Top 5 Fridays! 5 Ways to Redefine Manual Therapy

Let's face it, we know more about what is not happening with our manual therapy and exercises than what is actually happening.

I've been working on revamping my introduction to my Modern Manual Therapy: The Eclectic Approach seminars. Yes, they were a little long... tough to fit in my clinical story, how I've changed over the years, how I've simplified things, etc... sounds like a future blog post!

I don't look to redefine manual therapy as we know it, far from it. I only want to make people think about purported mechanisms behind manual therapy, and what I consider various techniques in my head as I'm performing them.

other than the sensation from skin contact/pressure, once we really start distracting or oscillating the joint (what I call, wiggling it), we are firing joint mechanoreceptors which send novel information to the CNS for interpretation

1) Joint Mobilizations

the term "joint mobilization" is not so bad, except when it is used in a pure mechanical sense
since it takes thousands of pounds of force to even deform fascia, let alone the joint capsule, using "mobilization" to deform either the entire or specific parts of the capsule (posterior, inferior, etc), is misleading
other than the sensation from skin contact/pressure, once we really start distracting or oscillating the joint (what I call, wiggling it), we are firing joint mechanoreceptors which send novel information to the CNS for interpretation
so when I "mobilize" a joint, I just think, I am really "stimulating" a joint
therefore, I like to redefine Joint Mobilizations to Joint Stimulations

for these patients, I say, "I'm just going to do a quick stretch"

2) Thrust Manipulation

what are the main differences between thrust manipulation and joint mobs - speed is one of the key factors along with duration of treatment
speed may fire mechanoreceptors in a way or send an even more novel or preferred stimulus to the CNS
since the treatment is much faster in duration, the level of threat and discomfort is usually much less
plus you have the whole "That did something" from the cavitation
factoring in patient preference for the technique, sometimes they can't relax when "they know it's coming"

for these patients, I say, "I'm just going to do a quick stretch"

neurosculpting - what I think happens in the cortex to smudged or ill defined virtual body part representation from pain and/or immobilization

3) Soft Tissue Manipulation

going back to what we are not doing - breaking up scar tissue, adhesions, deforming or quickly stretching fascia
remember, tissue adaptation for lengthening/deformation happens like hypertrophy does, over time and with repeated stimulus
my explanations for the rapid changes we often see are due to

changes in tone, either facilitation or inhibition (whatever happens depends on the state of tissue you are stimulating)
neurosculpting - what I think happens in the cortex to smudged or ill defined virtual body part representation from pain and/or immobilization

I think clinicians who have "discovered" STM, get "better results" than whatever they had been doing previously because of the potential to affect a larger portion of the cortex

i.e. scraping or rubbing an entire median nerve pattern vs merely mobilizing a wrist joint

every healthy joint should be able to hand load - that's part of joint play

4) Modern Manual Therapy Goal 1 - Threat Free End Range

something I started emphasizing in 2015 in my seminars was not only getting to end range, but making end range threat free
manual therapy is great at removing the neurotag or associated threat with position or activity temporarily, it has to be reinforced with patient exercise and movement
threat free end range is now defined

no pain during the full range actively
being able to tolerate passive overpressure at end range
the passive overpressure is something I regularly tested, but did not emphasize in earlier seminars
every healthy joint should be able to hand load - that's part of joint play
this makes is what makes closed chain activities work

manual therapy - is a "cheat" of sorts that hands gives clinicians with the ability to use their hands to get a patient to confidently move

5) Modern Manual Therapy Goal 2 - Change Patient Perception

manual therapy works because of perception, not because of pressure, repositioning, stretching things etc
ever fall asleep during a massage? - other than being rested, do you get the same feeling of relaxation and well being as if you felt the entire massage?

I explain to patients that through various techniques, we're going to change the red lights that your brain are giving you to green lights
you will feel better and move better, but it's up to you to keep it

understand also that manual therapy may give threat free mobility, but does not give capacity and that is also something the patient needs to work up through long term strengthening and conditioning
manual therapy - is a "cheat" of sorts that hands gives clinicians with the ability to use their hands to get a patient to confidently move

Hopefully, I've given you something to think about. Just because manual therapy as we know it is placebo, that doesn't mean you the effects are not powerful, rapid, and real. In fact, it means you should harness placebo even more by using patient expectation and preference to your advantage.

Here is my popular video that you can share with patients - email them before their first visit to start the conversation early.

Keeping the Window of Improvement Open

Want to attend a Manual Therapy Party? Check out my course schedule here!

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...