sx free as possible

5) Diaphragmatic breathing is the only way to breathe
  • it is true that mechanically it is more efficient and that neuromechanically, sternal breathing can lead to many different types of dysfunctional presentations
  • However, using the Capnotrainer and getting ETCO2 baselines has shown me for some, deep, slower breathing may be overbreathing, thus giving off too much CO2, and changing pH in the bloodstream, lymph, and interstitial fluids
  • if someone is overbreathing, they first have to learn an appropriate breathing pattern to get their ETCO2 levels to WNL, and then see if any of the unexplained complaints change
    • one example of diaphragmatic breathing not being appropriate I learned from Better Physiology is restrictive clothing may prevent comfortable diaphragmatic breathing, thus causing abnormal breathing patterns and learned habits
  • after being able to get in and out of dysfunctional breathing habits, then go after the mechanics of breathing
Bonus: It does not matter which way you wrap an EDGE Mobility Band; it can be proximal to distal, distal to proximal, clockwise, etc. It's just compression. Also, it does not get rid of gnarly adhesions. It just reduces threat and possibly redefines a smudged limb in the homuculus with even the lightest compression.

The EDGE/EDGEility Tools, CupEDGE, EDGE Mobility Bands are all still on sale through! Get them while they're hot!

Keeping it Eclectic....


  1. Great post Erson! I think you may have gotten the wrong SFMA logo haha

  2. Always enjoy your posts!

  3. Thanks John! I enjoy others enjoying my posts.