Once a Student - Always a Student

So if you have ever read my blog before you probably know that I am a big fan of The Manual Therapist and Dr. Erson Religioso, III, DPT. Its true and I have learned a lot from him, his blog and his videos. One of his mainstays is the ability to be dynamic, open-minded, and ever evolving and that is why he calls the way he practices The Eclectic Approach.

These are great qualities for clinicians and I have tried to adopt this style of practice myself. I learned about basic resets and repeated movement exams/treatments from Dr. E's material. I thought I had a pretty good handle on the basics. However, ask any expert in anything...The basics are basic but they are not basic. What? I mean that even if you try or practice sometime a hundred times...there is still something new to be learned or nuance to be perfected over time. So what is the point?

Well I have been struggling with some neck pain and muscle spasm for the last week as a result of my brazilian jiu jitsu training. I hadn't really done much for it because most clinicians suck at self-assessment and treatment. I at least made sure that I didn't have any fractures or other major red flags which thankfully I do not. So instead I set up a consultation with Dr. E and I was able to learn a few things even though we technically didn't do anything that I didn't already know! Check it out!

So what did I learn about using repeated-motions that I didn't know before?

• I wasn't aware that I was compensating out of fear-avoidance when attempting to treat myself using repeated-motions (specifically on repeated cervical extension with retraction)
• I didn't realize how profound of an impact there would be by correcting this
• A little bit of resistance while performing the repeated-motion like an active PNF can be immensely helpful for getting to end-range.
• I was not aware of how quickly I was going with my repeated-motions. Slowing down the pace of movement seemed to help lower the perceived threat and opened up my range of motion.
• I didn't think this had much an impact previously, I used to let my patients go to town doing their repeated motions as quickly as possible. There were some cases where the repeated-motions didn't net the effect that I was looking for and this could be why.

So what is the moral of today's post? Don't be afraid to get a second opinion or second set of eyes when trying to treat yourself as a clinician. Doing so doesn't make you a bad clinician, dumb, or incompetent...It just means you are currently a patient and not a clinician. Secondly and more importantly, ALWAYS keep an open mind and be prepared to learn something new every day, every hour, every minute. Lifelong learning = lifelong enjoyment.

This isn't quite what I had in mind.

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Neck Pain and a Wedding: Ain’t Nobody Got Time For That!

I am back in my hometown for my little sister’s wedding this weekend. Yesterday, my dad spent the day preparing and setting up for the wedding. He was lifting and carrying around a lot of awkward and heavy objects for most of the day. This morning my dad awoke with debilitating neck pain with radiating pain down into his right shoulder. His neck mobility was very poor with limited rotation and side bending to the right.

A year ago, I may have suggested Tylenol, Ice, Rest and perhaps some slight stretching. If I had access to modalities I may have wanted to use electrical stimulation to help control his pain. This was the type of neck pain that would have sent him running to the chiropractor’s office in the past.

Recently, I have been working to incorporate a lot of stuff that I have learned from my OMPT Channel subscription from The Manual Therapist and from the content on his blog as well. If any of you are regular readers of my blog you probably know this little fact already. One of the biggest things that I have learned about is how a large portion of injuries or pain fall into a “rapid response” sort of category. Specifically, this means that there was a good chance that I would be able to make significant and quick changes with my father’s neck pain.

Another concept that I learned and have written about previously is the use of repeated-end range joint loading. This is done into the direction of preference to increase function, centralize pain and improve mobility. This was a concept I used to produce rapid changes in my dad’s neck pain this morning.

Specifically, I did some very light Instrument-Assisted Soft Tisse Mobilization (IASTM) to the right side of my dad’s neck. I followed specific tissue patterns that I learned in the subscription section of the OMPT channel from Dr. Erson but he has some related videos for free on YouTube. I spent 3-4 minutes working these patterns with the goal of helping my dad reach his end-range. After the light tissue IASTM I showed my dad how to do repeated side bending to the right (side of unilateral pain) and cervical retraction as well. I had him do about 2 sets of 12-15 of each of these repeated movements.

Once or twice I had to stop him and help him reach his end-range more effectively. After he finished, the shoulder pain had centralized and his neck rotation and side bending was now normal. These effects are transient so I gave him instructions on how he would need to repeat these exercises for 10-12 reps once a hour. He gave me a look of incredulity but about an hour and a half later while trying on our tuxedos his neck stiffness started to return.

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