Having a brand of The Manual Therapist and Modern Manual Therapy is limiting from a certain point of view.
Course attendees and those who watch me interact with patients online or live are always surprised how much of my session is devoted to
- a thorough history
- positive patient interaction
- dispelling myths and misconceptions
- patient education on their responsibility in active care
As much as I emphasize the above points - probably about 75% of my first visit, Manual Therapy is still important, as are working on ways to improve your skills. None of the following suggestions I would consider "traditional" Manual Therapy advice. Here are 5 Ways to Improve Your Manual Therapy Skills
1) Work on a soft and confident touch
- many times during manipulation and mobilization practice, the learner is so focused on getting the "technique" right, they don't realize they have a death grip
- or, during simple P/A mobilization of the spine, they are contacting with the pisiform, but he rest of the hand is rock solid, instead of gently and firmly evening the surface area with a relaxed hand
- surface area and force are inversely related, so, when force is applied through a greater surface area, it is more comfortable to the patient
- plus, the way I conceive Modern Manual Therapy, you get more bang for your buck the more skin you contact - effecting greater portions of the homunculus
2) Factor the patient's preference for treatment
- if a patient tells you they've had great pain reduction and/or improvement in mobility with IASTM, dry needling, or manipulation -> what do you do?
- you should strongly consider working the treatment they had success with in the past into your current plan
- patient preference leads to positive expectations of benefit, which will effect your outcomes
- check out my favorite CPR development study using patient preference for cervical manipulation
3) Work on explaining why Manual Therapy is indicated in the patient's case
- if the patient does not have a particular preference or belief in any one treatment, next you have to work on selling it
- education that movement is beneficial and not harmful is important
- I like to tell patients that Manual Therapy is a way to trick the nervous system into giving a temporary window of improvement allowing them to move with no/less pain
- this is regardless of technique
- if there are true issues in the tissues - slow responders (frozen shoulder, s/p immobilization), the above still applies for improving discomfort during movement
- in the above case, you have to explain mobility will eventually improve and true tissue adaptations take time
- all of the above are why I think when I do any particular treatment, IASTM, manipulation, etc, I may have success where other clinicians have failed
- I set the stage with education and reduction of kinesiophobia
- instead of worrying about exactly where you are palpating, focus on relaxed hands and relaxed patient
- if you're in the general area, you are OK to mobilize
- don't worry about being on "the Articular pillar" - in my Modern Manual Therapy courses, I say, palate the back of the neck next to the spinous process, that's about as specific we can be with palpation
- specificity in terms of moving just one joint (or only a joint) is pretty much impossible anyway - at least spinal 5-6 levels move with simple grade 3 oscillations
- as Tim Flynn of EIM would say - "Move it and move on...."
5) Don't manipulate or mobilize through pain or tone
- unless the patient absolutely has a belief that only a painful technique will work
- or they have true constant pain - in that case, try not to increase the existing pain
- however, many clinicians mistake increased tone for "hard end feel"
- it's a lot easier to use light IASTM, Positional Inhibition Techniques, or PNF to reduce tone/pain first, then mobilization/manipulation will be pain free
- remember, the goal is not only end range, it's Threat Free End Range
Hope you learned something from the list! These are things that really changed the way I practiced and improved outcomes more than practicing specificity and hand placement for thousands of hours. Thoughts? Chime in below or on the Facebook page!
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...