1) Any One Commercial Model will net you success in 80% of more of your caseload
- nothing irks me more than grandiose claims of many commercial models stating you have to buy into what they do 100% to have success with your patients
- always be wary of those who say "always" and never trust those who say "never"
- if that were true, why do those who don't correct muscle balance, L AICs, unstable areas, correct cerebrospinal fluid rhythms or more still get people better?
- I have no doubt their faculty have success, but a lot goes into that including
- patient expectation of seeing an expert
- the faculty member really knowing how to sell their approach
- I think this starts in PT school on acute care rotations when your CI makes you crank on some unfortunate little old ladies fresh TKA to "get them to 90"
- it is perpetuated by having actually having patients improve after painful techniques like cross friction massage, trigger point release, etc
- I challenge anyone who is reading this, that if your patients are sore after your treatment, you are being too agressive (not counting DOMS)
- you will have better outcomes, and your patients will like you better if ALL of your treatments are pain free
- manual therapy, pain science education and other methods should be used to modulate as much pain as possible
- if pain alters motor control, and you are trying to facilitate certain movement patterns, it's not a great idea to exercise while the patient is under threat
- this does not include those chronic pain/centrally sensitized patients who have to learn to exercise and move while in pain, but even then, it should not dramatically increase with their prescribed exercises
4) Any one treatment or exercise is better than another
- going back to #1, if every treatment/exercise is really just an input designed to change an output, this again depends on patient expectation, preference, and how the interaction goes betwen patient and clinician
- some treatments may be more effective in your experience, but you are probably better skilled psychomotor wise, can explain it better, can make it more comfortable, and can recognize clinical practice patterns that tells you when to apply them
- like my pal Charlie Weingroff says, "Anything can work for anyone"
5) Palpation for motion/position is reproducible between clinicians (or even needed)
- let's face it, you may spend 5-10 minutes doing various palpation testing, only to really do the same needling, IASTM, functional release, joint mobs or manips based on their gross active/passive movement anyway, right?
- why not cut that out and stop poking and prodding and just do the treatments which are not really that specific anyway?
- giving up palpation during evaluation is very liberating and gives you more time to educate and treat, instead of perpetuating sensitization to a threatened nervous system
- even if a patient tells you the most painful spot, or most tight spot is very focal, you can have them palpate it, then you modulate it with your resets, their input is often less threatening than yours
What are the take homes? Stop hurting your patients, soreness post treatment is not normal unless it's from strengthening and conditioning, palpation is not necessary.
Keeping it Eclectic...