Reflections on The Eclectic Approach NYC Tour May 2013 | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Reflections on The Eclectic Approach NYC Tour May 2013

NY and Texas, like night and day! It was great to be back in my home state though! Here are some cases, vids, and pics from this amazing tour!

Can you take a picture of us? "How's this thing work?"

That's better! Brian Lau and yours truly - why so serious?

One of the recurring themes and newer concepts of this tour's Eclectic Approach was regarding the motion gained in a rapid responding patient. Since we are not
  • deforming fascia
  • stretching muscles
  • deforming joint capsule
the rapid change in range is the patient regaining the motion they already had. For whatever reason, perceived threat and/or motor control/stability issues, with manual therapy/MDT we merely help the body regain the physiologic range. Think of it as motion potential.

END RANGE! Wow, that's far... no it's not, it's just physiologic range that you already have. Can I say it enough? No, because that is where the rapid changes occur and also where they are locked in by the patient when they leave. I also cannot repeat it enough because a good portion of clinicians are anxious to push through to range that even their partner has. If you cannot get to end range safely practicing on another clinician, how can you do it to patients? How can we be afraid of this, yet someone who is crying because you're forcing their freshly inflamed TKA to 90 degrees prior to hospital DC?

Amazing! No It's Simple.... Amazingly Simple! or.... Simply Amazing! Check out this video of improving limited shoulder IR the previous professional tennis player has not had since he was a pre-teen. Rick, get these quotes on the next brochure!

Here is a requested cervical downglide thrust after MDT helped improve her previously very limited cervical sidebending to the right.

Here is the same thrust in slow motion, specificity anyone? Of course not!

NY is full of freakishly flexible MRE patterns! Check out these extra FN patterns!

WTH? Two more people were like this (not pictured), no excessive winging either!
The excessively mobile MRE reverse high five test
Great to meeet a blog reader plus MMIM instructor Joe LaVacca!

Quick Cases

As always, a recurring theme is the 5th “E” of the Eclectic Approach... Easy...

After helping several people with either acute, subacute, or chronic issues, using the same strategies of postural correction, loading strategy that is contrary to what they are doing repeatedly throughout the day, I asked, “Does anyone want to see me do the same thing to help a different condition?”

Case 1 – My MRI Says....

PT fell to the left, arm hit her side in adducted position, since then has radiating UE pain in radial nerve distribution, “constant” in the UE, radiating to below the elbow. Sx are better when working, worse when at home and still. MRI showed.... I really wasn't listening, but something about full thickness something or other, but she had good strength and full shoulder elevation with PDM during elevation.

Cervical SB full to the right, very limited and painful to the left. MRE DP on the left, FN on the right, LFR DP on the left, FN on the right. Thoracic rotation FN bilaterally.

repeated cervical retraction with SB to L centralized LE UE pain, unable to pull with left hand (involved side) due to shoulder pain, left with doing that hourly.

Radial neurodynamics DP, STM to radial patterns upper and lower LE 1-2, neurodynamics tested FP, then she was able to pull cervical retraction with SB left with left UE.

Day 2 – She came back to the Sunday course for a follow up

Feeling much better, the “constant” UE pain now intermittent, loading in overhead carry improved scapula stability. Had cervical pain now, but that was considered centralization. She was very encouraged. Not too much time to follow up because she brought her husband (a phys ed teacher) to watch, and by “watch” I mean intervention because he will not seek help for chronic left facial numbness, cervical pain radiating to left upper thoracic area.

Case 2 – The Husband Who Was Convinced to Get Treatment

After hearing me speak jedi mind tricks all morning.... “You will go to end range” He saw rapid changes and I placebo-ed him into wanting a quick eval and treat.

Typical rounded shoulders, pretty forward head. Wife was afraid to push him because repeated retraction made him dizzy and increased his facial numbness.

I explained the stoplight rule.

Postural correction with sustained overpressure on the maxilla for cervical retraction decreased left facial numbness, and remained better as a result. Sustained for 3 minutes, facial numbness abolished. Cervical retraction with extension and “wiggles” to get to end range abolished left scapula pain after 10 reps or so. He was completely Sx free in about 5 minutes.

It's almost end range
Case 3 – The Hypermobile Female Who Would Not Push Herself
Acute onset of right sided upper cervical pain and HA. MOI was putting on a tight dress and sidebending right and with excessive flexion of lower cervical and extension of upper cervical. She reads this blog plus took McKenzie A and B. So... She was already doing retraction with rotation to the right.

Me: “How often?”
Her “Probably not enough” “I'm working!”
Me: “Are you going to end range?”
Her “I think so?.?.?” - = most likely not

Cervical retraction with rotation right (without overpressure) decreased Sx, but did not remain better as a result. She had a loss in this motion as actively she sidebent to the right as a compenation. She also noted her co-worker's P/A mobs on the right upper cervical area improved it... temporarily.

Repeated cervical retraction with overpressure to the right, Sx decreased, better as a result. That was it.
Me: “You can now do this yourself, just go further and do this all day today”
Her: “Ok”

Jedi mind tricks, she only needed to go a bit farther and be pushed further (do you know the difference?)

As a compliment, she also got some right sided biased skull crushers which completely made her feel better, but she continued to perform her exercises the entire day

Case 4: The MT with a Chronic TrP

Do I treat TrPs? Ummm... yeah, but not by treating fire with fire. If painful tone is dysfunctional neurology, I'm not going to mash it in hoping the CNS decides to accommodate to the pressure/pain and release the lockdown on the area. She is a neuromuscular MT which I guess means TrP pressures and deep release.

She repeatedly stretches to the left to “stretch” the tight area. The massage strokes she performs the most seemed to be with one or two UE going from right to left with repeated trunk rotation left. She waited patiently until the end of the class to see me. She cannot sit upright, but tries often anyway = loading issue, but not fixed bilaterally.

Seated trunk rotation left FN right DP, significant loss. Repeated thoracic rotation “whip” to the right first 3 reps increased no worse, last 10-15 reps, decreased and remained better. Sitting upright was now completely pain free, and she could walk around with no pain. She had teared up a bit at this. Homework was to do this daily and hourly.

All in all, I had a blast in NYC, and got a lot of ideas for future course names. Highlight quotes
“Press and guess” “Hope and poke” “hacking into the nervous system”

It was good to meet so many of my blog followers, I knew NY would be full of them! Thank you all so much who attended and did not, and also of course to those of you who are regular and new readers. Without you, I would not be living my dream and passion of teaching an Amazingly Simple system all over the world!

Joe LaVacca, MMIM instructor, and my new unofficial official NYC Eclectic Approach Assistant, Eric Matuszewski!

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