It was great to get back to Partners in Rehab, in West Seneca, NY, where I did my fellowship hours and worked part time. I actually came and went several times over the years resulting in 3 going away parties in less than 3 years! The course was great, with mostly PTs, a few OTs, and one MT.
- modern manual therapy concepts
- inability to deform fascia/capsule
- all manual therapies, corrective exercises, repeated motions as inputs
- pain science
- pain as an output not needing nociception
- perceived threat
- stories, metaphors, and analogies regarding pain
- The SFMA Top Tier
- Repeated Motions Exam for the UQ and LQ
After the lecture in the morning, one astute and seasoned clinician told me during the break, "I've been a clinician for 25 years, and have wondered, why do we provoke patients' pain when they are coming in to get rid of their it?" Yes, it seems like an obvious observation, but a fair share of the not so special tests taught in school are provocation tests.
Mini Cases
Woman's Health PT Problem List
- right hand CTS like complaints - this is her internal manual therapy hand
- recent fall resulting in grade V AC separation on the left
- 3.5 weeks after AC joint mostly healed and reduced to grade III, was rear ended in MVA, resulting in several rib fractures on the left (both injuries in Apr-May 2014 timeframe)
- naturally occuring fusion of talocrural joint on left, and partially fused on the right
SFMA/Movement testing
- cervical rotation/flexion DN, mod loss on left
- cervical retraction and SB to left mod DP
- MSR DN left sev loss right FN
- seated thoracic rotation left DN sev loss, right FN
- shoulder MRE left DN sev loss, right DP, mod loss
- ankle df/pf left DN sev loss, right DN df only, left great toe extension DN sev loss, right FN
- upper limb neurodynamic test right median bias DP sev loss at wrist (0 extension)
Treatment
- IASTM in left cervical, upper trap, scapula borders, and thoracic patterns on left
- EDGE Mobility Band to left ankle, reset with repeated plantarflexion/inversion - she stated "That would normally hurt a lot" - pain free
- IASTM to left calcaneal and talus patterns, plantar aspect of first ray
- IASTM to left median nerve container
- all done 30-60 seconds per patterns and as light as possible
- post tests
- MRE on left went from hand at LS to near inferior angle of scapula
- seated thoracic rotation now FN on the left
- upper limb neurodynamic test FN on the right
- ankle plantarflexion and dorsiflexion still DN, but from severe loss to minimal loss
- great toe extension went from DN sev loss to FN
With very short, pain free treatments, much of her movement became either FN or near FN. HEP consisted of
- median neurodynamic prayer stretch
- repeated ankle plantarflexion
- thoracic rotation open book to the left (not given ballistic whips due to having RA)
- cervical retraction and SB left
- it's more than I normally give, but there were asymmetries in UQ and LQ as well as symptoms
Case 2: Traumatic injury to right hip > 20 years ago, resulting in pain in standing, WB ADLs, loss of balance and hip ROM
- MSR left DN min loss, right DN, sev loss
- hip IR and ER left FN, right IR DN sev loss, left DN min loss
- SL stance left FN, right DN, inability to stand greater than 2-3 seconds
- ASLR left FN right DN, mod loss
Treatment:
- IASTM to lateral thigh, calf patterns
- EDGE Mobility Band to right thigh, combined with active 90-90 hip flexion with active knee extension
- my overpressure into hip distraction, IR, and adduction
Post test
- MSR right improved to DN, min loss
- hip IR improved to FN
- tibial IR improved to DN, min loss
- most importantly, his SL stance was now FN!
Keeping it Eclectic...
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