Showing posts with label manual therapy. Show all posts
Showing posts with label manual therapy. Show all posts

Nov 18, 2014

EDGEility Tool Free Giveaway!

Howdy Readers! To go along with my Ultimate EDGE Mobility/Stability Combo Pack Review that I posted yesterday...I am giving away one of the pieces of the pack. I am going to be giving away one EDGEility tool courtesy of Dr. E himself, the man behind the entire EDGE Mobility System. Want to know what this tool is and haven't seen my review video yet? Well check it out and see if you want one...for free!

You can enter below by liking my Facebook Page or following me on Twitter. The entry period will go until next Tuesday Night at Midnight! Good Luck! 

Mar 19, 2014

Guest Post: Acute idiopathic torticollis in a male high school basketball player.

Hey everybody! Today's post was written by my good friend Yuya Mukaihara. He was telling me about some success he was having using some Rocktape samples that I had given him so I asked him to write up one of the cases for my blog. So without further adou here it is:

I am one of Adam's classmates at Illinois State University and I work at a local HS. I am a Certified Athletic Trainer with CSCS, and NSCA-CT credentials. I have Graston Technique and Technica Gavilan IASTM certifications. I have also taken some PRI courses--Myokinematic Restoration, Postural Respiration, CCM, and I just finished Impingement & Instability this weekend. I use manual therapy, PRI, and corrective exercises in my practice but this case was an acute episode of left torticollis. So, I mostly used manual therapy to manage this case.

The athlete kind of looked like this...


Torticollis, also called as cervical dystonia or spasmodic torticollis, is a condition of the neck that results in sustained involuntary muscle contractions that may cause pain and neck rigidity.1,2 66% - 75% of the patients experience pain, which is the main cause of disability in those patients.1 It is more common in women than men and occurs in 5 to 20 out of 100,000 individuals.2 Idiopathic torticollis is considered as primary cervical dystonia due to no history of physical examination or laboratory tests whereas the secondary cervical dystonia is due to an abnormal developmental history.1

Currently, the pathogenesis of torticollis and the anatomical origin of its symptoms are unclear; however, an onset of idiopathic torticollis is often gradual and it displays sustained co-contraction of agonists and antagonists of cervical muscules.1,3 Commonly, it is treated with a series of Botulinum toxin A injections into overactive musculature.1 However, torticollis can conservatively be managed by reducing pain and involuntary muscle contractions with Kinsiotaping 4, manual therapy 5,6, and therapeutic exercises.3

In this case report, I used Muscle Energy Technique (MET) and Strain-Counterstrain (SCS) technique with an application of Rocktape to manage acute idiopathic torticollis in a male high school basketball player while he played playoff games.

Case Report

A 16 year-old basketball player came into the ATR 10 minutes before his practice started, c/o of left neck pain and tightness that resulted in his inability to look left. He stated that he started noticing tightness and pain that gradually becoming worse in the afternoon. Any other symptom was stated. It was in-season and was a day before his playoff game and he was needed in practice because he was one of better players on the team.

- At resting with seated, his neck was rotated and side bended to right a little bit.
- Active left cervical rotation was limited and was about 15deg with pain in the left side. Full right rotation.
- Active left side bending was also limited and was about 10 deg with pain in the left side. Full side bending.
- Palpable tightness over left cervical extensors, upper trap and levetor scapula compared to right. He c/o pain with palpation of these muscles.
- MMT to cervical flexion, extension, right rotation and right side bending were 5/5 without pain. Left cervical rotation and left side bending were 3/5 due to pain.
- No history of a car accident, head or neck injury, or shoulder pathology. No history of medical conditions or surgery that should be noted. No signs and symptoms other than tightness, pain, and limited ROM of the c-spine.

Course of Treatment

Day 1, after a quick evaluation, he had to go to the practice so I only had 10 minutes to treat him. I began with MET isometric reciprocal inhibition on left rotation and side bending. I didn't target specific muscle but general motions. I had him to rotate and side bend to the right from neutral to gain motions on the left side by inhibiting these tight musculature. There was not much improvement but he had to go to the practice.

15mins later, the player came back to me because he could not play due to pain. So, now I had a little bit more time to treat the athlete. I had him lay supine and checked his passive ROM. Passive left cervical rotation and side bending caused pain as did active, displaying limited ROM.

I used SCS on his left upper trap and levator scapulae because I suspected muscle spindle hyperactivity.  After resetting the mechanoreceptors, he had increased left cervical rotation and side bending.

After finding the most tender spot, I kept a pressure and started counting time. Then I slowly increased left rotation. Once he feels no tenderness under my finger, I stayed there for about 20-30sec and then increased a little further and repeated. At the same time, I added some side bending a little by little to gain the ROM.

After one session of this technique, his active left rotation was about 80% of his right rotation and side bending was about 30% of his right side bending. (active left cervical rotation about 75deg and side bend about 25deg).

