Top 5 Fridays! 5 Lessons From a Recent Mentoring Session Or Things I Learned the Hard Way | Modern Manual Therapy Blog

Top 5 Fridays! 5 Lessons From a Recent Mentoring Session Or Things I Learned the Hard Way

I want to reiterate some advice I learned along the way from course instructors and my own mistakes.

1) We can't help everyone

  • this stemmed from an online telehealth session with a colleague from NYC and one of his patients
  • she is doing much better but has plateaued and recently flared up with some unusual complaints suggesting occipital nerve irritation
  • the point was that this colleague does "not give up on anyone"
  • I asked if he felt he could help 100% of the patients get 100% better
  • I told him what older MDT research stated about signfiicant changes in first 2 visits, and you're unlikely to make significant and/or rapid changes after 6
  • he's been at it for months (we've all done this), but also she is a chronic pain patient from a whiplash injury
    • recent research by Jull, et al has shown even the best evidenced based approaches do no better than the control group with this particular subset of patients

2) Referring out is not giving up, it's another way to help the patient
  • the patients should be assured that if you cannot help them, or they plateau along the way, that you have a plan B
  • I keep a short list of specialists I would refer out to for a second opinion or alternative treatments
    • neurologist
    • physiatrist who does TrP injections
    • acupuncturist
  • my thought is either they have an actual disease process that needs to be looked into, or they need an alternative input to their CNS to change the output of pain or motor control that you cannot provide
  • after a few sessions of these alternative treatments, the goal should be to follow up with you again, maybe your treatments/HEP will stick then
  • I also have to say most PTs say "Please refer to me" but think they can do it all so do not refer back
  • a great way to build relationships with referral sources is to have it work both ways

3) Know your limitations
  • As a profession, we should be at the primary care forefront for all kinds of neuromusculoskeletal conditions
  • we are better prepped to Explain Pain, Assessment movement, make rapid changes, and educate on self treatment than most others offering passive treatments only
  • how this differs from point 1, is that you should know your limitations/weaknesses as a clinician
  • my list would be
    • vestibular treatment (always had someone in the office to refer out to until recently, this will have to change now)
    • the 4x4 matrix of corrective exercise - haven't taken FMS or SFMA 2, so I just make them up, but it helps to hear ones that work great and from the horse's mouth
    • my impatience for noncompliant patients
    • scapular stability exercises - hey, I learn from Cressey, Weingroff, and Reinold too!
    • I am not great with names (why the patient is there and their movement, yes... names... not so much)

4) Go home and be yourself
  • as a novice clinician, I used to obsess over patients I was not helping, and sometimes lose sleep over it
  • I would then see that patient's name on my schedule and get that sinking feeling in my stomach
  • Greg Johnson of The IPA said he learned from Maggie Knott (PNF fame) to go from patient to patient and forget the last
  • he then passed that onto us, try your best and move on
  • if you've educated them, tried your best treatments that work on all similar cases, the patient is compliant, you have done your best
  • go home, have your favorite drink, listen to your favorite music and spend time with your loved ones and be fresh for the next day

5) Work on your patient interactions
  • a colleague, Mark Strickland, told me he would tell his employees, "Be interested, not interesting"
    • we all love to talk about ourselves, which is why "I" is the most commonly stated word
    • the patient is there for you to listen to them, if they ask about you, or you eventually have a rapport and they know all about you and your family, that's different obviously
  • I'm not great with names, but here is a tip I learned from my buddy Jesse Awenus
    • write down your patient's name, kids names, where they go to school, what sports they play etc, so you can engage your patients better
  • read Therapeutic Neuroscience Education to realize why you have to soften your words and make your interactions very positive for those in pain - seriously, how many times do I have to recommend this text?
Any advice you had or lessons learned over the years? Share in the comments below! Have a great weekend and forget you're a clinician for once!

Keeping it Eclectic....


  1. A great book for relating to people (and not talking about yourself all the time) is How to Win Friends and Influence People. I'm reading it now and about a quarter of the way through. Helps to build trust and tricks to get to know people better.

  2. Stacy, I have it in my kindle library, it's on my huge list of to reads! I can always tell when someone takes a Dale Carnegie course... very interactive and personable.

  3. never take a tough patient friday night at 8 pm

  4. How about no patients Friday night? Used to work that as a new grad. Highest percentage of cancellations

  5. I really appreciate your down-to-earth approach to patient care and therapist care. The content you put out shows a genuine commitment and talent in not only education but also in interpersonal communication. You're open and honest and generous with your time and knowledge. How I wish others could follow your lead. Thanks for a great Friday list that I really related to.

  6. I just found your blog and it looks great. This article in particular is a good one for us all. I had a therapist, Brian Mulligan, PT who taught us Snag,Nags and PRP's a great manual therapy skill. He told us to remember the successes and forget the treatments that didn't help. Not to say forget that something didn't work, but rather don't dwell on who you didn't help. I believe a good referral is useful and if you're not making much difference in 1 to 2 visits, it may be time to change course. Thanks for the great blog.

    What I've found success with is Matrix Energetics as a foundation or umbrella for everything else I do which include Integrative Manual Therapy and other tech. It's a grew way to let go and trust. from there miracles happen.

    Ralph Havens of Ralph Havens Physical Therapy, Bellingham, WA

  7. Thanks Ralph! Never heard of Matrix Energetics, and not sure what to make of their site. How do you incorporate it to your treatments?

  8. Thanks Bob! Patient and therapist care, that may have been one of the greatest compliments I've ever received! Have a great weekend!

  9. hi Dr. E.

    I heard about matrix energetics from our friend and teacher, Kim Burnham, PhD. I read Dr. Bartlett's first book Matrix Energetics in one day and thought it was funny but also that he was telling something true as well. Kim was working in our clinic at the time in San Diego, and having some miracles that were way beyond anything I had seen. So I took the class, a 5 day class and started using it with my clients. The results were crazy and beyond my belief systems, but I kept using it because my clients were healing from all sorts of chronic conditions. It's based on the physics that has shown that there is infinite energy and information in the vacuum. Matrix Energetics is a technology that accesses this; access consciousness and has reliable and reproducible results. It's also fun for therapists and clients. It is easier to demo than explain. If you'd like a demo, I'd be happy to do that for you in a short private session or if you have a group they could do it with you as well. We could do it via Skype. This technology works via phone and Skype. I actually have a Phone client today from San Diego. I am now living by the forest near Mt. Baker Washington and still have clients who seek me out from San Diego and worldwide. Let me know and I'd be happy to show you and you could see for yourself. Here's my site if you'd like to look thru some of our success stories or my blog

    You have a great site and you already do so much for our profession and it's clear you value and appreciate the work. You already do this now.

    if you might be interested in experiencing matrix energetics just let me know. here's my email and a link to our site *