Thursday Thoughts: How Much is Too Much or When Do I Add Manual Therapy? | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Thursday Thoughts: How Much is Too Much or When Do I Add Manual Therapy?

Early on in my career, I used to believe and think that everyone needed manual therapy. Even when I first got MDT Credentialed, I still used manual therapy.
Starting off with anything passive or perceived as fancy may lead the patient to dependence on your treatments. Too much is most likely more than 1-2 treatments/inputs to the same area prior to test/re-test.

What every patient needs is (but not all at once)
  • education to reduce perceived threat, misconceptions of pain and pathoanatomy
  • the importance of movement
  • novel input that can be anything from
    • IASTM
    • joint mobilization/manipulation
    • neurodynamics
    • PNF
    • taping
    • repeated loading strategies
    • general exercise
    • motor control

In order to empower the patient with the belief they can self assess and self treat, I start with repeated loading strategies, and test/re-test their functional limitations or asterisk signs. Not having layers upon layers of extra inputs, the patient ends up with the belief that a simple movement strategy can reset their nervous system and raise their pain and movement thresholds. The more you add, the less they will buy they can do it on their own.

I am not as patient as a typical hardcore MDT clincian, and will rapidly add some light IASTM to reduce threat or perception of stretch during a movement, then immediately try the repeated loading strategy in the directional preference again. Typically, on one visit, I may also regress to a NWB position and throw in some PNF or a joint manipulation so they can get to end range in WB. Assuring the patient can perform WB repeated loading resets is the best way to ensure compliance in the mode prescribed.

You will not be able to get most patients doing a WB REIS, or cervical retraction in all cases, but in my experience, if you play your cards right (and use as little tricks as possible), they will end up with a simple reset than can be performed hourly or as needed to keep the improvement between visits.

Keeping it Eclectic...

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