Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews: soft tissue manipulation

Showing posts with label soft tissue manipulation. Show all posts

A #MMTTV Q&A from a student of my online course - Modern Manual Therapy: The Eclectic Approach to UQ and LQ Assessment and Treatment - https://modmt.com/onlineseminar had a question.

If you've been following along on my blog or youtube channel for years, you may have noticed a theme. That theme is all rapid responses are neurophysiologic and not mechanical. Tissue eventually deforms and stretches, but very similar to how it hypertrophies; this means with repeated stress and over several weeks.

Mike Reinold are having a sale on our acclaimed IASTM Technique 2.0. It's normally an amazing value at $199.99 but for this week only, from Aug 21 to 27, you can SAVE $50! You get everything you need to level up your soft tissue toolbox in over 9 hours of training

IASTM basic and advanced techniques
Compression Wrapping Mobilization
Functional Cupping
live cases
lectures
integration with your existing toolbox like neurodynamics, joint mobilization and more!
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The sale ends Sunday Aug 27 at midnight EST. Click below to learn and save!

Keeping it Eclectic...

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Listen in as a patient gets 90% better the day after getting a massage after a skeptical recommendation from Dr. Erson Religioso III.

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Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com . Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Jason Shane at Shane Physiotherapy.

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...

Pin and stretch type soft tissue techniques are very popular. Early on in my career I used them to great success along with great discomfort! However it's a fallacy that with great improvement comes great discomfort (with manual techniques).

One of the main tennets of Modern Manual Therapy is that any technique can be pain free. Here is my modified version of a subscapularis inhibition - don't call it release or Greg Lehman will come after you!

This along with a Lat Positional Inhibition are two great ways to improve shoulder ER and overhead mobility with little to no discomfort. Make sure to follow this technique up with wall angels/slides or repeated shoulder extension.

Thoughts? Chime in below at the bottom of the post! Yes, comments are now back after popular demand!

Pain Free Subscapularis Inhibition

Keeping it Eclectic...

There are some in the manual therapy world that have moved on beyond specificity and pathoanatomy who believe the "art" of manual therapy has been lost. The "art" as it stands now is not in the isolation of joints, fascia, or nerves, but interaction, education, and framing the treatment as a means to an end, not a solution. Here are 5 Concepts of Modern Manual Therapy

1) Replacing "specificity" with treating adjacent areas up and down the chain

20 years ago, I learned you had to isolate the hypomobile (and thus pain generating - duh!) joint with your hands, and thousands of hours of practice on as many patients
a common theme in courses from IASTM, to needling, to neurodynamics is to treat the neural container
example - wrist pain (or CTS like complaints)

old school - wrist mobilizations and stretches, neurodynamic tensioners that feel like lightning shock of pain/paraesthesia
new school - light IASTM along medial upper arm, forearm to decrease perception of stretch in a neurodynamic, cervical repeated motions to centralize complaints, joint mobilizations to any of the joints making up the neural container

the new school method can affect the local complaints, but treat many areas that have no association of threat

2) Replacing appropriate aggressiveness with soft, confident hands

I used to teach students all about the stress/strain curve, and to push, push, push, until you deformed and elongated fascia/joint capsule
getting results made me think force was necessary
there are patients who absolutely believe a hands on technique will be beneficial, and you owe it to the patient to take advantage of this placebo or patient's belief of positive effects of a preferred treatment
hand contact may start - if the patient is not too guarded physically or emotionally during the history or even leading the patient back to the exam room
a gentle pat on the back, or holding an elderly patient's hand as you walk them to their table
for joint mobilizations, lay your hands on the patient, and use full contact to increase surface area, but only use as little force as necessary to stimulate the nervous system

3) Replacing "this technique is going to fix you" with "this technique will temporarily make your nervous system give a green light - the rest is up to you"

many of us old school clinicians and I'm sure #FreshPTs got into this business not only because we wanted to help people, but we loved being able to "fix" people
magic hands used to be the best compliment, now I cringe at the mention
even if a patient has the strong belief that manual therapy fixes them, I start with the education about what not only mine, but previous treatments do

Pt: adjustments put my pelvis back into place
Me: I do plyometrics - huge jump landing in a squat or single leg landing - what uses more force - an adjustment or this landing?
verbal and physical examples of the magnitude of force our bodies can withstand without subluxing, deforming tissue, etc make a patient realize that the forces have to be modulatory in nature and not physical

the next step is to explain the transient nature of any "fix" they may have received

I often say, "What every movement, position, or hands on treatment is applied today, the window of improvement is temporary, and it's up to you to keep the improvement going between visits."
my example is, "Having regular passive treatment like manipulation without homework is like asking me to run on the treadmill for you and expect yourself to get more fit."

