Guest Post: Eclectic Approach NYC Review | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Guest Post: Eclectic Approach NYC Review

@NYCDPT on twitter or as he is known in real life, Eric Matuszewski, DPT attended my first course in Mid Town and was offered to audit the second and third classes. He came to all three. This review is was not asked for or was commissioned, honest! I don't know if I think of myself this highly!
Impressions of the Eclectic Approach for the Upper Quarter. NYC 

Bruce lee would say that the best Martial Artist is one free of style. That the perfect style is one that takes what works from every style and leaves the rest for whomever else might be able to use it. Like a buffet, if you like crab legs, take some, but if you’re allergic . . . it makes no sense making yourself sick.

Lee would often quote the philosopher Lao Tzu’s advice to “be like water, formless”, because it’s in that formlessness that unbreakability resides paired with the power to carve natural wonders like the Grand Canyon from rock. 

Looking back, it’s clear that Lee’s prescription was prophetic. We’re now unimpressed by the lack of professional “purists” in MMA competition. We don’t ask why there are no boxers competing who can’t grapple, or Greco-Roman wrestlers who can’t coordinate a roundhouse kick. We know that for either competitor to win a major event, a donkey would sooner win the triple crown. It’s well accepted that to rely on one style is to fight and furthermore to live with a disadvantage. 

In the modern information explosion where no secrets can hide, “pure” styles either hybridize to meet the needs of the arena or become extinct. 

The eclectic approach (EA) is such a hybrid of approaches suited particularly well for the healthcare environment we’re on the brink of. It’s a framework that adopts techniques for “hacking in to” the nervous system and for ending pain and dysfunction cycles by focussing the clinician on meeting patient centered stages.

EA respects the greatness of the quarterback (a single approach) but at the same time is smart enough to know that a team full of quarterbacks is going to disappoint. It’s strength is the adaptability that results when one is willing to draft whatever players (approaches) to accomplish one of the goals in the framework. It also serves as a navigation system so that you know where you are in the journey and what off ramp or subway stop you missed rather than just letting you keep driving/riding and wasting your time. 

As Charlie Weingroff says “there are plenty ways to skin a cat”. The standout quality of the eclectic approach is that it’s a really fast way to skin it and it lets you know where you are in the process while you’re skinning it. 

Components of the eclectic approach

Gray Cook says he has prospective employees show him “ a cheat” as one of the tests for working in his clinic. After evaluation, the cheat is the first intervention in the EA framework. 

The cheat, like the Chinese pole acrobat in Oceans Eleven who hides in a cash box to get the gang into a casino and jumps across laser alarms with the grace of a squirrel from a telephone wire to a tree, is simply a way to “Hack in” to the nervous system. 

Repeated end range loading with overpressure, a manipulation, mobilization, mobilization with movement, soft tissue mobilization, taping, compression. These are just some of the ways to get in that the course discusses. EA gives little favoritism here. If you can get it to work for you, and it suits the patient, use it. 

It’s easy to focus on the “manual magic” of various cheat techniques but the real magic of EA is in knowing that hacking in is transient success that needs to be crystallized. 

Anyone initiated in MDT knows that one of the hallmarks is frequent patient repeat of the new movement pattern. EA endorses that plan of change but diverges from the traditionally explained re-modeling rationale for it, doing a profound credit to MDT and to the late great Robyn McKenzie by explaining the man’s genius in terms of modern neuroplasticity and combining it with the publishing of Butler and Moseley. 

Frequent (10/hour every hour) repetition of the HEP is to rewire the malfunctioning alarm that still has a hard time accepting that the fire is out. 

Bad habits, whether they be bad movement habits or habits of painful sensation, die hard. Neuroscience has proven our brains plasticity and that focused and frequent repetition can be the antidote. In EA, it’s not that the procedure is any different, but that the updated rationale gives clinicians the go ahead to use a protocol that works while observing the findings of modern pain science. 

The great thing about using this treatment framework is that a clinician working in it should be less fooled into thinking that the goal has been reached just because he or she “hacked in” and created a temporary change. The clinician & patient knows that the job has just begun. 

Students in the course are frequently reminded that the “cheat” only gives a 1-2hr window of opportunity, and that making the change permanent requires a protocol consistent with modern neuroscience. . . . Frequent and regular repetition. 

I’m calling this a framework rather than an approach because approach sounds like a straight line that while accurate in terms of speed between two points, doesn’t credit the flexibility of the framework for a patient who would prefer not to be manipulated for instance, or the sedentary office worker who isn’t interested in investing time in identifying and training to prevent risk factors that might concern a distance runner. 
Checkpoints in the framework as I see them go something like this: 

1) Hack in (cheat) 
2) Crystallize (HEP, Re-sets, education), 
3) Identify contributing patterns/risk factors (SFMA), 
4) Self Check Risk factor (patient educated in self check) 
5) Repeat framework as needed.

The uniqueness isn’t in the elements of the approach, but in their combination, and how they are not just told to play nice together but meaningfully connected thus complimenting each other like players of any great team. 

EA takes schools of thought that diverged (probably more so because of their followers than from their founders) and gets them to not only play nice together but gives them new life by letting them augment each other, and it does it in a way that makes it seem so obvious. You come away wondering why every one doesn’t already do it this way. 

Values of the class structure/presentation. 

Things to be aware of:

 Erson is so well versed in so many schools that he has too much to teach for a one day class structure. You will find yourself wishing you had more days to learn more of what you just scratched the surface of. He definitely needs to add more classes to the eclectic approach program. 

Because the approach pulls from many other approaches it also uses many sets of vocabulary/notation. I suggest learning as much of MDT and SFMA notation from before you take the class so when you get to those parts you can just use them without slowing down. 

If you haven’t done coursework in Paris, McKenzie, Institute of Physical Art, Mulligan you will miss some of the references the course makes. You’ll still greatly benefit, but you’ll get more out of it with some of the back story. For example the course takes about 5 minutes to explain the MDT traffic light system which many people in my McKenzie “A” class had questions about and it takes time/struggle for most people to fully grasp. Don’t be afraid to ask questions in person, or via the website . 

Highlights of what the course does well: 

It gives an overview and review of many schools of therapy including a review of MDT and the SFMA with practice using their documentation. It’s a lot to pack in, but if you’ve done coursework in the schools listed earlier it’s a great review and shows you how to tie them together so you get more value from the knowledge you already have. 

You get to test out cheats for yourself and try them on different people. The kinesthetic part of the course is invaluable. There’s no substitute for feeling true end ranges and getting feedback on how much pressure techniques take, whether it be on the Rocabado “Skull Crusher” or how to use an EDGE tool ( for soft tissue mobilization. 

When combined with all the web content, frequent updating and interaction, there are plenty of ways to reinforce and clarify your learning.

Erson has taken plenty of notes on charismatic presenters like Butler and Moseley and knows the value of humor to learning. He keeps you engaged with case studies and humor and breaks frequently for hands on learning. This isn’t a sit and listen (daydream) course. You’re evaluating and treating, or observing demonstrations at least 40% of the time. 

Eric Matuszewski PT, DPT, CSCS

edit: Wow, to be compared to Bruce Lee and to have my name mentioned with my influences of McKenzie, Butler, Moseley, and now Gray Cook... Thank you so much!

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