Your Argument Is Invalid…

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Let’s start this “Rick Rant” with a full disclosure.  The following is a representation of MY thoughts, opinions, ideas, and beliefs- but here’s the caveat- what I’m about to discuss, I am certified in, I have been through proper training, and have years of clinical experience to support my assertions.  Now that the housekeeping is out of the way, here we go:

The internet is full of trolls.  We all know them and have likely experienced their wrath at one point or another, and it’s miserable to try to have a rational discussion with these people.  These folks are bullies sitting behind the screens of their technology of choice, waiting to pounce on someone’s, heck ANYONE’S social media posts to belittle, attempt to derail any enlightened discussion, and generally be a nuisance.  That’s cool and all, we all have a right to free speech, however, these individuals usually claim to be “experts” as to why your theory/method is wrong, but when pressed for the basis of their “expertise”, they likely have had no formal training in the topic being discussed.

Awesome, right?  Yeah, not so much.

I have been inspired to discuss this because I am seeing a disturbing increase in these trolls attacking and trying to discredit the SFMA (Selective Functional Movement Assessment) which is a system, as I stated previously, I am certified in.  I love it when people ask questions- genuinely attempting to deepen their understanding of the topic, but when statements are made like “it’s not backed by science” or “it lacks validity”, I’m baffled.  As Mike Voight said in a recent Facebook discussion on the topic (Mike is one of the creators of the SFMA) “The system is made up of 73 clinical examination techniques, most of which have been validated in the literature as stand-alone tests”.  In 2014 Glaws, et. al found the Intra and Inter rater reliability of the whole system to be excellent.  I could go on listing studies that have validated the SFMA and its parts, but a quick internet search will yield you the same result.  The SFMA is meant to be a road-map of movement diagnostics.  It doesn’t tell you HOW to treat your patients, but gives you a guide as to WHAT to treat.  If you utilize it as intended, you’ll get results.

This is just one example of a broader issue.  Overall, I’m concerned by the number of clinicians out there who are completely adamant in their beliefs, refuse participate productively in discussions, and then accuse you of being an “idiot” if you don’t blindly buy in to their thought process.  Critical and thoughtful discussion needs to be just that, not fodder better suited for the elementary school playground.

troll

I suppose the point of this whole rant is to put a plea out to our neighborhood trolls- If you want to be your awesomely nasty self, at least educate yourself before you start to pick a fight.  Otherwise, leave the discussion to the grown-ups.  The world has enough senseless stupidity already.  Don’t add to it.

-Daigle Out

Instrument Assisted Soft Tissue Mobilization – Part Deux

Tools

After seeing the responses, shares, likes, etc from last weeks blog on Less is More, I wanted to take a few moments to expand on the foundations of IASTM and provide y’all with some points to think about when considering adding this treatment to your clinical repertoire.

The General Consensus

Like every other technique we use and know works- more research is needed. I am by no way shape of form a “research guru” and i really strive to use the take true evidence informed practice to heart. The basic jist is that from a mechanical standpoint, there are a lot of proposed methods of how the technique works.  Quite a bit have merit, but more in-depth studies need to be done.  In general we know when you increase perfusion to the tissue, health properties can increase.  There are also some studies that have looked at increased fibroblast production and others that have show an increase in MMP-1, which is an enzyme that cam break down unwanted collagen (Schleip).

From a neurological standpoint we know there are roughly more than 500 nerve endings per sq inch of skin and of those nerve endings, 80% are sensory fibers that have a high concentration of interstitial receptors.  These receptors are highly adapting mechanoreceptors that respond best to light touch and pressure.

Why Tools vs Hands?

There are lost of reasons why you might want to use tools…  For starters, it sure is a nice way to save your hands!  That’s half true and half kidding.  When done right, it truly is a great way to save your hands.  There is no need to “dig” or “rake” at their skin so the pressure you use is not forceful/etc.

I think it’s important for people to know that this technique is not meant to replace your hands.  A great clinician will use this tool (pardon the pun) as a way to enhance what they feel with their hands and as well use it appropriately in conjunction with other manual techniques.  Personally I always do hands on manual therapy first prior to using any tools.  I want my hands to tell me first what’s going on and then fine tune it some more with the tools.

