Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews: Dennis Treubig
Showing posts with label Dennis Treubig. Show all posts
Showing posts with label Dennis Treubig. Show all posts

Part 1 of this Post Op Progression Series is here - 5 Considerations for Post-Op Patients

Over my years of practicing, I’ve realized that many clinicians have no criteria for progressing/regressing their post-surgical patient's rehab programs.  They seem to do it randomly or solely based on time or “just because.” And if you’re anything like me, those reasons (especially the “just because”) doesn’t fly.



I don’t think these will come as any surprise to people, but they are often overlooked by clinicians (especially those who work in really busy clinics) and they can play an important role in a session.



I'm going to keep this post short and sweet and let you reflect on this quote and do some deep thinking about it.

I recently came across this quote from legendary strength & conditioning coach Johnny Parker and while he was saying it with regards to training people, it couldn't be more true and applicable to physical therapists too....especially PT students and recent grads.

"They won't care how much you know until they know how much you care."


Read it again a few times and let it sink in.

I wish I had read this quote when I was in PT school and understood the meaning/significance of it back then because it definitely would have helped me get to the point I'm at now a lot quicker.

All that technical, medical mumbo-jumbo some PTs spit at their patients to show them how smart/good they are (I'm looking at you, confident recent grad), won't mean diddly-squat if patients feel their therapist doesn't have empathy and truly understand their current problem and it's effect on their lives.

If a patient feels like just another number, I don't care how "good" your PT skills are, your outcomes aren't going to be that good (or at the very least consistent).

If you truly understand the concept of this quote and put it into practice, I guarantee you will see a difference in your therapeutic alliances, patients' buy-in, cancellation/no-show rates, outcomes, etc.

To learn the soft skills and what patients want/need out of an encounter, check out Modern Patient Education our fully online seminar on recovery/sleep, mindfulness/breathing, nutrition, movement exercise and practical pain science education.


Keeping it Eclectic...


How I Treat My Patients From a Backpack

Can you treat your patients from a backpack?

Do you rely on a bunch of treatment and exercise equipment to treat your patients?

If so, I challenge you to try to treat your patients from a backpack. Think that’s crazy!? Well, I can tell you that it’s entirely possible and I’ve been doing it with success and it feels great to not be reliant on much to be able to get my patients better. And it doesn’t have to be literally from a backpack, like me. What I’m getting at is to challenge yourself to make your hands and brain (and some small tools, equipment, etc.) what you depend on to help your patients.

And yes, I understand there are some patients that this isn’t the best fit for, but you’d be surprised how many people you can help from a “backpack.”

How did I come about this idea? I have a small, side-hustle PT business, Modern Sports PT, that I run out of a CrossFit gym in my area and since space is limited there and due to me wanting to keep overhead as low as possible, I treat patients in a “temporary” space in the gym. Essentially, I set up a table in an area that’s not being used and treat my patients. What this temporary space also means is that I don’t have an area to store supplies or have my own larger equipment (I will say that I do have access to all the gym’s equipment if I need it, but, again, that’s not that often).

So I have to bring everything I would need to treat my patients with me each time (except for my treatment table which the gym owner found a spot to keep it after I break it down). And I don’t want to be carrying a boatload of things with me every time, so I challenged myself to get everything I would need into a backpack. The added bonus of being able to do this, is I can be mobile and provide high-level orthopedic PT from the comforts of people’s homes. And I can also treat family friends “on the spot.”

Now I know you’re wondering what I keep in my backpack, so here is a list (and picture) of everything that’s in there.





Table ($99 from Best Massage on Amazon)

Obviously this doesn’t fit in my backpack but it is needed to treat my patients (and it fits in the trunk of my car). The table I use is by Best Massage and I bought it because it seemed decent and was pretty cheap compared to many others. And I’ll say that it has held up fine and I don’t have any complaints. I don’t keep all the accessories with it, I just have the basic table in the carrying bag. The only modification I made to it was to slap a couple of my company’s stickers over their logo.

Backpack ($99 from Dadgear)
I’m a very neat person and love organization so I wanted a backpack that had lots of compartments and storage space. And at the time I had this idea, my two kids were under 2 and this backpack was what I was using as my diaper bag for them (I wanted my own “manly” diaper bag to use instead of lugging around my wife’s feminine-looking one). So I just ordered another one to use for my PT supplies and I absolutely love it. I’m sure you can find other backpacks that have multiple compartments like this...it was just the phase of my life that I was in at the time.




IASTM Tool - Edge Tool ($115 from edgemobilitysystem.com)
I have been using this tool for ~5 years now and I love it. Great tool, great price. It fits in my back pocket - which is usually where I keep it when treating (that’s how often I use it). If anyone I talk to is interested in using IASTM, I always tell them to buy this tool rather than spend hundreds, if not thousands, of dollars on some other tools.

