Top 5 Fridays! 5 Ways to Improve Your Manual Therapy Skills

Having a brand of The Manual Therapist and Modern Manual Therapy is limiting from a certain point of view.

Course attendees and those who watch me interact with patients online or live are always surprised how much of my session is devoted to

a thorough history
positive patient interaction
dispelling myths and misconceptions
patient education on their responsibility in active care

As much as I emphasize the above points - probably about 75% of my first visit, Manual Therapy is still important, as are working on ways to improve your skills. None of the following suggestions I would consider "traditional" Manual Therapy advice. Here are 5 Ways to Improve Your Manual Therapy Skills

1) Work on a soft and confident touch

many times during manipulation and mobilization practice, the learner is so focused on getting the "technique" right, they don't realize they have a death grip
or, during simple P/A mobilization of the spine, they are contacting with the pisiform, but he rest of the hand is rock solid, instead of gently and firmly evening the surface area with a relaxed hand
surface area and force are inversely related, so, when force is applied through a greater surface area, it is more comfortable to the patient
plus, the way I conceive Modern Manual Therapy, you get more bang for your buck the more skin you contact - effecting greater portions of the homunculus

2) Factor the patient's preference for treatment

if a patient tells you they've had great pain reduction and/or improvement in mobility with IASTM, dry needling, or manipulation -> what do you do?
you should strongly consider working the treatment they had success with in the past into your current plan
patient preference leads to positive expectations of benefit, which will effect your outcomes
check out my favorite CPR development study using patient preference for cervical manipulation

3) Work on explaining why Manual Therapy is indicated in the patient's case

if the patient does not have a particular preference or belief in any one treatment, next you have to work on selling it
education that movement is beneficial and not harmful is important
I like to tell patients that Manual Therapy is a way to trick the nervous system into giving a temporary window of improvement allowing them to move with no/less pain
this is regardless of technique
if there are true issues in the tissues - slow responders (frozen shoulder, s/p immobilization), the above still applies for improving discomfort during movement
in the above case, you have to explain mobility will eventually improve and true tissue adaptations take time
all of the above are why I think when I do any particular treatment, IASTM, manipulation, etc, I may have success where other clinicians have failed
I set the stage with education and reduction of kinesiophobia

4) Forget specificity

instead of worrying about exactly where you are palpating, focus on relaxed hands and relaxed patient
if you're in the general area, you are OK to mobilize
don't worry about being on "the Articular pillar" - in my Modern Manual Therapy courses, I say, palate the back of the neck next to the spinous process, that's about as specific we can be with palpation
specificity in terms of moving just one joint (or only a joint) is pretty much impossible anyway - at least spinal 5-6 levels move with simple grade 3 oscillations
as Tim Flynn of EIM would say - "Move it and move on...."

5) Don't manipulate or mobilize through pain or tone

unless the patient absolutely has a belief that only a painful technique will work
or they have true constant pain - in that case, try not to increase the existing pain
however, many clinicians mistake increased tone for "hard end feel"
it's a lot easier to use light IASTM, Positional Inhibition Techniques, or PNF to reduce tone/pain first, then mobilization/manipulation will be pain free
remember, the goal is not only end range, it's Threat Free End Range

Hope you learned something from the list! These are things that really changed the way I practiced and improved outcomes more than practicing specificity and hand placement for thousands of hours. Thoughts? Chime in below or on the Facebook page!

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...