4) Replacing Muscle Energy Technique with Plain Old Isometrics

What's MET other than fancy PNF?
18 years ago, I learned standard osteopathic assessments and treatments but since I like to "fix" people, I preferred manipulation over MET
like much old school assessments and techniques, MET and type 1 and 2 lesions are bogged down in specificity and minutiae
any time a patient has pain during movement or end range, lightly resist into the direction of loss, often after several sets of light and possibly greater (or lighter) resistance, the movement is now threat free
forget about isolating muscles or joints, since it's not possible, and it's much easier

5) Replacing the technique emphasis with an education emphasis

even if your patient believes it's the technique that fixed them, you still need to get across that maintenance of the improvement is up to them
some busier clinicians complain that they do not have time for a lengthy pain science or education session
work it into the treatment, or as the patient is warming up, reinforce each session with previous concepts gone over in the last
the nervous system is easily tricked, but not easily convinced

Keeping the Window of Improvement Open

These concepts represent the new "Art" of Manual Therapy. Want to see them in action? Check out the tons of live cases on Modern Manual Therapy Premium!

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...

Mike Reinold and I are super excited to announce the release of our brand new IASTM Technique 2.0 program at IASTMtechnique.com.

IASTM Technique 2.0 is an add-on to our VERY popular program teaching you how you can quickly, easily, and affordably start using instrument assisted soft tissue mobilization in your manual therapy practice.

Since Mike and I released this program a few years ago, we have received amazing feedback. You don’t need to spend thousands on IASTM tools and lose a weekend attending a course. Our program teaches you all you need in a simple online format.

This is no doubt your best opportunity to learn how to perform instrument assisted soft tissue mobilization AND now cupping too!

Advanced IASTM Techniques, Cupping, and More

And now with the additional content in IASTM Technique 2.0, not only will you be able to perform instrument assisted soft tissue mobilization, we also show you some of our advanced techniques to enhance movement patterns, how to use functional cupping, and how to use mobility bands!

· Advanced IASTM Techniques - Learn our latest techniques designed to use IASTM to enhance movement patterns

· Functional Cupping - Learn how we use cupping and combine IASTM and cupping together. This has been a game changer for us!

· Mobility Bands - Learn how to use mobility bands during manual therapy and self-mobility drills

· Discounts on Edge Tools and Cupping kits - Anyone that purchases access to IASTM Technique 2.0 also gets a great discount on Edge IASTM tools, cupping kits, and mobility bands!

Save $20 this week only!

IASTM Technique 2.0 is on sale for $20 off now through Sunday 8/28/16 (midnight EST). Click the button below to learn more and start learning IASTM and cupping today!

For people that have already purchased the original IASTM Technique 1.0, you can upgrade to 2.0 for a super low price.

Click below for our giveaway. We are running a raffle for anyone who visits Modern Manual Therapy facebook page and shares iastmtechnique.com on their twitter. The raffle runs from Monday 8/22 to 8/29 and you may enter once each day. The winner receives an EDGE Mobility Tool, EDGE Mobility Bands, CupEDGE Mobility Tools and an EDGE Mobility Pouch!

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[Click here to go to the IASTM Technique course page and you’ll find a link to upgrade to 2.0!]

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...

Shhhh... don't call them trigger points, you might cause a social media meltdown from folks so inclined to flip out at the "T" word. The video below is a demonstration of Positional Inhibition, a technique I teach at MMT courses.

If your patient has tenderness around the posterior medial border of the scapula, limited trunk rotation, and/or difficulty with shoulder elevation, this may be a good starting technique that enables them to reset with Thoracic Whips and then load with strengthening exercises. The full video with pre-testing and PNF loading will be up at MMT Premium soon.

