More than three years after becoming a part of the Modern Manual Therapy team, I had the opportunity this past weekend to finally meet Dr. E in person and attend his "Eclectic Approach to Upper and Lower Quarter Assessment and Treatment" at The Virginia Center for Spine & Sports Therapy (my home clinic) in Richmond, VA.
What I like about Erson’s approach is that he synthesizes some of the best attributes and techniques from many schools of thought and applies them in practical and simple manner together with what the evidence is currently showing.
I’ve been a practicing clinician for 12 years, and aside from being residency and fellowship trained, I have taken numerous con-ed courses on all manner of techniques and topics. What I can say after attending this course, is that one, there is always more to learn. And two, I have never been able to apply concepts and techniques from a course as seamlessly and effectively right away as I did with The Eclectic Approach.
If you have the opportunity to take a course from Dr. E, don’t miss out! Also, (shameless plug alert), stay tuned for The Eclectic Approach to Modern Patient Education from yours truly coming soon!
Without further ado, here are my five biggest takeaways from the weekend:
1. Many of the treatment techniques produce change rapidly!!
I have to admit, I was very skeptical at first with the apparent effectiveness of many of the approaches even after I saw them be used in demonstration and then even personally during lab breakouts. My fears were lessened after implementing them multiple times in the clinic and seeing some rather drastic and significant improvements in symptoms and range of motion where previous gains had been achieved slower and through more “work.”
2. If we can make a technique pain-free, why not?
img via http://www.quickmeme.com/meme/3rtl11Erson admitted to past years of bruising people in an effort to “deform fascia” and “break-up” scar tissue. We have probably all been guilty of causing our patients pain through excessive pressure or force because we thought we needed to. The reality, is we know we’re not deforming fascia or breaking up “adhesions” with our hands or putting joints back into place. Do you want to help improve patient adherence? Do you want your patients to enjoy coming to therapy? Your technique does not have to be painful to be effective!
3. The “Costanza” approach
Early in my manual therapy residency training, we were taught that an initial approach to a painful movement or technique would be to go in the opposite directions. For example, if cervical sidebending or lateral glide to the right was painful, ie a “closing” movement, perhaps an opening movement was more appropriate. That sounds logical enough. However, sometimes it’s painful because it’s not used to being loaded and has developed sensitivity and fear-avoidance which creates threat messages that our brain perceives as painful. Only by gradually exposing ourselves (and our patients) to loading strategies may we see more significant and lasting changes in pain and motion and eventually return of function.
How’s your loading strategy currently working with your patients? Are you making progress as expected? Perhaps consider trying the opposite approach.
4. The best strategy is novel and simple
It’s human nature to crave novelty. And when dealing with people in pain, novelty can be very powerful. Remember Einstein’s definition of insanity: doing the same thing over and over again and expecting a different result. What habitual movements, postures, positions has your patient been in? What previous treatments have they had and were they effective?
The advantage of a new movement or gentle manual technique (see above) is that it can often help reduce what David Butler refers to as DIMs (Danger In Me) and enhance feelings of SIMs (Safety In Me). The advantage of simple, whether it be a movement or a manual intervention, is that it further enhances feelings of safety as opposed to those that could be perceived as threat.
5. Educate, educate, educate!
Even the best technique or exercise will ultimately be ineffective if we do not empower the patient towards independence and self-efficacy. Manual therapy opens a window that the patient must keep open. If we are able to produce change in the clinic, that means that ultimately they should be able to keep those improvements in pain or mobility on their own.
While it is true that some patients just want to be “fixed,” often times, we are at fault as well. Let’s be honest- it feels good to be needed, to think we have “magic hands” or that special technique that our patients can’t get anywhere else. The truth is, we’re just guides along the path, albeit, very good guides, but guides nonetheless.
We need to continually make it clear that the positive effects from manual therapy and even some active movements are only short-term and to keep that window open, they need to be consistent with the home treatment loading strategies that we have found work in clinic. Demonstrating effectiveness and value while empowering the patient to be self-efficacious should help improve treatment plan adherence and overall outcomes.
Thanks for reading,
Andrew
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Keeping it Eclectic...
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Keeping it Eclectic...
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