Treatment Progressions Options

In the ideal world, static before dynamic and unloaded prior to loaded techniques.  Think about it this way- stick to static techniques with your early stage patients and/or acute cases.  You’ll start wanting to get into some dynamic techniques once you have progressed and you’re attempting to use the tools to help retrain some motor control issues or reinforce the good movement.

What Tools Do I use?

My personal preferences are The Edge Tool (www.edgemobsys.com) and Smart Tools (www.smarttoolsplus.com).  These are my preferences, but it’s good to note that there are TONS of options out there.  Graston, ASTYM, Hawk Grips, Myofascial Releaser, Fat Tools, Reflex hammers, butter knifes, etc.  I think they all have their positives and all have their limitations.

Where to Find Education on IASTM

Obviously you can go straight to Medical Minds In Motion and search through our seminars.  We will be in Las Vegas, NYC, Boston, Hattiesburg, Houston and many more locations between now and the end of May.  Keep checking back for more info on future dates!

– Daigle Out

Less is More: Instrument Assisted Soft Tissue Mobilization

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It’s been a while since i’ve posted any of my patented “Rick Rant’s” so I think it is only fitting that I take on one of my biggest pet peeves of manual therapy.  Harder is not necessarily better.

Let me start with a little background before I get into the juicy stuff.  I’m just as guilty as the next person for going to get a massage and saying “yeah, dig as hard as you can”.  Just think about the last time you got a massage and had the therapist go to town…  Were you able to relax through it?  Did it feel good while it was happening?  The answer is most likely no.  When we are in pain, that’s our nervous system perceiving a threat which in turn is going to potentially make us guarded, fight the treatment and ultimately put the nervous system on more notice.

Manual therapy is meant to help people move and help them feel better.  If we are digging, pushing, scraping so hard that we heighten the nervous response, we are just going to spin our wheels and waste our time.  Less is more.

Now with that background out of the way, let’s get into the real reason for this post…  Recently I’ve been seeing more and more people post pictures on social networks of post IASTM treatments which show massive bruising and discoloration kind of like this!

nope

I’m sorry, but if you think this is correct you need to take a step back and re-evaluate your treatment philosophy.  There is absolutely no evidence that shows harder force is better, in fact what we know about the nervous system is that it responded much better to lighter force.  Roughly 80% of sensory fibers are interstitial receptors which respond best to light touch and pressure.  When you scrape too hard, you run the risk of causing chemical irritation.

IASTM works from two foundations- Assisting with the healing process by improving localized circulation and generating a good healing response.  Secondly, IASTM works by decreasing threat to the nervous system to help with improving mobility.

The goal is to generate a nice amount of redness, but not bruising.  Bruising could happen, but that should not be the goal!  If your patient looks like the above picture, you’re doing it wrong.

I’ll post more soon with research/etc but this post was just made to make y’all think a little and prime the engines for more detail later!

-Daigle

Meet Brent Brookbush and Why Functional Anatomy Is Important

I’d love to take this opportunity to introduce the MMIM Community to Brent Brookbush, PT, DPT, MS, PES, CES, CSCS, ACSM H/FS.  Brent is a breath of fresh air in our industry and even though he is a new grad to the PT world, he brings a ton of knowledge into rehab from his strength/conditioning background.  Brent has a unique skill set of taking daunting Human Anatomy and making it simple, and most importantly, functional.  Enjoy this 1st of many guest blogs from Brent where he introduces himself and lays the framework of why Functional Anatomy is important and critical.  As usual, for more Info on MMIM visit Medical Minds In Motion, LLC

-Rick

“The Brookbush Institute of Human Movement Science was created to enhance the delivery of evidence-based, practical education in human movement science. Most of our content is concerned with exercise and technique selection, routine design, assessment, etc. – the very application of the science in our field. With that being said, the fastest growing section of our online education platform is the portion dedicated to “Functional Anatomy” (Introduction to Functional Anatomy & Integrated Muscular Anatomy). Despite the fact that I’m as drawn as you are to new and innovative techniques, I have come to realize that understanding when to apply those techniques, understanding the intent of those techniques, and comprehension of the concepts with which those techniques were developed, is dependent upon on a strong knowledge of anatomy. Just as anyone can swing around a scalpel, it takes a surgeon’s knowledge of anatomy to use that scalpel in a manner that is effective. It could be said that a repertoire of effective techniques and assessments lies just beyond a conceptual doorway, and that functional anatomy is the key to that door.

