Modern Manual Therapy Blog
🤣🤣Thanks to @theperformancedoc for uploading these hilarious videos to his instagram! Make sure to follow him on instagram for informative and epic hilarious videos like these.🤣😎

Check out Leon's website here, ptmovementsolutions.com

How Common is Cervicogenic Dizziness in Concussion?
Over 80% of concussions have been observed to recover within 7-10 days, but ~20% of sports-related concussions can take longer than this period of time to resolve.  Predictors and factors associated with a protracted recovery and reasons for post-concussive symptoms can be of many reasons but for the purpose of this post, we will delve into the cervical spine.



What’s more frustrating than a patient who just won’t listen? A provider who has never heard of “Pain Science” and proceeds to tell you what you don’t know about what it is they do. Sigh…
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…

Tendinopathies need to be loaded. However, that can be painful for the patient and this may affect their dosage. Dosage and regular loading is key for the adaptations needed to recover. Where does BFR fit in with this?

Our Untold Physio Stories Podcast is perfect for commutes! Or if you're travelling and want to catch up on interesting stories, cases, or clinical failures that we learned from, listen in an subscribe!

  • a case I had as a #freshPT and one I'll never forget
  • wish Pain Science was even a thing in 1998!
  • two stories via co-host Jason Shane on widely different outcomes for dry needling
  • what symptoms could a bra trigger?
  • a patient ends returning to function and feeling much better despite missing an important pathology
  • when does a rotator cuff tear matter for rehab and return to function?
Thanks to everyone for listening and sharing our podcast this year! On iTunes and Google, our feed has been merged with UpDoc Media's Therapy Insiders Podcast for several months. If you normally subscribe via a podcast app, you're going to have to search for Untold Physio Stories again and resubscribe until it's fixed!


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...


It’s an unavoidable question. Why is school so expensive?! It isn’t a question of if it should be or what education and academia ought to be — let’s just talk about what is.
Well, I’m not in the thick of academics. Therefore, it only made sense to get the thoughts of someone who is. To this, I had the pleasure of interviewing a developing DPT program’s chair and department director for their perspective on the functional economics behind higher education.
The following are summary points from an interview conducted at CSM 2018 with Dr. Stacie Fruth, Founding Chair at the Western Michigan University Doctor of Physical Therapyprogram.

Why Does Grad School Cost So Much?

A Thought Primer
First off, it’s important to express that “No one is targeting DPT or PTA students.” It’s not a financial game or some type of scam… this is all about the almighty “Credit Hour.” So, what’s a credit hour? The credit hour is the unit by which academic programs attribute the necessary hours a week for a course to be successfully ran — at least, that’s what I got out of it from a plebeian viewpoint.
A 3 credit hour course needs to have 3 hours of lecture a week. However, depending on the structure of the program and the institution’s policies, these hours may be more or less depending on many factors. One constant remains: At least for this chair I interviewed, their goal is to contain as many credit hours as possible for their DPT program — for many courses, 3 credit hours may actually be charged to students for tuition; HOWEVER, class may be meeting 9 hours a week. This saves student’s money, but is tremendously taxing on the faculty.
As communicated during this interview, CAPTE requires 90 credit hours in the form of “seat hours.” Classroom hours are different, of course. And, in this complex machinery that is formal academia, both the university and CAPTE have their own requirements… all of which can create a perfect storm making graduate level education more expensive than it has historically been.
Demands On Faculty
Now, before we get into how expensive everything is and the fact that is accepted by most… that education is indeed a business (as is healthcare). Again, we’re talking about what *is,* now what should be… … we need to first explore what is required and impressed upon the faculty — What can they control? What can they not?
Nearly all faculty members have pressures of grants and students… all the time. Beyond this, clinical education is determined by an internal university budgeting process. An increase in tuition dollars come from a pack of reasons. While educators desperately want to give 1 on 1 time, with even simple considerations such as retakes and remediations… “More. More! MORE!” is being demanded of everyone.
Just as no clinician wants more patients and more procedures, no educator truly wants more students.
In fact, the shear time required of faculty to do their jobs can be elusive to the unaware eye. Many see an educator’s life as a cushy gig — 9 to 12 hours of teaching a week? Piece of cake, right?! In reality, educators spend more like 70 hours a week to do their job in tasks that are virtually impossible to streamline. Their responsibilities may include:
  • Spending time with students
  • Grading entire class working of 50 students at a time
  • Online classroom management; setup and materials
  • Committee services
  • Pursuing the “Service. Scholarship. Teaching.” core responsibilities
  • Research projects; coordinating experiments and subjects
  • Writing and publishing; revisions
… Just to name a few. Naturally, none of the above can be predictably or systematically blocked out for efficiency of time. Educators want to press for affordability and relevant topics; however, regulations require divergent efforts.
People Want To Teach
Typically, after a career launch, everyone in clinical care looks to teaching with interest. However, there is way more involved than just showing up to speak in front of a classroom. Typically there is 15 hours of preparation time to 1 hour of delivered lecture time.
As someone who had a teaching residency and speaking frequently across the nation — I can very much attest to this.
Many faculty members have made a habit of making their work “look easy” only because of their own mastery to this craft. It can be promised that there is far more effort than is being shared. On top of this, tenure-ship and scholarship — all done in 6 years within a career pivot, which isn’t a long time, detracts from the teaching element of being an educator. There is also the task of writing scientifically versus writing for research versus writing for scholarship purposes.
Then, there’s this question of: CAN YOU TEACH?! Some of the best researchers are the worst teachers. There’s classroom management, student guidance, and understanding cohorts — identifying when they don’t get it, when they do, when to move on, when to motivate, when to give tough love… it’s a lot to juggle. And, there are institutional leanings that may sway for departmental makeups.
Of course, should anything go wrong, faculty members are put on a process improvement plan… perhaps for the smallest miss which wasn’t even under their control.
To Become An Educator
If you hear yourself thinking “I want to teach,” try out the environment. You can teach through media, through clinical instructorship, through continuing education — there are a lot of ways to be part of the next generation’s growth.
Most people who are educators and thrive in this environment have something in common: To be a part of it, they BELIEVE in it.
50% of people in education have a PhD, EdD, or an advanced doctorate like a PsyD. Some may have their DPT had be board certified. However, a clinical doctorate such as a DPT, OD, DDS… these do not qualify individuals for TEACHING. These qualify professionals to be TREATING. The skill set in managing courses, contributing to the university as a faculty members — all this requires validated “contemporary expertise.” Perhaps the quickest way to this in Physical Therapy is board certification.
“ACADEMIA IS FUN!”