Then, I performed a 1st rib MET on the left for one set of five isometric contractions to inhibit his left scalenes and to regain the function of left side bending.

Fortunately, I had a sample of Rocktape from Adam, so I put the player’s neck into flexion, right rotation and right side bending to place his left neck muscles on stretch then applied two strips of Rocktape.

One strip was applied from the occiput to about T3 level and the other strip was applied from the mastoid process to scapular spine. My intension to use Rocktape was to inhibit the hyperactive or hypertonic muscles. I had some personal experience of inhibiting hypertonic muscle with Rocktape previously.

After those interventions during 15 mins of treatment, he was still limited to left sidebending with pain, but was able to complete the practice with the team. He ended up keeping the Rocktape on for the next four days.

Day 2, the day of the playoff game, he returned with full left cervical rotation without pain and improvement on left side bending, which was 80% of right side with minor pain. On that day, I used MET for left 1st rib, upper trap, and levator scapulae with isometric autogenic inhibition. He played the game without any complaint, and we won the game.

Day 3 and 4, he had no limitation on both left rotation and side bending and no pain. On that day, I used MET for 1st rib only. No deficit with RROM for flexion, extension, both rotation, and both sidebending. He completed a practice without any complaint.

Day 5, he had returned to play without treatment. He completed a practice without any complaint.

Day 6, he had no complaint from day 5.  He played the playoff game without limitation or complaint. We won the game.

Conclusion and Discussion

In conclusion, Rocktape and manual therapy were a lifesaver for this athlete, his team, and me. Without them, I think he would continue to suffer from his tight and painful neck muscles, which could have affected the dynamics of our entire team and lost their first playoff game. Also, I was satisfied with the immediate improvement of cervical motions, especially rotation, with SCS technique. I wonder how an outcome would have been if I did not know SCS technique and just provided a very traditional intervention, such as heat modality and stretch. I need to thank my undergraduate program and faculty, which brought a SCS technique expert from University of Oregon for us to learn.

Further, I think the tape maintained immediate effects of the SCS and MET techniques and even more so enhanced inhibition of those hypertonic muscles that caused pain. Overall, I was happy that he responded so quickly and positively to the intervention thus allowing him to return to play very quickly.


1. Crowner BE. Cervical dystonia: Disease profile and clinical management. Phys Ther. 2007;87(11):1511-1526.

2. Patel S, Martino D. Cervical dystonia: From pathophysiology to pharmacotherapy. Behavioural Neurology. 2013;26(4):275-282.

3. Dool JVD, Visser B, Koelman JH, Engelbert RHH, Tijssen MAJ. Cervical dystonia: Effectiveness of a standardized physical therapy program; study design and protocol of a single blind randomized controlled trial. BMC Neurology. 2013;13(1):1-8.

4. Pelosin E, Avanzino L, Marchese R, et al. KinesioTaping reduces pain and modulates sensory function in patients with focal dystonia: A randomized crossover pilot study. Neurorehabilitation & Neural Repair. 2013;27(8):722.

5. Godse P, Sharma S, Palekar TJ. Effect of strain-counterstrain technique on upper trapezius trigger points. Indian Journal of Physiotherapy & Occupational Therapy. 2012;6(4):77.

6. Iqbal A, Ahmed H, Shaphe A. Efficacy of muscle energy technique in combination with strain-counterstrain technique on deactivation of trigger point pain. Indian Journal of Physiotherapy and Occupational Therapy - An International Journal. 2013(3):118.

Jan 1, 2014

A Year in Review: 13 Lessons of 2013

Happy New Year and welcome to 2014! This is my first post of the year and my 75th post overall.  This is going to be a reflection on some of the things that I learned in the previous 365 days. I was inspired to write this post after reading many of Mike Reinold's similar posts over the last few years. I guess I learned a lot this year because this turned into an epically long post. Sorry.

Oct 18, 2013

Quick Video Update: Ankle Dorsiflexion Mobilization with Movement Variation.

Hey Everybody! Just wanted to take a moment to share a video that I recorded yesterday while in the clinic. If you have ever been here before you have probably heard me mention Ankle Dorsiflexion and I often find it to be restricted in a lot of people.

Well I use a lot of different techniques depending on the situation and I wanted to show you all one variation that I've been using with success.

The only separating factor with this technique is that I'm using two edge mobility bands simultaneously. Hope you all enjoy it!

Sep 30, 2013

HEP for the HIP: Self Hip IR mobilization!

This is a quick video that I shot in the Athletic Training clinic the other day when working with a basketball player. This is a self-hip internal rotation mobilization that I have my patients perform on their own.

This helps to maintain the benefits gained from treatment and manual therapy when working with me in the clinic.  Ideally, this would be done about once an hour for a single set of 10-20 reps but it can be hard to have a student-athlete comply with this and fit it into their busy schedules.  I also have some of them do this before practice and lifting weights for temporary mobility gains.

