Modern Manual Therapy Blog

All Biologically significant events involve multiple senses, and this has obvious survival benefits. When we think of an injury or any event in which pain is expressed in the body, we typically focus on what we are feeling in the physical body. This approach has been reinforced throughout our education, but thankfully we are starting to see a shift from hyper-focusing on the physical location of pain to the whole person. After all, if it was purely a physical issue, shouldn’t we be able to rub, stretch, needle, exercise, or scrape the pain away? Wouldn’t it be great if it were this easy? The unfortunate truth is that we’ve all had clients who just don’t respond to this approach. So where do we go from here? At IKN, we put emphasis on the multisensory nature of our human experience, and integrate multiple senses into pain and performance rehabilitation to facilitate more rapid and longer-lasting change.

What is neurology and why use a multisensory approach?
In order to move and adapt to our environment, we need to receive accurate information through our senses to execute efficient movement patterns. Neurology is the study of how we receive this information, interpret it, and produce an output based on this interpretation. This interpretation is based on two main principles:
  • Survival
  • Movement
Humans are wired for survival. We are constantly scanning our environment for threats to increase our chances of survival. If we interpret a threat, we will MOVE AWAY from the threat to achieve safety.

In Lorimer Mosley’s pain neuromatrix theory, pain can be viewed as a “neurotag,” an output from the brain to help us maintain homeostasis. From an IKN perspective, this “neurotag” can be viewed as a snapshot in time of all the sensory inputs (visual input, sound, smells, proprioceptive position etc) as well as the outputs (pain, feelings) at a particular point in time (injury, stress, trauma). So, what if the body part in question is fully healed, yet another component of that “neurotag” is enough to surpass the pain threshold for you to experience pain? Have you ever experienced smelling something and find yourself reliving a past memory? But it’s not just the memory that comes to your mind, the feelings experienced at that time can also elicited? Why would our experience of pain be any different in more chronic situations?

Let’s say for example you have had back pain in the past after an injury, and after short while of rest and some light stretching it settles back down after a few weeks. Over the next few years you get frequent “episodes” or “flare ups” of the same issue. This may be in part due to the insufficient rehab of the area to improve the cortical representation of that area. Within your nervous system, you have a virtual body map called the sensory cortex that represents every area of your physical body. The amount of this sensory area devoted to each body part is not dependent on size, but how much neurological innervation that area has.


image via http://dc-injuryclinic.co.uk/homunculus-man/

From the image above, we see how the eyes, lips, face, hands, tongue and feet have a larger representation, whereas the lower back and other structures have much lesser. It is postulated that these smaller areas within that cortex are more likely to express pain or stiffness.

Going back to our example of back pain, let’s say they go to their doctor to get an MRI, and told that they have a “slipped disc.” Now, we can say that they have a “neurotag” from the initial experience of pain, and a slipped disc “neurotag” from the doctors words.

Mosley has theorized that these “neurotags” can overlap, and so now when our client with back pain hears the words or thinks of the words “slipped disc,” it is enough to trigger an output of pain, or at least trigger a threat response. This threat response could be in the form of a spike in cortisol, increased tension, weakness, or pain. From an IKN perspective, we have a few different options in how we can help this client. Of course, using pain science education to develop a platform for safety is the best place to start.

We can work through the input phase first by addressing all the neurological and sensory systems to improve the input back to the nervous system and redefine the cortical representation of the back. This may ultimately allow the nervous system to feel safer when we move. With the IKN approach, we utilize a specific sequence of hands on techniques (which can also be self-performed) in a specific pattern to enrich the brain with more accurate neurological input.

We can use certain neurological sensory stimulation drills to improve cortical representation on a different level. With this, our aim is to allow the nervous system to get into the most connected or integrated state by working though the sensory systems, so that when these “neurotags” are activated, it doesn’t cause a threat response and the associated pain output.



image via http://jonlieffmd.com/blog/neuroplasticity-learning-and-brain-circuits

This is achieved by targeting many different sensory systems simultaneously utilizing applied neurological techniques. Additionally, we use many other specific drills and movement patterns to create this sense of integration in the brain and body to lessen the chances of a pain output. The key is integrating as many systems simultaneously to achieve this state of connection, and doing this in simple manner so that it can be reproduced by the client at home. The more resources we can focus on an issue, the more rapidly we can facilitate change. The more we separate body parts or systems, taking a reductionist view, the slower we respond.