This clip was taken from the full seminar of Modern Manual Therapy: The Eclectic Approach to Temporomandibular Management on sale until the end of today July 4th, 2016.

Positional Inhibition of Rhomboids

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...

Screen Shot 2016-02-10 at 8.14.05 PM.png

Conclusions:

The results of the current study demonstrated that patients with CH who received cervical and thoracic manipulation experienced significantly greater reductions in headache intensity, disability, headache frequency, headache duration, and medication intake as compared to the group that received mobilization and exercise; furthermore, the effects were maintained at 3 months follow-up. Future studies should examine the effectiveness of different types and dosages of manipulation and include a long-term follow-up.

A strong randomized study by the AAMT group just released this year, which will more than likely result in critical chatter from the mobilization clan. Nevertheless, a compelling difference between groups and confirms, to me clinically at least, the difference between the two manual interventions for this subgroup of headache patients. If appropriate, I find upper cervical manipulation more comfortable, greater improvements in pain and changes in FRT for my patients. Figure out what is best for you and your patients, but as always with Dr. Dunning’s work, the article is open access so take advantage of that and have a read for yourself.

Screen Shot 2016-02-10 at 8.07.08 PM.png

To go along with a clinical study above on cervicogenic headaches, this article by Enix, et al in 2014provides histological, anatomical and clinical implications to the cervical myodural bridge. This basically implies the myofascial connection between Rectus Capitis Posterior Major and Obliqques Capitis Inferior with the dural mater. See picture below from Complete Anatomy Application:

3d4Medical - Harrison Vaughan

Considering the amount of tone and “facilitation” that can occur in these muscles as a dynamic stabilizer of the cervical spine—the connection to the cervical dura mater, which is dense with nocioceptors—could implicate reasons for symptoms we treat: cervicogenic headaches, tension-type headaches or even dizziness.

Modulation of this region, through arthrogenic manipulation > mobilization as in Dunning’s work (explanations of possibly why manipulation was better than mobilization in the previous study may give reasons…), or more of a myogenic approach through soft tissue work can be necessary clinically. The debate of joint vs soft tissue as main nocioceptive peripheral input continues.

Have any articles, youtube videos or other information you would like to share on my series? Just email me! harrisonvaughanpt@gmail.com.

You can also sign up to receive emails and further information on my blog at http://intouchpt.wordpress.com

Thanks for reading and always welcome clinical chit-chatting.

edit - Thanks for sharing Harrison! I often cite Dunning's research in my Spinal Manipulation Seminars. If I have to play devil's advocate here, it seems one of the only recent researchers showing benefits of Spinal Manipulation over mobilization either short or long term is Dunning. Despite the above seemingly being a multi-center study, were all of the clinicians trained by Dunning and prefer manipulation over other treatments as a primary focus? If so, there may unintended personal equipoise instead of clinical. This could affect outcomes, what do you think?

- E

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...

image from http://www.afortlauderdalechiropractor.com

It's amazing what can be done under anaesthesia - you can be cut open and repaired all without sensation, perception of threat or pain.

I am trying out a new Microsoft Product called sway, it's like pretzi, but auto formats to each device, mobile, tablet, pc, very easy to use, and built to share!

Modern manual therapy should be based on what we know regarding biomechanics, pain, and movement.

I heard a great quote on another blog recently. Foam rollers and trigger point balls (like the EDGE Mobility Ball) are great for finding trigger points. Once you find them, stop rolling!

There are schools of thought out there that think that discoloration is either a normal response to tissue work, or that it even leads you to more dysfunctional areas.

Do you work out? Are you strong? Do you hammer away at adhesions, tender or trigger points to release them?

Last week I had a poll on a painful/limited cervical case and pain and limited SLR. It asked whether or not you would treat the painful side/opposite side/both for cervical and hip flexors/extensors/both with the SLR. That poll can be found here.

For a quick overview of some of the concepts on why you should consider treating the ipsilateral side of pain rather than the contralateral, click here for a vidcast I did a while back.

We've all treated our fair share of frozen shoulders. While I do not have any sort of magical technique that will auto-magically improve their ROM, I do have a technique that will make ranging and mobilizing them much more comfortable on their end.