There are some in the manual therapy world that have moved on beyond specificity and pathoanatomy who believe the "art" of manual therapy has been lost. The "art" as it stands now is not in the isolation of joints, fascia, or nerves, but interaction, education, and framing the treatment as a means to an end, not a solution. Here are 5 Concepts of Modern Manual Therapy
1) Replacing "specificity" with treating adjacent areas up and down the chain
- 20 years ago, I learned you had to isolate the hypomobile (and thus pain generating - duh!) joint with your hands, and thousands of hours of practice on as many patients
- a common theme in courses from IASTM, to needling, to neurodynamics is to treat the neural container
- example - wrist pain (or CTS like complaints)
- old school - wrist mobilizations and stretches, neurodynamic tensioners that feel like lightning shock of pain/paraesthesia
- new school - light IASTM along medial upper arm, forearm to decrease perception of stretch in a neurodynamic, cervical repeated motions to centralize complaints, joint mobilizations to any of the joints making up the neural container
- the new school method can affect the local complaints, but treat many areas that have no association of threat
2) Replacing appropriate aggressiveness with soft, confident hands
- I used to teach students all about the stress/strain curve, and to push, push, push, until you deformed and elongated fascia/joint capsule
- getting results made me think force was necessary
- there are patients who absolutely believe a hands on technique will be beneficial, and you owe it to the patient to take advantage of this placebo or patient's belief of positive effects of a preferred treatment
- hand contact may start - if the patient is not too guarded physically or emotionally during the history or even leading the patient back to the exam room
- a gentle pat on the back, or holding an elderly patient's hand as you walk them to their table
- for joint mobilizations, lay your hands on the patient, and use full contact to increase surface area, but only use as little force as necessary to stimulate the nervous system
3) Replacing "this technique is going to fix you" with "this technique will temporarily make your nervous system give a green light - the rest is up to you"
- many of us old school clinicians and I'm sure #FreshPTs got into this business not only because we wanted to help people, but we loved being able to "fix" people
- magic hands used to be the best compliment, now I cringe at the mention
- even if a patient has the strong belief that manual therapy fixes them, I start with the education about what not only mine, but previous treatments do
- Pt: adjustments put my pelvis back into place
- Me: I do plyometrics - huge jump landing in a squat or single leg landing - what uses more force - an adjustment or this landing?
- verbal and physical examples of the magnitude of force our bodies can withstand without subluxing, deforming tissue, etc make a patient realize that the forces have to be modulatory in nature and not physical
- the next step is to explain the transient nature of any "fix" they may have received
- I often say, "What every movement, position, or hands on treatment is applied today, the window of improvement is temporary, and it's up to you to keep the improvement going between visits."
- my example is, "Having regular passive treatment like manipulation without homework is like asking me to run on the treadmill for you and expect yourself to get more fit."
4) Replacing Muscle Energy Technique with Plain Old Isometrics
- What's MET other than fancy PNF?
- 18 years ago, I learned standard osteopathic assessments and treatments but since I like to "fix" people, I preferred manipulation over MET
- like much old school assessments and techniques, MET and type 1 and 2 lesions are bogged down in specificity and minutiae
- any time a patient has pain during movement or end range, lightly resist into the direction of loss, often after several sets of light and possibly greater (or lighter) resistance, the movement is now threat free
- forget about isolating muscles or joints, since it's not possible, and it's much easier
5) Replacing the technique emphasis with an education emphasis
- even if your patient believes it's the technique that fixed them, you still need to get across that maintenance of the improvement is up to them
- some busier clinicians complain that they do not have time for a lengthy pain science or education session
- work it into the treatment, or as the patient is warming up, reinforce each session with previous concepts gone over in the last
- the nervous system is easily tricked, but not easily convinced
Keeping the Window of Improvement Open
These concepts represent the new "Art" of Manual Therapy. Want to see them in action? Check out the tons of live cases on Modern Manual Therapy Premium!
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...