Top 5 Fridays! 5 Easy Explanations for Common Treatments | Modern Manual Therapy Blog

Top 5 Fridays! 5 Easy Explanations for Common Treatments

After reading the blog for a while, or after taking one of my courses. I am often asked how I explain certain treatments or exercises to patients. Here are 5 Easy Explanations for Common Interventions

  • studies show it is near impossible to break up scar tissue
  • surgeons have difficulty cutting it with a scalpel
  • this is to prepare them that the lightest skin stimulation is often enough to make rapid changes, no "bashing, smashing, bruising needed"
  • the virtual representation of the body in the brain becomes blurred/smudged upon being in pain or not moving for only a short while
  • lightly scraping the skin helps redefine this blurred area, plus sends the brain, that is under alert, a message that movement is ok

2) Joint Mobilizations/Manip
  • every manual treatment goes back to the cortical smudging initially
    • making sure to say also that the blurred area has a loss of awareness, ownership etc
  • "wiggling" the joint in various directions provides bombardment of the brain with healthy, novel, and non-threatening joint information
    • normally the brain perceives movement in the area as threatening
    • or has altered the motor control/coordination of the area for so long, it needs a "reset"
  • the information, being novel, often resets the alarm in the CNS, which then raises the pain and movement thresholds back to pre-threatened levels

3) Motor Control/Stability Exercises
  • "core strength" is not correlated to pain
  • when the brain is threatened, pain alters motor control/coordination
  • when I move you (passive) versus your active movement, there is much more movement and/or less pain
  • this indicates you have the movement, and your brain is either limiting it, or no longer knows how to access it
  • choosing a strategy that changes the pattern, or breaking the pattern down into pain free parts eventually convinces your brain that the movement is threat free

4) Repeated Extension in Standing/Lying
  • your nervous system thrives on variety
  • the average person flexes forward 1000s times/day
  • on occasion, too much forward bending, or combination of forward bending and rotational movements sets off an alarm
  • with back pain, most people try to repeatedly "stretch" it, meaning further unloading
  • the directional preference, or direction that allows you to self treat works best when it is a novel strategy
  • getting to end range eventually convinces the nervous system that movement and bearing load is now ok, raising your pain and movement thresholds
  • the above explanation also works for cervical retraction (restoring ability to load, full ability to load keeps the nervous system threat free)

5) kinesiotaping
  • it's tape on skin!
  • there is no magical properties of taping a certain direction (and most likely specific patterns do not matter either)
  • normally I apply it after an input, i.e. IASTM, so the tape is a type of novel stimulation that gives the brain awareness to an area that could use some
  • as a clinician, my clinical decision making tells me someone would benefit from taping when they benefit from any manual therapy but particularly IASTM or broad based tissue work
  • for me, it is for my less compliant patients or those who need more stability in single limb stance in the beginning to solidify their motor patterns

What I stress to all patients is that all manual therapies, corrective exercises, repeated loading strategies, etc, are all inputs. The reasons why they tend to work better than passive modalities is because they require a degree of skill to implement, teach, and thus have more expectation behind them. Some nervous systems have preferences, some will respond rapidly, others need a bit more convincing before they stop policing the area in question.

Keeping it Eclectic....


  1. Good Morning Erson,

    I do not disagree that Joint manipulation provides a novel stimulus to the CNS. The works of Pickar has show that SMT stimulates peripheral mechanoreceptors/muscle spindles to provide a novel stimulus to the CNS. Additionally, the work of Murphy has demonstrated direct CNS changes with joint manipulation to the cervical spine. Please remember that the "true" therapeutic mechanism of SMT has not be proven or agreed upon in the research. Recently, Fritz, Kawchuk et al., demonstrated that local spinal stiffness changes with SMT and that was correlated to decreased pain in a group of participants with LBP. There are two categories of suggested therapeutic mechanisms for SMT, those that fall under the neurophysiological category and those that fall under the local mechanical/biomechanical category. While I also feel (only opinion, but based on support) that the majority of the benefits of SMT are likely neurologically based, we simply do not know. Thanks for listening.

  2. Thanks Shawn. At this point I really do not separate mechanical from numerological. It would be like trying to isolate a VMO. Probably not possible or worth the effort. Are you faculty of a certain Institute?

  3. Thanks for reinforcing the messages we can drive home to our patients. One question related to the repeated extensions item. Would you, in the words of another MDT practitioner, keep it simple and sagittal, before exploring side to side possibilities with repeated movements? Or, for example with LBP, would side gliding be a preferred starting point over REIS?

  4. It depends on the patient, but as a pattern, I check SGIS first for unilateral loading issues on the involved side. Especially if extension in standing, they deviate away from the involved side. This is a shortcut I noticed MDT Diplomats that I was mentoring in my clinic go right to from experience, but not how it is taught in MDT A