With this understanding, wouldn’t it make sense (excuse the pun) to address these along with our current approaches, especially since they may be significant components to the “neurotags” we spoke about earlier? Now, you may be asking, “well we’re always using our eyes and ears, and our vestibular system is always being stimulated with movement.” While this may be the case, we will teach you a specific way to work through these senses to create integration in a very simple manner, but in a manner that makes sense to both you and your clients. Don’t worry, we’re not going to have our clients taste certain foods or smell different things. It is much simpler and more tangible than that. We believe this may be the missing link when treating or training individuals with pain and performance issues. Working through these systems in a simple way, and integrating it with your current skills can facilitate very positive change.

Want to learn more? MMT Webinars is starting back up! Our next one is called

“An applied-neuroscience approach to the treatment of neck pain”

5 Things You Will Learn
  1. Hands-on neuro-stim drills to create the best environment before touching the area of pain
  2. Visual and vestibular system influence on neck pain. It’s not all about proprioception. Integrate!
  3. Neuro-layering techniques to achieve better results with hands-on techniques
  4. Is it really a neck issue or a midline control issue? Ways to assess and approaches to treatment.
  5. How the tongue impacts the neck function, breathing, and the stomatognathic system
Presented by Drs. Ryan Foley, and Kyle Paxton, DPT of Integrated Kinetic Neurology

Keeping it Eclectic...

Space and fuel


There are many factors that influence how and what you feel. Space and fuel you use are two that are instantaneously transformable. Of course what I mean by space and fuel is the environment you are in and the food that you eat.
A key part of managing and building energy is choosing the right fuel. To engage with life and to pursue a purpose, we need energy. And to have energy there are certain practices that are musts, not shoulds. These include a healthy sleep pattern, movement, exercise, a focused mind and the fuel we take on board. The question to ask yourself is:
What must I eat each day to have the energy that I need to feel great and be successful?
You will know the foods and snacks that give you fuel and those that meet a short-term need. The quick fix may make you feel better for a few minutes, but quickly you realise that it is no solution to the energy problem if you are often tired and yawning. Here are some more questions:
  1. Are you tired and grouchy in the morning?
  2. Mid-morning are you struggling and telling yourself how tired you are?
  3. What about mid-afternoon, how is your energy?
  4. Are you enthusiastic about your daily endeavours, or is it often a drag?
The kids and space and fuel
As adults, we shape the patterns of the youngsters by setting the standards. So if we stock the cupboards with sugary things, that is what the kids will consume. We must normalise the good stuff. It is pretty clear now that the gut and brain hugely interact, meaning that the stuff we put inside us affects our emotions and our thinking. At this vital time in life when there is so much learning and development, we often excuse grumpiness and lethargy as being a ‘teen’. Yet when you look at diet and the space that they live in, if it is sugary and cluttered, guess what?
Observing youngsters in their environment you can see how they react. They will of course model behaviours of the adults nearby, so together with the space and how it is organised you can see the patterns emerge. Again it is about setting the standard of what works for health and wellness and what does not. We are both part of and creating the environment in which we reside. There is no separation, and hence to look after ourselves with compassion, we must care for the environment. Kids can understand this at an early age and develop patterns that nourish, nurture and support healthy development.
Tidy space = tidy thinking
Contrary to the common belief, tidying and cleaning are both useful practices. They create the opportunity to build a routine of movement and focus, appreciation and caring. These are all vital for health and wellness. Kids and teens understanding that health and wellness underpin their enjoyment in life are more likely to engage. This is also a chance to share time together and demonstrate the importance of giving, which is one of our human needs. Here is a great little monk’s guide ~ click here.
We are all shaped in our early years, but this does not mean we must continue in that way. Realising limiting beliefs, we can disrupt them and use empowering beliefs to feel great. When we do this as adults, we can then help to mould the youngsters in ways that mean they work to their strengths, building energy, confidence, self-belief, self-compassion, gratitude and generosity. These are all great states and those that drive health, wellness and success.