Albolene (~$15 for 12 oz. tub on Amazon or from local drug store)
This is what I use when using IASTM. I actually buy a 3 pack from amazon and it’s a little cheaper per tub that way. And I get the big tub because I use it that often. I’ve heard of people using cocoa butter too.

Towels ($14 on Amazon)
Basic necessity for obvious reasons - draping, wiping up lotion, etc.

Mobility Bands ($28 from edgemobilitysystem.com)
I love using mobility bands - it amazes me how many times they can improve motion/symptoms so quickly. I’ve had both these bands and a set of Voodoo floss bands and they both work equally well.

“Mulligan” Belt ($9 on Amazon)
I don’t use an actual/official Mulligan belt. I actually bought this 6 ft long gait belt and it works fine for me (mostly use it for hip mobility). And if anyone ever complains of too much pressure on their thigh because this belt isn’t padded, I just put a towel in there.

Rocktape (~$19 a roll on Amazon)
I find kinesiology taping helpful for a lot of people and Rocktape is by far and away the best one I’ve used. It sticks the best and lasts the longest. And patients can get all different colors and designs if they like. I actually buy my tape through Rocktape’s website because I took their course and am “certified” and get tape at discounted price.

Scissors (I'm sure you have an extra pair laying around your house)
To cut the Rocktape...duh. edit - You need a pair of titanium non stick scissors if you're regularly cutting RockTape - here's the ones I use  - Dr. E

Alcohol wipes (couple bucks from local drug store)

To prep an area before putting on Rocktape.


Occlusion Cuff Elite ($130 from edgemobilitysystem.com)
I love using blood-flow restriction training with my patients and the Occlusion Cuff Elite is awesome. It’s so much better than the original version (I’ve used both). The ability to detach the tube enables patient to exercise without having to worry about the tube getting in the way.

Portable Doppler ($140 from edgemobilitysystem.com)
A must-have if you are using blood-flow restriction training on your patients. It enables you to determine the exact Limb Occlusion Pressure so you greatly improve the safety and efficacy of the BFR.

Resistance Band ($16-$45 Monster Band from Rogue Fitness)
I use a green band because I think it’s the most versatile for what I use it for. I mostly use these to show people how to do band-assisted mobility drills. Rarely do I actually use them for resisted exercise, but you could do that also.

Mobility Ball ($15 - from EDGE Mobility System)
To show patients how to use them for self-myofascial release. A lot of times, I’ll give them to patients too.

Suspension Trainer ($60 from edgemobilitysystem.com)
To perform various exercises with patients. I have personally used this suspension trainer and a TRX one over the years and this one works just as well and is less than half the price of a TRX.



Lysol Wipes (few bucks from local store)
To wipe down the table/equipment after each patient. I actually keep these in the pocket of the carrying case for the treatment table.

Empty Plastic Bags (“free” from your grocery store)
To bring dirty towels home to wash.

Binder/Clipboard/Pen (few bucks each from office supply store)
To write down any notes, measurements, etc. In my binder I keep copies of some of the forms I use in case someone didn’t fill them out prior to coming in.

Iphone Tripod ($10-15 from Amazon; lots of available options)
I use this when I’m making a video for a patient of their HEP.

Some things that weren’t in my backpack that you might be wondering about:
Dry needling equipment - in the state of NY where I practice, PTs are unfortunately not allowed to dry needle. I’d imagine you could find a spot in there for this though.

Val-slides - I just use a towel or paper plate (to use on wood floors); you could also use a cheap set of furniture sliders. But I don’t use them that often because I’ll use the suspension trainer instead.

Cupping - I haven’t gotten into cupping, but if you are, I’m sure they don’t take up that much space and could easily be put in your backpack.

Stim Unit - I don’t use TENS for patients but I do like to use NMES to the quad when applicable. But I don’t know of a good, reasonably priced portable unit to use for this. I used to use the Empi 300PV but it broke. If anyone knows of a portable unit that packs a lot of juice like the 300PV did, let me know!

Clinical Notes - I use google drive to do all my notes, paperwork, etc. and it works out well for me. edit - Check out G Suite for Inexpensive EMR 2.0 by Dr E!

Scheduling and Payments - I use the app PocketSuite and it works for the small amount of people I see. It’s free, has a small fee for credit card transactions, and the scheduling features work for me (syncs up to google calendar, sends reminders, etc.)

The roundabout total of all these items comes out to ~$750 (and that’s IF you bought ALL the items I listed). $750 for the ability to treat people wherever you (or they) want is well worth it in my book.

Now that you’ve seen what’s in my backpack, give it some thought and let me know what would you put in your backpack?

What am I missing? I know there has to be more things out there that I could use, so I’d love to hear your suggestions.

via Dr. Dennis Treubig, DPT - Modern Sports PT





Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...