This is done by the athlete applying an active-assisted hip internal movement while simultaneously providing slight distraction/traction. Check it out!

I have this athlete using an Edge Mobility Band in this video but they could also do this without the band. However, I feel that using the band is more efficacious due to the better hand-hold and compression provided by it.

In other news, I found an old but good video about pain by Lorimer Moseley on "Why Things Hurt". It is actually a pretty funny video and I am sad that I have only just now found this video. For some of you this will be old but for some of you it may be new. This guy's book is on my current to-read list.

Enjoy and Happy Monday!

Sep 2, 2013

Case of The Week: Bilateral Plantar Fasciosis

Today's post is centered around a patient that I have been working with lately. This athlete is a sophomore collegiate runner that competes in middle distance running events.


This patient is now a 19 year old male that began running in 4th grade. He was in a running club affiliated with his grade school and was soon running around 160miles a year. He began to suffer minor injuries during middle school and somebody had prescribed him orthotics. He struggled with stress fractures, hip pain, and plantar fascia pain all through middle school. Despite these issues, he still managed to run a 4:43 Mile as an 8th grader.

Throughout high school he continued to struggle with injuries such as hamstring strains/tendonosis, spinal stenosis and low back pain, chronic ankle instability and piriformis issues. He also struggled with plantar fasciitis/osis during this time as well.

Once this athlete got to college he tried to transition to minimalist footwear in attempt to "correct" his heel strike. He did not suffer at all until halfway through his first cross-country season when he had a week long flare up of pain that was similar to his previous plantar fasciitis/osis. He was fine again until the beginning of his first indoor track season. The pain became unrelenting despite being prescribed new orthotics and undergoing an expensive shockwave therapy procedure. The patient decided to just cross train and rest for the remainder of his freshman year as a collegiate runner. 

This is where I entered the picture and had a few small conversations with this athlete regarding his plantar pain and I gave him a few exercises to perform on his own such as a self-mulligan mobilization with movement technique for ankle dorsiflexion and repeated end-range plantar flexion prior to runs. The patient used these few exercises all summer long until he returned for his sophomore year with good results but was not completely pain free.

I heard that he was still struggling with his plantar pain and offered to help him with a proper evaluation and treatment plan.

Aug 29, 2013

The Edge Mobility Band Review

(Disclosure: This was not a free item given to me for review. I paid for this on my own but I have learned a lot from the creator of this product and that information has helped me and my patients a ton so maybe that makes me biased. If that is a bias I hope I continue this bias for a long time.)

Today I will be reviewing the Edge Mobility Band which is part of the Edge Mobility System by Dr. Erson Religioso, DPT of The Manual Therapist. I have been following his blog for quite awhile now and from the start I was very intrigued by the magical blue bands that he kept using on his patients and in his videos.

I would watch his videos and read his blog posts about the increased function, mobility and decreased pain associated with using these bands as part of his treatment protocol. At the time I was unaware of the Voodoo floss bands so this was my first exposure to compression wrapping for anything other than edema prevention/reduction. I even tweeted at him back in April of this year to inquire whether a poor graduate student like myself could substitute a resistance band for his bands and get the same effect. He answered my tweet with complete honesty and told me that there was nothing magical about the Edge Mobility Bands. He stated that a simple resistance band should suffice.

While there may be nothing magical about these bands there is definitely something special about their construction and design considering that I wasted many hours trying to experiment with resistance bands instead of coughing up $24 bucks for two Edge Mobility Bands of my own. Most of those experiments led to cutting off the circulation of extremities, excessive body hair pulling, and the constant rolling and tearing of many thera-bands. It simply wasn't a feasible substitute for me but maybe it works or would work for somebody that is more coordinated, stubborn or cheap than me.

Jun 18, 2013

Putting The "soft" Back Into Soft Tissue: Video Post

Hey all! New video for you all today that follows the same theme as my last blog post regarding foam rolling. I hope you all learn something and sorry for my amateur videography. I forgot to comment on it in the video but it is important to note that these gains in mobility are only temporary.

However, this treatment can and should (in this case, she as she is still restricted in terms of mobility) be combined with other treatments like joint mobs, Mulligan MWM's and repeated end-range plantar flexion. This will produce a synergistic effect and reapplication can help lock in the temporary gains.


Disclaimer: Please note that some of the links on this blog are affiliate links and I will earn a commission if you purchase through those links. I have used all of these products listed and recommend them because they are helpful and are products from companies that I trust, not because of the commissions that I may earn from you using these products.


All content on this blog is meant as instructional and educational. The author and guest authors of this blog are not responsible for any harm or injury that may result. Always consult a physician or another proper medical professional for medical advice. Registered & Protected