Thoughts on the Eclectic Approach UQ: New England Area 3/2013 | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Thoughts on the Eclectic Approach UQ: New England Area 3/2013

I had my first tour in the New England area over the past weekend. Each course was a bit different than the last, as like myself in the clinic, my courses are always changing.

I barely made it in to Portland, ME, due to the inclement weather the northeast has been having. I finally arrived around midnight. Shot an email to Rick Daigle, founder of Medical Minds in Motion, saying "I'm so glad my course starts at nine." The reply was, "It starts at 8, and you have to start setting up at 7 am!" D'OH! Now I know how the away team feels!

For those of you who attended the course and follow my blogs and social media, thanks for attending and for your constructive feedback. I literally changed some things from day 1 to 2 to 3. On day 1, my intro with modern mechanism review and research lasted the entire morning! On day 2, it was only 2.5 hours which left 1.5 hours for lab.

On day 3, I did not teach cervical thrust manipulation as enough time could not be given on the other days to do more than a cursory introduction. Instead, I taught upper thoracic and supine thoracic thrust manipulation, as both of those should help a patient's cervical complaints and function.

Future lab manuals will have pics of the HEP, but many were printed for now, so on day 3, I had someone shoot an updated "My Favorite Resets" video from head to toe which will be embedded below and easily found on the OMPT Channel as well.

Day 1 pics
neurodynamic practice

skull crusha!
Day 2 pics

honored to have Mike Reinold attend my course!

Special thanks to Brian "tripod" Hoffman

@tommyDPT on twitter! Start blogging Tommy!
Day 3 pics
"It was the last course he ever taught..." - quote of the day!

knocked the wind outta me!

these guys helped me tear down on the third day! So appreciated, thank you!

Only a Filipino would take all the leftovers!

Here is the updated My Favorite Resets Video.

  • these are the more common directional preferences per body area
  • the directions are not laws, but rather patterns based on the direction contrary to what the patient is often performing
  • 10 times/hour!
Interesting Cases

Day 2

A smaller woman, PT, perhaps in her early 60s stated she had shoulder pain when I asked for volunteers for assessment. After she got to the front, she said her "shoulder pain" also radiated to her right forearm. She took her fleece off and was totally ripped! She said "I do P90x." I asked her if that hurt her shoulder and she said no, it only hurts when she is writing.
  • Sx were reproduced from a sitting position (head forward in cervical protraction and scapular elevation) with lifting herself from the table with her UEs from a seated position
  • PNF cuing of her right scapula along with postural correction with head/neck into neutral significantly reduced her complaints
  • passive overpressure into cervical retraction with my right hand cuing her right scapula into the set position eliminated the right UE pain
  • patient self generated OP into cervical retraction abolished R UE pain even after she slouched and tried lifting herself off of the table again
  • HEP: sit upright while doing your notes, break up prolonged sitting with repeated cervical retraction
Day 3
  • a PT in the class was suffering from frozen shoulder for over 1 year
  • she was not able to tolerated any kind of passive stretching or joint mobilization because it was too painful
  • she received 2 cortisone injections which helped with the pain
  • she was in the "thawing" phase and noticed at least once a month that she woke up spontaneously with 10 degrees more shoulder ER/elevation
  • she admittedly had very high fear avoidance but wanted to see if I could help
  • the first question I asked, "Has anyone screened your cervical spine?"
    • sadly, her answer was, "No."
  • using a soft and calm voice, I gently reassured her of the stoplight rule and that I needed to check end range cervical loading to her involved side (right side)
  • she agreed to try and I again assured her I would stop if it increased and remained worse or at any time was unbearable
  • baseline right shoulder had moderate resting pain around lateral upper arm and lateral scapula to the QL area
  • flexion was about 125, and abduction was about 140, both with moderate pain during the movement
  • I started with cervical retraction and SB to the right, with very gentle passive overpressure
  • the first few reps were slightly painful and moderately blocked compared to the left which was WNL actively and passively
    • after 10 reps she was going much further with also much less resistance
    • after 20-30 reps she was nearing end range and I was able to passively overpressure until her left scapula started elevating
    • she said her left upper trap was sore, so to slack it, she put her left hand webspace on her proximal thigh which elevated her left scapula
    • this enabled her to go even further
    • after about 5-7 minutes of end range overpressure and constant updates with gentle verbal encouragement, we re-tested her shoulder flexion
    • the class let out a collective gasp as she got to at least 150 with little to no pain, her abduction had also improved to at least 145
    • I asked her if she was still afraid to move, and she turned around (I was behind her doing the overpressure), looked me right in the eye very emotionally and said "You're my hero."
    • later Tx involved IASTM to right lateral upper arm, and lateral scapular patterns which eliminated the remainder of any discomfort she had. 
    • supine thoracic thrust also gained about 10 more degrees in abduction and flexion
    • HEP = repeated shoulder extension and cervical retraction with sidebending right and OP, also no more cortisone injections!
All in all, I look forward to meeting more of my readers and fellow manual therapy clinicians in Texas, Illinois, and upstate NY later this year!

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