Top 5 Fridays! 5 Q&A From a Recent Mentoring Session | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 5 Q&A From a Recent Mentoring Session

I had a new blog reader of just 1 month fly all the way down from Southern California for 3 mentoring sessions this week. Here are 5 of his questions along with my answers.

At Duff's after 3 intense mentoring sessions
1) Do you treat acute injuries the same as an acute rapid responder?

While I do not see too many acute ankle sprains, muscle strains, or traumatic injuries in my practice, the answer would most likely be "No" to this question. True injuries kick start the body's natural healing mechanisms and the actual injured area is peripherally sensitized due to the inflammatory soup. It will be guarded, as well as hypersensitive and in general just needs rest. In the past, previous patients came to me immediately after a MCL sprain or a moderate MVA, and all I could do to the local area was some light counterstrain to improve the pain free movement, and tell them to rest for a few weeks then come back to me.

2) I'm not all in with everything being changes to the homunculus. Do you see any value in using more force than the lightest force possible?

I often get asked this, and my answer is more then 9/10 times I do not use what I deem "excessive" force anymore. With IASTM and my EDGE Tool, this usually means either no harder than a kitten licking you aggressively, or how another clinician put it, like you are spreading icing parallel to a wedding cake to flatten it out. For other techniques like functional release or a pin and stretch, I do use a bit more force to "pin" an area, but I mostly use many fingers or an EDGE Mobility Ball to make it easier on my hands and the patient. The larger surface area distributes the force.

Since we're not deforming fascia, or magically making muscles grow new sarcomeres immediately, there are very few reasons why you would use more force than the lightest you could possible be.
  • patient preference - they've been grasterbated or ART-ed forcefully in the past and enjoyed it and had good results
    • meaning they don't buy your neurophysiologic explanation
  • you've exhausted all the "light" ways and feel like some of your old school "hard" ways may make a difference
    • give it a shot, they've obviously worked for you and on patients in the past, the worst you could do is cause pain, make their symptoms worse temporarily, or cause the patient to dislike you forever
3) Do I think it's still feasible to "separate" muscles with IASTM or Functional Release?
  • This is just a variation of the questions above, mostly "no"
  • however, since taking Functional Dry Needling, there have been a few patients that are coming to me with central sensitization and have overall much better function, but still moderate levels of pain with many ADLs or at rest
  • after pre-testing functional squat and an adductor drop test ala PRI, I "poked around" for some TrPs in muscles that I thought would be facilitated
  • I had to push a bit harder than I was used to, and quickly provoke discomfort and sometimes pain
    • however, I chose to use counterstrain or very light functional release to inhibit the TrP
  • in many areas this was "between" muscle groups like the VL and the ITB, or the hamstring and adductor magnus
    • after ward, they "felt" like they had better "separation."
    • years ago I would've went to town on them with my hands and EDGE Tool, these days, I'm still looking to use as little as force as possible
4) Are the patterns presented in your courses the "only" ones you use for IASTM?
  • Definitely not! I've been teaching manual therapy for 16 years now, and if there is one thing that I learned, is that most expect a rote explanation 
    • meaning, use these patterns to improve cervical SB/rotation and unilateral headaches, lateral upper arm for shoulder impingements
  • however, my mentee quickly saw how general my IASTM technique was, both sticking to patterns for median and radial nerve after neurodynamic testing, but moving from area to area and stroking in different directions
  • I try to cover as large of an area as possible corresponding to the region of complaint, but also do not stay in one area for longer than 20-30 seconds before moving on
  • this minimizes the chance of irritation or soreness
  • the bottom line answer to this question is that since we are stimulating both the periphery and re-drawing a smudged homunculus, you can probably have very similar effects but using defined patterns or stripes just stroking the skin in broad areas
5) Mobilization, versus manipulation, versus IASTM, which one would you choose for a busy caseload?
  • I get it, my fellowship was in a very busy practice seeing either 2 patients every 30 minutes or one patient every 15 minutes - I hated them both equally
  • bang for your buck, I get more rapid and more comfortable results using IASTM along broad patterns of skin 
  • since you are affecting a larger area of skin, you are also potentially redefining a larger area of homunculus, thus providing the CNS with novel input
    • this is more likely to give you a better reset than a more uncomfortable mobilization than targets a "joint" thus a smaller cortical representation
Any of you are free to schedule mentoring sessions either online or live with me! Contact me via the box in the bottom right of this site or via email!

Keeping it Eclectic...

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