Happy New Year Everyone! I have been on vacation for most of the holidays, out of town, so this post is a few days late, but better late than never! As usual, we had a ton of great blog posts from The MMT Team. Here are the Top 5 MMT Blog Posts of 2017 in case you missed them.

  • most manual therapists (myself included a long time ago) just beat the tar out of frozen shoulders
  • you can't rush true tissue extensibility/length changes any more than you can rush hypertrophy
  • try this Novel Mobilization for a pain free tone reduction which enables the patient to move in a greater range threat free
  • this technique could be a good starter for lateral shifts that are too painful to accept load
  • I used it successfully on an ipsilateral lumbar lateral shift with pain below the knee, normally having very poor prognosis
  • I've since used it as the LCAP - Lateral Chain Arm Pull Test to quantify single limb stance stability and lateral chain strength
  • Dr. Dennis Treubig, star MMT Blogger and inventor of The Knee Terminator as usual dominates our Top posts of the year
  • do you agree or disagree with his list items?
  • it's a build up to why The Knee Terminator is a no-brainer for your post op knee patients, but as such, it was still very close to the top post of the year!
  • honestly, if you use the prone knee stretch for LLLD stretching, you're somewhat of a sadist
  • this used to be one of my favorite go to pin and stretch type techniques; I used to hammer away at it until motion improved
  • this variation gets the same results, but is much faster and is pain free
Thanks to everyone for your comments, questions, shares and support! Live Q&A/mentoring is coming to MMT Premium in 2018 (along with a price hike so now is the time to join before that happens!) See you in the new year, and check out our 2018 Eclectic Approach course schedule here!





Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...


Part 1 of this post can be found here.
Ther-Ex

For the sake of this article, I’ll consider ther-ex as strengthening, dynamic stability, neuromuscular, etc. exercises.
I progress/regress my patients’ ther-ex programs based on my interpretation of the “Soreness Rules” (developed by the University of Delaware PT program for throwing programs) for general ther-ex.  The ‘Soreness Rules” use the presence of and duration of joint soreness after the prior session to dictate progression.  Click here for the official UDPT “Soreness Rules” (used with throwing programs).

Notice, I specifically said joint soreness and not muscle soreness.  If your patient says they were sore after a session, further question them to figure out if it was joint or muscle soreness.  Muscle soreness (DOMS) imposes no limitations and feel free to progress as tolerated.

If a patient complains of joint soreness after a session, the next important question to ask them is how long did that soreness last.  Depending on how long it lasted dictates how I progress them.

Even though I don’t think there is any evidenced-based research about it (sorry EBP police), I have found the “Soreness Rules” to be a very useful way to objectively and safely adjust patients’ the-ex programs.

Here are the “Soreness Rules” as I interpret them for my patients (who don’t come on consecutive days):

No soreness after last session
Eligible to progress
Sore after session but gone by the next morning
Eligible to progress
Sore for ~24 hours after last session
Stay with the same program
Sore for >1 day after last session
Regress program


For Knee Surgery
Another guideline, in addition to the soreness rules, I use when dealing with patients who have had a knee surgery (excluding TKA) is their knee effusion.  Measuring effusion is a simple, easy way to give you more information that will help you safely progress your patients programs.

The way I measure knee effusion is with the Stroke Test - to see how to perform this test check out Stroke Test - How to Objectively Measure Knee Effusion (video included).  I will measure knee effusion before and after the session to see if there was any change

Once you measure and grade their effusion, here are the guidelines:
  • 0, trace, or 1+ → no limitation
  • 2+ or 3+ → ther-ex not progressed
  • If effusion increases more than 2 grades → decrease ther-ex to the level prior to the change in effusion
  • If effusion now present when it was previously absent → decrease ther-ex to the level prior to the change in effusion

Other Factors I Consider
I don’t think these will come as any surprise to people, but often they are overlooked by clinicians, especially those who work in really busy clinics, and they can play an important role in a session.  I’m sure there are other factors that I think about but those are the ones that came to my head.
  • Mood - if someone is just having a bad day, you probably don’t want to add more challenging or increase intensity of ther-ex; you understand what I mean here
  • General health - are they a little under the weather, did they have a bad night’s sleep, etc. - these all get factored in to my thoughts
  • Stress - is the person always stressed out, then you’ll probably have to progress things slower because their body just won’t be able to adapt as well
  • Vacation/special event coming up - you don’t want to add in some new ther-ex if their daughter is getting married the next day, or they’re leaving for a much-needed vacation soon, etc.
  • Prior training experience - this can be a good thing (expect and understand DOMS, technique, etc) or a bad thing (have no clue what to expect afterwards, set/rep schemes, etc)

Summary
So that’s the thought process and criteria that goes through my head when deciding how to progress/regress patients’ programs.  It’s not an exact science or set in stone, but it at least gives me some set of guidelines instead of doing things randomly at will.

Let me know what other guidelines you use!



Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...