Thoughts & Takeaways

HAVE ALL THE QUESTIONS BEEN ANSWERED? NO.
DO WE HAVE MORE INFORMATION FROM WHICH WE CAN GLEAN POTENTIAL SOLUTIONS? YES!
This CSM interview was quite enlightening. Having the fortune and privilege to have experienced a teaching residency as well as every major setting in healthcare, I hold a different perspective to the flow of economics — and, now, a better understanding with the financial model that is in institutional education.
Now, it was even mentioned in the Private Practice Section exclusive conference called Graham Sessions, that the student debt being accrued is unsustainable and “threatens the health of our profession.” I’m inclined to agree.
So, what’s the solution? We are getting a better picture of even supplying grad school level education; but, what about the demand? How do we make this more affordable, or better yet, a better return on investment?
Here are some off the top thoughts:
  1. We need to make business management, legislative advocacy, public relations & marketing, as well as entrepreneurship — as both an interwoven theme and a forefront focus within our professional education, training, and cultural priority as a profession. After all, it is through these above that industries truly grow — providing a quality product is a mere entry level prerequisite; to go above, you must reach beyond what consumers expect.
  2. We need to leverage technology and content platforms to engage in learning experience that are more effective and congruent with the Millennial economy. Like it or not, here are two facts about our contemporary age: Technology tends to make things more affordable -and- This coming generation of learners are soon to become the next generation of colleagues — not to mention, healthcare providers. It would behoove EVERYONE to work in the channels that most meaningfully connects learners from entry-level to experts. In Other Words: We need more virtual classrooms, learning apps, new models of clinical education and instructorship; we need to re-think what is truly prerequisite upon entry level graduate programs — after all, on international playing fields, there are physicians trained at what is equivalent to undergraduate college prerequisite levels, providing truly skilled clinical care. Let us adopt what is effective, lean out what may be superfluous, and adapt to the coming demands of healthcare’s economic landscape.
  3. We, as a profession and an industry, need to STOP IT with the scarcity mindset. It’s so very quick and easy to turn on each other as competitors; we need to start seeing each other as collaborators. After all, we can only boast 7-9% of marketshare to the musculoskeletal market. EVEN THEN, this means the outpatient Physical Therapy setting is conservatively a $30 BILLION dollar industry — meaning our total value could actually be $300 BILLION if we chose to expand our reach past our current marketing, outreach, and legislative efforts… into the greater consumer populace. RIGHT NOW: If you’re practice primarily runs on word of mouth and medical office referrals… I’m CHALLENGING you to look beyond this singular lead source pool; where else can you find new patient discoveries? where else can you engage your immediate COMMUNITY? HINT: Social Media.

The best answers come from daring ideas. Let us dare to conversate and innovate!



Keeping it Eclectic...

Here's a variation on assessing hip extension based on the SFMA. In this video you can see how to 

➡️look at hip/lumbar extension in standing
➡️tease out which hip is limited in standing
➡️check in NWB/prone actively/passively
➡️runners who are overstriding

Checking hip extension is very important in sensitized SIJ, lumbar spine, and central canal stenosis presentations. Restoring the ability to load in extension can help with a lot of the above listed presentations. For the full mini case check out Modern Manual Therapy Premium! Click Learn More below to see the treatment and HEP prescription.

Quick Hip Extension Assessment


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...


Tired of seeing all the ads, polls, fake news and unwanted opinions on facebook? Do you just want to have a better quality feed that is relevant to what you want to know? Try instagram instead, I tend to keep instagram to professional use, and leave facebook for personal use.

