Modern Manual Therapy Blog





In this episode of Untold Physio Stories, Erson interviews Bobby Edwards. Bobby was a physio who attended a seminar where Erson was only an assistant.


From the years of gathering job market data here at UpDoc Media… the talent surveys, our Amazon Best Selling Physical Therapy Industry Prospectus, and even in the launch of HIYER — we found one thing consistently important to all… regardless of the size, setting, or specialty. What is this one thing? Culture.

Let me tell you this. When you look at who has referred patients to our practice, 50% are word of mouth and 50% are from the internet. People say, “Oh, I know Aaron. I’m a friend of Aaron.”

Photo by Dan Burton on Unsplash

Remarkable People


We all know of, or know remarkable people. They may be your gran, your teacher, your wife, a mentor or someone you read about or listen to in person or on the web. On looking closely you will often notice that such people don’t consider themselves remarkable at all. They just do what they do and love it.

A couple of life’s rules

Immediately I can think of five remarkable people who I know. As soon as I visualise them individually or as a group I notice how my emotional state changes. There are two reasons that follow a couple of life’s rules. Firstly, that what you focus upon determines how you feel, and secondly that we adopt the standards of those around us. What can you learn from this?
There are a few things you can take away.
  1. Choose carefully what you decide to focus upon — what is your picture of success?
  2. Choose carefully who you hang out with and are influenced by

A simple exercise

Try it now. Close your eyes and think of a remarkable person that you know. Someone who inspires you. Feel what happens in you. Now ask that person a question. Something you are puzzling over or tangling with. What do they say and how do they say it? Are they kind and warm? Listening deeply and understanding? They should be if they are remarkable people. Don’t worry if the image is fragmented or unclear, it is the intent and purpose and awareness of the feelings that are important.

Gratitude

Building upon this we can simply express gratitude for such people, aspiring to take on their qualities in us. Again, notice what happens when you do this. Feel the state of gratitude emerge in you. There is a potent biology at play. Everything has a biology.
Further, you could choose to write to the remarkable people who you know and express thanks for the way that they inspire you.
Enjoy and be wise in who you spend time with in person and in your (embodied) mind.

These are two of many practices and tools you learn in The Pain Coach Programme to live life and overcome pain, or on your road to mastery as a clinician 
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...


Patients and clinicians both want to stretch "tight" muscles. For the hips, there is often a strong perception of stretch in the hip flexors. This may also feel like compression anteriorly with squatting. Try testing these "tight" muscles with a sustained and progressive break test, not just going for 5/5 immediately, but starting off light and progressing the force.

This is a repost of items I use in what I call The Recovery System. I knew this information was valuable, and not all patients need it, but we all have the difficult cases that need more than just exercise and hands on techniques. They need complete behavioral and lifestyle changes to make the most of their recovery. This is where Modern Patient Education, a brand new Eclectic Approach seminar comes in. Sign up below to get on our list and be the first to take it online, live in person, or live online!

The title of this blog is a loaded question, but generally speaking it entails the risk : benefit ratio and adverse events of performing manual therapy on a patient who has suffered a concussion.  In particular, we are speaking of someone who is suffering from post-concussive symptoms after mild traumatic brain injury (mTBI).  In this post, we will use mTBI synonymously with post-concussion symptoms. This patient is already in your office, you have determined some type of musculoskeletal generator for symptoms, most likely neck pain, dizziness and/or headache; so you proceed with what you have in your tool box.
Cervical spine involvement in mTBI is gaining more traction over the years. There have been countless case reports and case studies on the benefit of manual therapy for mTBI (to name a few–Gurnseley 2016Burns 2015Weltzer 2017).  In fact, Brolinson recommends using manual therapies alongside neuromotor/sensorimotor training for more effective  mTBI recovery than rest and exercises.  Also, we can’t forget the all important Schneider study from 2014 that found a significant number of athletes returned to sport in manual / vestibular group compared to control group.
Most recently, Quatman-Yates in 2016 found the following conclusion:
The results of this systematic review indicate that several physical rehabilitation options with minimal risk for negative outcomes are available for treating patients experiencing persistent post-mTBI symptoms. These options include: vestibular, manual, and progressive exercise interventions.
In general, the literature does guide us that manual therapies can be a safe and effective intervention to the cervical spine for mTBI.  In fact, if you break down adverse events in Cervicogenic Dizziness / Cervical Vertigo, you will not find the literature shying away from manual therapy either.  Even though no study has been conducted directly examining adverse events, it can be noted that the largest randomized control trial and long term outcomes to date by Reid and colleagues specifically state no adverse events in the group of eighty-six participants receiving manual therapy.
However, there is one study I want to bring to light.  It is from Dr. Greenman and his colleague, Dr. McPartland back in 1995 entitled, “Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain injury“.  For those who do not know, Greenman was well known at Michigan State in Osteopathic Medicine and well cited in books and journals.  Even though the practice and treatment of craniosacral manipulation is beyond this blog and post, it is worth noting the findings of this brief review below:
Out of 55 cases, the authors describe 3 cases of adverse events of craniosacral therapy in patients with mTBI, including 2 requiring hospitalization.  They noted a 5% incidence rate and quoted the following, “craniosacral manipulation in a traumatic brain-injured patient can be useful and effective, but is not without risk”.
This number may not mean much to you—but we all hope as clinicians it is 0%—but it all depending on how you define iatrogenesis.  Nevertheless, I suggest you compare this number to Carnes’ 2010 study noting incidence estimate of proportions for minor or moderate transient adverse events after manual therapy was approximately 41% (CI 95% 17-68%) in the cohort studies and 22% (CI 95% 11.1-36.2%) in the RCTs; for major adverse events approximately 0.13%.
However, Sabel and Patini in 2018 in a pilot study examined safety of Osteopathic Manipulative Medicine in PostConcussion Symptom Management and elicited the following conclusion:
Osteopathic cranial manipulative medicine was considered a safe adjunctive treatment option to improve concussion-related symptoms and recovery.
In conclusion, I say there are minor adverse events to any intervention but we definitely want to have a treatment approach that minimizes risk while add benefit.  The type of technique, approach and handling skills can all be combined to making this formula turn out best for you and the patient.  In our Cervicogenic Dizziness Course, we teach a variety of techniques that add on what you already know and propel it towards maximal comfort and relief.  Come check us out near you.

You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course.  Pertinent to this blog post, the 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.
If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for more information.

Authors

Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT    
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist  
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

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...



Jason recounts some seemingly contrary advice to a patient who comes in with knee pain. She has a lofty functional goal. Unloading doesn’t often restore the ability to repeatedly load, so get loading! 
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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 Jason Shane at Shane Physiotherapy.
Keeping it Eclectic…