Thursday Thoughts: Load Em Up! | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Thursday Thoughts: Load Em Up!

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My regular readers will know my penchant for "10 times an hour." However, the question really is from most patients, "How often will I have to do these exercises?"

The answer for everyone is "It depends." The age old cop out is also a major truth. It depends on many variables, probably too many to list. Let's review and list some here...

It depends on....
  • if you are doing the exercise correctly
  • if you are getting to end range "Where the magic happens"
  • how long the reset lasts - reference the window of improvement and pain/movement thresholds
  • and a major one - if you are doing anything to negate the reset
    • this is an often overlooked one
    • a patient can be doing everything correctly, even more than hourly, yet forgets their lumbar roll, or sits still in a position that places threatening loads on tissues that triggers the CNS alarm
I often tell patients, most of whom have intermittent pain, that is wonderful news! It means, your pain goes away. This also means, you are doing something (or many things) to perpetuate it, and not enough to keep it away.

"How long will I have to do these exercises for?"
  • The initial phase of resetting the nervous system requires frequent dosages, again depending on how long the alarm stays reset, and what you are doing to negate said reset
  • in general, you can decrease the frequency that keeps the pain/movement thresholds raised to normal if you are moving well with no pain in all ADLs for 48-72 hours
Even after that pain free and return to function state is reached, patients need a self assessment to know they have a loss of motion or asymmetry (SGIS, cervical retraction with SB, loss of terminal knee extension, etc) so they know to double down on their resets so they can head a future recurrence off at the pass.

What's the bottom line? Initially, load them up as much as possible! Heck, I'm having left sided radiating LE pain, can't figure out why, but lying in prone roadkill with left LE up while typing this entire post has abolished it.

Keeping it Eclectic...

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