There are a TON of amazing instagram influencers out there, and here are 5 that I check out regularly in no particular order.


Jarod's feed is chock full of messages similar you get with The Eclectic Approach and MMT. Eliminate pathoanatomical explanations, patient education and positive interaction come first. He's also not afraid to debate the old school thinkers out there.


It's great to hear similar messages from different people (tends to strengthen the belief in the message). Anthony Teoli MScPT posts regularly with a similar modern view on assessment, treatment, and patient education. Follow him and you'll get infographics, regular research reviews and more.

💥TENNIS ELBOW REHAB💥 ——— Tennis elbow (lateral epicondylitis) typically involves pain in the region of the lateral elbow where the common tendon for a number of the wrist extensor muscles attaches. Like other tendon issues, resistance training appears to be helpful in many cases for both reducing painful symptoms and improving the work capacity of the tendon. Here are several strategies that you can try if you are currently experiencing pain in this region. . 1️⃣Radial Nerve Mobilization: The radial nerve runs through the extensor compartment of the forearm and may be associated with tennis elbow type pain. The specific movement shown here will put the radial nerve on tension and can be a useful technique for decreasing any nerve sensitivity in the region. . 2️⃣Wrist Extensor Isometrics: Position the arm so that only the wrist and hand are hanging off of the support surface. From here, hold a weight that is challenging and shoot for 4-5 reps of 30-45 seconds. Moderate discomfort is okay while performing exercises that load the tendon. Start with this exercise if your symptoms are more severe in nature and progress to the next one when they dissipate a bit. . 3️⃣Wrist Extensor (Heavy-Slow) Curls: Move through the full range of motion, which will work the wrist extensors both concentrically and eccentrically. Shoot for 3-4 sets of 6-12 repetitions. . 4️⃣Arm Curls with Wrist Extensor Emphasis: In this arm curl variation, hold the bar so that the palms are pointed down. When the bar is in the start position, move the wrist into flexion. As the elbows bend and the bar raises, squeeze the wrist extensors so that the wrist is in full extension at the top of the movement. Slowly control the bar and move the wrist in the opposite direction on the way back down. . Give these a try and let me know if you have any questions. . #RehabScience
A post shared by Dr. Tom Walters, DPT, OCS (@rehabscience) on


Dr. Tom Walters, DPT has almost 200k followers on instagram for a reason, his feed is awesome and informative. As both a PT and a kinesiology professor, his feed sometimes has anatomy reviews/movies as well as movement analysis breakdowns that only someone with his resources can provide. He also has awesome EB posts like the tennis elbow one above.

4) Dr.NicolePT

Dr. Nicole Surdyka, DPT has tons of informative quick videos on her feed. Her experience with D1 Soccer and being a CSCS gives her feed everything from kettlebells, to dynamic warmups, tendinopathy rehab and more.

It's here!!!! Pick up the, "How to Prime the Brain for Neuroplasticity" eBook (link in bio). . For the brain to be in the BEST state for neuroplasticity we FIRST need to restore the general health of its' neurons and microglia. Consider this like prehab for the brain. . 🤔So, how can YOU do this? Well, let's dive into the big 3: . 🍍DIET: Did you know that gut is often called the 2nd brain? Yup! Gut health is HUGE in recovery, especially for those with inflammation as a component of continued symptoms. We can reduce inflammation and increase gut health with diet. . 🌜SLEEP: Essential for us all of us, but often affected after concussion. Sleep is when the brain rids itself of waste and toxins. I'll show you a few techniques to help you catch some quality Zzz's. . 🌿CALMING THE AUTONOMIC NERVOUS SYSTEM: The autonomic nervous system is meant to keep us safe. In concussion recovery we often see folks struggling with sympathetic dominance, meaning the brain didn't get the memo that you are SAFE. This can make it difficult to heal, learn, and connect. Shifting the nervous system into the parasympathetic state creates an environment for optimal recovery... and I got you covered. . 🧠eBook will include: •WHY diet, sleep and the nervous system are important •HOW they can be used to optimize neuroplasticity for YOU •3 parasympathetic activating techniques •3 sleep restoration techniques •3 Printables: Sleep hygiene checklist and Anti-inflammatory diet checklists . 🔹️🔹️Take home point: This is an EXCITING time in neurorehabilitation. Learn how to prime YOUR brain for healing through neuroplasticity by picking up your FREE mini eBook today! . . Follow👉 @mollyparkerpt 😍Like it? Share away!
A post shared by Physical Therapy + Concussion (@mollyparkerpt) on

It took just part of a podcast with Jess Schwartz for hosts, Gene, Joe, and myself to realize, we had a LOT to learn about concussion rehab. I like to follow both people with similar messages to myself, and of course those who have expertise in part of a field I do not. I stumbled upon Molly's feed in instagram's search and saw that she had great information.

If you didn't make the feed, don't worry! These are just 5 (again in no order) of the PTs I follow and I wanted to have a good diversity with different types of posts from videos, to infographics, and research based posts.

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...