Top 5 Fridays: 5 Ways to Explain Manual Therapy to a Patient

Do your patients think you have "magic hands?" Do you think you do? I can tell you one thing, no one has magic hands.



It is important for the patient to realize that any and all treatments you do in the clinic are to make it easier for them to perform the HEP, which is really what keeps the improvements going. Here are 5 ways I explain manual therapy to patients

1) IASTM

• an area of the body that does not move or is in pain for even a short time loses definition in the virtual representation in the brain
• your skin is the perfect outline to help redefine the picture of the smudged area
• using a tool lightly and non-threateningly helps redraw the limb
• the bumps that are felt by both the patient and the tool? It's questionable that it is needed to even change them or they are of benefit for palpation
• some US studies do show improved movement and less pain with light scraping with The EDGE Tool before and after

2) Joint Mobilizations

• an area of the body that does not move or is in pain for even a short time loses definition in the virtual representation in the brain
• "wiggling" the joint, helps activate receptors in the joint that tell the area that is under alert that movement is not a threat
• reducing the threat increases pain and movement thresholds

3) Facilitation and Inhibition

• pain alters motor control, this could result in difficulties with coordination
• too much tone or too little tone (resting tension) often results with improper motor patterns
• either of the above treatments, or exercises directed at improving motor patterns restore the natural balance of the body
• in other words, introducing a stimulus to the area that requires change, brings about that required change
• too much tone, light IASTM reduces tone
• too little tone or inhibition, light IASTM improves tone and facilitates movement

4) Neurodynamics

• your nervous system is dynamic, designed to stretch, get compressed, and slide all around your bones, muscles and various tunnels of the body
• occasionally, due to either threat perceived by your brain, or a tethered point in the limb, the nerve in the periphery may get a bit worn on the outside
• I describe this by moving my arm or leg inside a sleeve or pant leg
• then bunch up the sleeve or pant leg - representing a peripheral tethered point
• what would cause chaffing of the arm or leg represents how the outer portion of the nerve may be worn 
• when the myelin gets worn, it may be peripherally sensitized becoming an AIGs, which sends abnormal impulses both proximally and distally
• the site of the AIGs is often not the symptomatic point
• this is why we are treating all the way up and down your limb to restore the dynamics of the nervous system
• avoid calling it "adverse neural tension" unless you like using terms like lumbago - the connotation of adverse tension is that the nervous system is tight, which it is not

5) Repeated loading

• many joints have a directional preference
• this is a direction or position we can repeated load the joint in that works just like the joint "wiggle"
• only it's easier and you can do it yourself! (because it's osteokinematic versus arthrokinematic)
• loading the joint to end range helps bombard the brain with healthy and novel movement information so it can be convinced that full range is ok, and not longer needs to be limited - the threat is over!
• certain directions can get to end range easier than others that may be threatening or do not load the joint to end range effectively - elbow flexion versus extension or soft versus bony end feels

These are some of the explanations I give to patients, obviously talking either up or down depending on their level of comprehension. However, the most important concept is that anything done is very transient and MUST be maintained by the patient - only if they want to get better and stay better. Do you have any other or better ways to describe various manual therapies to a patient? Chime in below! 

Keeping it Eclectic....