Thursday Thoughts: Another Way to Use Eccentrics | Modern Manual Therapy Blog

Thursday Thoughts: Another Way to Use Eccentrics

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This year, one of the changes to The Eclectic Approach seminars is the structured way I teach treatments. I may not follow these in order for every patient, but in general, the way I use these treatments goes from simple to more complex.

The current sequence of treatments are
  • repeated motions
  • Positional Inhibition
  • Joint Stimulation (my modern term for mobilizations)
Any of the above can rapidly restore threat free motion. Lately, I have been experimenting with loading the newly restored mobility.  If...
  • the directional preference is fully restored with motion and pain free, plus
  • all ADLs are pain free for 48-72 hours, and
  • the direction opposite the directional preference DOES NOT, cause increase in Sx or loss of mobility
  • it's time to load!
I suggest firing the agonist at mid range, and then applying a light eccentric load, then again at 3/4 range, and then again through the full range. Here is an example
  • patient with left cervical and upper trap pain
  • repeated cervical retraction with SB left centralized and abolished pain
  • repeated cervical flexion or retraction with SB right did not reproduce Sx or cause motion loss to the left
  • start with head bent left and left scapula slightly elevated, place resistance hand on superior left scapula
  • cue, push upward toward my hand, but let me overcome your resistance, start at mid range scapular elevation
  • repeat this 2-3 times, if pain free repeat again with a head in neutral and scapula slightly more elevated
  • if this is pain free, repeat again with scapula in full elevation and cervical spine bent to the right for another 2-3 reps of light eccentric through the full excursion of the muscle groups
This is an example which is harder to use as a self treatment, but they can do something similar holding a weight in the involved side hand and do eccentric shrugs, or teach a friend or family member to replicate this eccentric load a few times/day.

Is this necessary with most patients? Most likely not, but it is useful to challenge the tissues and CNS to loads greater than the inputs you get from normal ADLs. Apply this to any current athlete or regular gym rat who you have restored mobility, but they are having difficulty with restoring capacity.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...


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