Last weekend I had the opportunity to attend Dr. Craig Liebenson's seminar for the second time. I first saw Craig over 4 years ago in Toronto and that review can be found HERE. It was funny reading my old review because much of my thoughts on the course and its content have not changed except for a few key details.
When I first took his seminar I was less than 2 years in practice and was still very new to a lot of the concepts being taught. This time, with more years under my belt, I was better able to understand the concepts being presented and had a firmer grasp on how to apply what works for me and leave behind what doesn't. Unlike 4 years ago, this time I was actively thinking about patients in my practice that would benefit from the concepts taught without overwhelming myself with minutia. I felt better able to appraise what was being taught, both the good and the not so good.
First of all, this course is almost impossible to review based on its concepts because it doesn't really have any specific method or model to it. This course was a mishmash of content derived from many other schools of thought. The course notes, I must admit, aren't fantastic as they are mainly filled with quotes, pictures, and charts without much context as to why they are there and how to decipher their applicability to what we do in our practices. This makes going back to review the material challenging as there is minimal framework as to why certain slides are put into the manual. In short, the manual is hard to follow.
Here is a sample of what was touched on
- The inactivity crisis (obesity, diabetes, low back pain prevalence etc)
- Postural "dysfunction"and our culture of sitting
- Exercise as the best medicine
- Traditional vs functional approach
- The "Mag 7" functional exam (Toe touch, wall angel, overhead squat, single leg balance, single leg squat, single leg bridge, respiration/belly breathing)
- Stuart McGill's "Big 3" (Bird dog, curl up, side bridge)
- Kettle bell exercises
- Core activation drills (wall press dead bug, side plank hip thrusts, stir the pot, plank rolls)
- Crawling patterns and the developmental sequence
While sitting in the audience listening to the course content I made a list of what I liked about the course and what I really thought could have been done without or at least modified. I will share a few pros and cons as I saw them.
Pro: Craig is fantastic at getting his audience to change their gestalt on patient care. He challenges course participant to incorporate more active care into the assessment and treatment of each patient. He is very good at giving tips and "tricks" to help patients see the value of active care over a passive care. I talked to a few people in attendance who really wanted to try more active care in their practices after this course and I think that's fantastic.
Con: Many times on the course he would use a demo who had pain doing a task such as a squat and would do an exercise drill with them, often targeting the core or another area of the body far removed from site of symptoms and then re-assess their pain in front of a crowd of at least 75 people. Each time the participant would say they felt better and was better able to do the functional test they had issues with before the exercise intervention took place. No one ever said what Craig did with them didn't help (I personally never bat 100, do you?) This smoke and mirrors show wowed me 4 years ago, but now I kind of take it with a grain of salt as anyone when pressured by a course instructor in front of a huge crowd of peers would say they felt better due to confirmation bias. Dr. Andreo Spina has an excellent video explaining why he doesn't use demo's in his course. Basically, you can temporarily trick the CNS into "better" movement but the results are often very short lived. I think without knowing it, he may have made it seem like a simple corrective exercise is a cure-all, when we know it's not. One other point that needs mentioning is that when he was instructing participants on how to do the exercises, he made it look easy. The problem is that most clinicians aren't treating healthy and fit 20-30 year olds with awesome body awareness, which is what the crowd demographic was. We are treating chronic pain patients with huge gaps in motor control and exercise capacity. This fact alone makes applying the concepts much more challenging then was let on in the course.
Pro: I liked how Craig was able to introduce the audience to many other approaches such as SFMA, DNS, McKenzie etc without bashing any one approach, stating many times that they each have value and are all tools that can be used depending on the patient in front of them. Many times I have found course instructors need to bash another courses or instructor in order to legitimize their methods/ideas. This manufactured controversy might appeal to contrarians (like me) , but it also looks unprofessional. I like Craig for his non-guru approach to functional medicine and does a fantastic job of letting people know their are "many roads to Rome" as he liked to say.
Con: This next point is just a personal opinion, but I found the lecture components to be quite preachy at times. At one point I counted over 25 quotes, one after the other, in his power point slides. He literally read quote after quote, which I think only served to dissuade the audience from paying attention because it started to feel more like a church sermon then a rehab course. Only this time it became quite confusing as to how and why certain quotes fit into the topics we were discussing. I personally could have done without the excessive number of quotes used to drive home points.
Pro: Simply put, I got some pretty awesome corrective exercise ideas that help with "buy in." Since the course I have incorporated some of his exercises like the side plank hip thrust as a post test "re-set" and have had great results. For example, I had a new patient who had ++ knee pain with single leg squatting. I had him do it 3-4 reps, each time being sore. I then had him to the side plank hip thrusts with the painful leg on the downside and after about 10 reps we re-tested his single leg squat and he literally said "holy shit, how did you do that!?" because his pain was virtually gone. Now, I know that won't last and there is a lot he needs to keep doing, but nothing beats that kind of buy in for patients to trust what I am saying and the motivation to comply with the home program. I am also sure a number of other drills would have worked, but hey..I can't argue with those results. In all fairness, there have been a few other cases where the corrective drills didn't make a change and I needed to think of other things on the fly. The course just gave me more ideas that really help the patient see the need to do exercise to help with their pain complaint. For this reason alone the course was well worth the time.
In all honesty I took this course again to help motivate me to keep pushing active care in both my assessment and treatment. I found myself "succumbing" to patient preferences for passive care and as a manual therapist it was easy to do that. It's a huge challenge in a service industry (and yes, private physio is just that) to not cave to what the patient wants. I always give exercises based on what I see as being issues, but I found myself being more lax with patient compliance. I needed a kick in the butt to get creative to find ways to get better buy in because I am a firm believer that passive care is great and helps with symptoms, but it will not provide the fix patients need if exercises isn't the staple of the program. And I know I get so much more job satisfaction if patients get better quickly and their goals are met. That just doesn't happen nearly as well with passive care (manips, mobs, needles, soft tissue therapies etc). This course was great at giving that push I knew I needed.
Overall, I would recommend this seminar for it's inclusiveness for other ideas in the rehab world and as a way to get your feet wet in the "functional" approach if you are growing tired of a structuralist model of looking at the body. You can find out when Dr. Liebenson will be in a city near you by clicking HERE.
Please feel free to ask me any more specific questions you have about this course in the box below :)
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...