Modern Manual Therapy Blog

There are a lot of amazing stories out there about the Apple Watch. It's a successful wearable, it upended Fitbit, it has saved lives by detecting falls and irregular heartbeats. In this Untold Physio Stories, our special guest recounts how the Apple Watch caused an injury.

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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 Andrew Rothschild at Modern Patient Education.

Keeping it Eclectic...


Pain Science Education is one of the best things to ever happen to the rehab profession. I remember just how eye opening and mind blowing David Butler's first Explain Pain course was in 2002. Yes, I took it 17 years ago. I remember thinking, this is going to change EVERYTHING!



Everything should be made as simple as possible, but not simpler -- Albert Einstein

We've all heard of KISS, No, not the rock band that grew to fame in the 80's. I'm talking about the phrase "Keep It Simple, S....(insert your word of choice)" Within our profession, there has been a propensity to make things more complex than necessary Why is that? There are several possible explanations. I heard Greg Lehman (@GregLehman) make an interesting observation while on the Chews Health Podcast (@TPMpodcast) and more recently the NAF Podcast with Adam Meakins (@AdamMeakins): "There are a lot of smart people in the profession. It's hard to get in [to school] and you work really hard and I think there's a desire to do something that's complex because simple makes it seem that anybody can do it." 

That does make a lot of sense. However, do patients want what's simple? Ideally, I think so, but I so know that if we each reflect upon our own clinical practice, we'll probably find several examples of a strange balance between the simple and complex.

Early in my career I ran into a situation that illustrates why I think phyios struggle when it comes to keeping things simple. The patient was a middle aged female that would have been every McKenzie MDT instructor's dream demo subject. She had low back pain with radiating pain into the right leg. Symptoms peripheralized with flexion and centralized with extension. I sent her home with prone press-ups as her primary exercise with standing repeated extension for her to do during the work day. I saw her for a second visit and she was already significantly better. We continued with press-ups without any force progression as that was all that was necessary to centralize/abolish symptoms. She demonstrated improved lumbar flexion motion on re-assessment without production of low back or leg symptoms. I had planned to continue and gradually reintroduce flexion in a future treatment as long as it was indicated, but she never came back. When I called two weeks later to follow-up, the discussion that followed was not anticipated.

"You didn't do anything" was the response I received when I inquired as to why she had not followed-up with her appointment. (Remember, this was very early in my career when my patient interaction skills were still quite lacking! But I remember the conversation almost verbatim) "What do you mean?" was my reply.

"I was expecting a massage or something more." So there we go-- lesson one, establish/understand expectations. 

"Are you having any back or leg pain now?" I asked. "No." "So, you're better?" "Yes." "Then I don't understand; how is that you say I didn't do anything?" "Because all I did was that simple exercise that I could have done by myself!" And there it is. 

"But you didn't come up with it by yourself, did you? You came to me and I determined that was a good movement for you to do. I could do that other stuff, but I didn't think it was going to be as beneficial for you." Silence. And then, "Well, I was expecting something different." I don't remember exactly how the conversation ended, but you get the idea. 

While that very well may have been an example of how NOT to perform a follow-up patient interaction, the point there highlights what some  physios do fear with regards to simplicity. However, there are times when patients do gravitate towards simple, as in the explanation by physicians for the reason for their back/leg pain as a "pinched nerve." We know that's rarely what actually is happening and the true reason is often more complex. 

Simple with exercise is usually good. Most patients will struggle with movements/exercise with too much complexity. Even if it's the "best" exercise, if they do not do it, it's not very effective. However, something as simple as a Farmer's carry is met with skepticism. "What is this supposed to do?" I'll get asked. "Why don't you go walk to the end of the room and back and when you get back you tell me what you feel?" What can I say, I'm a smart-ass. 

via Dr. Andrew Rothschild, DPT, FAAOMPT
Lead Instructor: Modern Patient Education
Mentor: Modern Rehab Mastery
@spear_physio

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Keeping it Eclectic...


On this episode, Andrew talks about a PT colleague with recent onset of TMJ pain after hiking. What was the novel solution this time? One that you wouldn't guess! Check out Andrew and Erson's new online mentoring group at Modern Rehab Mastery!

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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 Andrew Rothschild at Modern Patient Education.

Keeping it Eclectic...


Even the APTA has a white paper on appropriate loading for older individuals. The short of it is that PTs and other rehab professionals often make mistakes with their strengthening programs. Here's a quick infographic from Brad Beer @running.physio on instagram.
[STRENGTH SUNDAY] 5 STRENGTH TRAINING MISTAKES TO AVOID 🚫 _ πŸ‘‰πŸ»Endurance runners must perform strengthening exercises to realise a raft or benefits (improved running economy, bettered time trial performance ⏱, reduced risk of injury ⬇️ + more)πŸƒ‍♀️ _ ☝🏻Here’s 5 mistakes to avoid to ensure you are getting the most out of your strength work exercises πŸ“Ά πŸ’ͺ🏻 _ πŸ“ŒTAKE HOME: check your program for any of these common mistakes this week coming ✅ πŸ‹️‍♂️ _ ‼️If you know a runner this can help please tag or share it with them ✋πŸ»πŸƒ‍♂️ _ ❓Q’s and comments are welcome . . . #physio #physicaltherapy #strength #rehabilitation #sportsscience #resistance #training #marathon #marathontraining #runstrong
A post shared by Brad_Beer Running.Physio πŸ‘ŸπŸ‘πŸ» (@brad_beer) on




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Keeping it Eclectic...


A #MMTTV Q&A from a student of my online course - Modern Manual Therapy: The Eclectic Approach to UQ and LQ Assessment and Treatment - https://modmt.com/onlineseminar had a question.
In this story, Erson recounts trying it "his way" with a hamstring strain on an otherwise healthy young athlete. After getting little results with increase in function after light soft tissue work for a few weeks, his intern politely asked for a change on the patient's behalf.



Subscribe to Untold Physio Stories
Search for Untold Physio Stories on your favorite music/podcast apps!

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 Andrew Rothschild at Modern Patient Education.

Keeping it Eclectic...



πŸ›‘Here are a list of myths that are commonly believed and still taught despite there being a wealth of evidence to the contrary. I've believed most of these things at some point in my 20 year career and the reason is always the same. We are victims of our own success. You apply technique or exercise "x" - it works, and the mechanisms or reasons behind why it works or why you're supposed to use it are automagically validated. πŸ§™‍♂️

I'm not saying don't use these things if they work for you. What I am saying is you can do things differently than the way they're traditionally taught. Don't try to force someone into explanations they're not ready for. Don't use painful treatments, even if research shows it's ok to load a tendinopathy into pain; you're kind of a jerk if you can actually make it more comfortable for the patient using some modulatory technique.

What are some of the things that you used to do or believe that you've changed over the years? If you haven't changed a major belief or school of thought recently or ever, might be time for a change!! If I could give up my beliefs or use of some or many of these things, you can too! πŸ€”

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Text placeholder by Erson Religioso III


Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

Learn more online!


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...