A fuel exercise
What foods give you great fuel? Make a list if you like, and then plan how you will use these each day. You know that much like cleaning your teeth this is a daily practice, not a one off! Writing things down helps us to commit.
My great fuels are:
1.
2.
3.
To get momentum behind what you are doing, you decide upon a standard that you set in your life. How do you want your life to be? Sustained joy or just meeting short-term needs? If it is the former, then we set that standard and live by it each day, enacted by the moment to moment decisions. Having a standard and a vision of success means that you have a reference point for these decisions: am I heading towards my vision or not?
Here is an experiment you can try (if you are following a medical diet or you are under medical instruction, please check with your provider) => for 2 weeks cut out sugar, red meat and bread and see what happens.

Your space


How do you organise and manage your space?
The environment has a clear impact upon the way we feel, the way we work and our health. On a simple level, being able to move with freedom, locating things with ease and seeing the space around us help to keep clarity. Thinking (cognition) emerges from the embodied person meaning that how your body feels (your physiology and your interpretation of your physiology) impacts upon the way you think and reason. Being cluttered, unable to move and hunting through to find something all result in frustration and suffering states.
Here are some simple questions:
  • Do you put things away when you have finished with them?
  • Do you wash the dishes before you go to bed? Or wake up with them to do?
  • Can you walk round your house without having to navigate bags, shoes and other clutter?
  • Have you got drawers full of stuff that you never look at?
  • Have you got clothes in your cupboard that you have not worn for a year or more?
We change when we are desperate enough. Or we are inspired. Whichever it is, we must associate either enough pleasure with our current approach or too much pain and suffering with a change. This must switch so that there is pleasure associated with new actions: tidying, clearing, cleaning etc. The long-term joy arises from the clarity that emerges, the ease of living, the pleasure of seeing a clean kitchen. What is going to happen if you do not change? What is the cost of that now, and in the future?
Space and fuel are important parts of living a great life. If you have set a new standard, and you have a clear picture of how you want your life to be, getting results and being successful, this becomes a simple way of being.



Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...


Still having trouble restoring SB/rot in the cervical spine? After trying isometrics and various PNF described in part 1 here.


5 Reasons to Consider Nutrition and Behavior Change in Rehab
  1. Nutrition, that being the foods we eat and science behind its digestion, provides energy for our bodies, for our patients’/clients’ bodies. However, proper nutrition does more than fuel day to day activities.
  2. In a rehabilitation setting nutrition can affect functional mobility and recovery. First off, for our patients/clients to participate in therapy sessions, they need to be fueled to do so. But in addition to that, proper nutrition will facilitate more efficient healing, building, and strengthening of tissue, which will ultimately affect functional outcomes. 
  3. Nutrition also plays a role in the development of chronic disease. With proper nutrition, your patients/clients will not only function better, but reduce their risk of developing conditions such as heart disease, diabetes, and obesity. And for the older population, adequate nutrition can prevent malnutrition and the devastating associated effects. 
  4. With the previous three reason in consideration, nutrition will ultimately affect your patient/client’s quality of life. Are they able to thrive in the environment in which they live? And are they able to do so without the burden of disease?
  5. As a healthcare provider, know that you can help facilitate behavior changes if needed. Including changes that can help your patients/clients achieve the benefits of proper nutrition. Though remember, much more goes into merely providing education. Among many factors, medical history and scopes of practices must be taken into account.

via - Dr. Patrick Berner, PT, DPT, RDN - Fuel Physio

If you're looking to add a nutritional screen to your practice, check out Dr. Patrick Berner's awesome resource, now updated with 4 easy to digest (pun intended) sections. The newest section is on patient behavioral modification strategies, definitely important for nutrition and health/wellness.


Keeping it Eclectic...

image taken from learnmuscles.com

I have reviewed some new research that aims at clarifying the information out there.



Patient having trouble with loading one side of their cervical spine? Check out these problem solving strategies when traditional manual therapy techniques like IASTM or joint mobilizations aren't tolerated or possibly indicated. This video is from a Modern Manual Therapy Seminar - click here to check out our offerings and register for an upcoming course!


5 Reasons to Take Our Cervicogenic Dizziness Course

Ever have a teacher that was just unbearably intimidating? Listen in as Erson tries to win one over in this hilarious episode.

Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com .  Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Jason Shane at Shane Physiotherapy.


Keeping it Eclectic...