Why “Functional” anatomy over traditional “Anatomy & Physiology”: Functional Anatomy implies a bias toward the subcategories of anatomy that specifically apply to human motion. It’s one thing to know that the trapezius originates from the external occipital protuberance to T12 and inserts on the spine of the scapula, acromion and clavicle, but it is another to know that the upper and lower trapezius work synergistically with the serratus anterior to upwardly rotate the scapula and ensure optimal acromioclavicular joint arthrokinematics. Further, all 3 of these muscles have a propensity toward under-activity in those individuals who exhibit upper body dysfunction, and due to this propensity may be the target of activation, integration, neuromuscular re-education and taping techniques. Further, these muscles have an effect on other joints, nerves and fascial structures – knowing how these structures are affected by dysfunction that may have originated with a change in the length and behavior of the trapezius, may provide us with a list of additional techniques that improve carry-over, or may simply be necessary for the more “stubborn” patient complaint. And that’s just one long-winded example…

If I may say with the utmost humility and respect for what we do, most of the concepts we build our interventions upon are fairly simple. Reciprocal inhibition, synergistic dominance, movement impairment, altered activity, adaptive length change, relative flexibility, compensation patterns, recruitment, release, stretching, mobilization, activation, integration, neuromuscular re-education, taping, IASTM, dry-needling, etc… can all be explained in a paragraph or less and often can be summarized in a sentence or less. But again, the concepts are just the doors to learning a repertoire of effective techniques and assessments, and our knowledge of functional anatomy is the key.

Where does that leave us? Dedicating time to increasing our knowledge of functional anatomy should likely consume the same amount of time that we dedicate to reading and understanding research in the pursuit of evidence-based practice. In essence, research refines our practice of techniques, built upon a foundation of functional anatomy knowledge. As an educator, I am excited about the opportunities a partnership with MMIM will provide. I can continue to build upon our library of foundational material, providing Rick Daigle and his faculty with a resource they can refer workshops participants too – leaving more time for practical education and lab in live workshops. I also look forward to gaining insight from the ingenuity of his staff, as they provide the Brookbush Institute with more great techniques for our library of practical content.”

Sincerely,
Brent Brookbush, President and Founder
DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

Brookbush Institute of Human Movement Science

BrentBrookbush.com

Brent@BrookbushInsitute.com

Why Developing a Niche is Critical to Private Practice Success

Medical doctors specialize all the time…  Orthopedic surgeons specialize is specific joints/body parts… Attorneys specialize… Real Estate agents specialize… Chefs specialize…

So why can’t Physical Therapists specialize?  Before I go any further, I want to clarify that while I will be discussing Niche practice and specialization, I fully understand and agree that you have to keep your doors open for business and taking a wide variety of patients is critical to that success.

I will outline here how I think developing a Niche practice will make your practice more successful.

In this day in age, there are almost as many PT clinics out there as Starbucks or Fast food joints.  How does a patient know the difference from one to the other? How does a patient know if Clinic A is better at something than Clinic B?  How does a patient truly know what place is right for them.  Personally I think these questions are difficult to answer, but with a few steps you can market your practice in a way that will give patients insight on what you are the best at what you do and why they should comes see you instead of Joe Therapist, DPT down the street.

There are many ways to do this, but one of the most successful ways is to develop a Niche program.  In other words, a specialty that sets you apart from the rest.  By developing a Niche specialty you will have the following opportunities:

1- Get patients in the door that might not have in the first place.

2- Once you have those patients in the door, they become a referral source for you.  They can refer others that are searching for what you are offering and they also become a referral source for any patient that might need Physical Therapy in general.

3- Direct Access.  Simply speaking, you get patients in the door before they enter into the system and before they have seen any other practitioner.  This way you can help expedite the process by either treating them or referring them to the right professional.

4- Strengthen your already developed MD relationships.  Now you have Direct Access patients who might need a PCP, or maybe you need to refer to an Orthopod for further testing.  This is a way to get patients to someone you trust and make sure they get excellent care.  This also will show your referral source that you trust them as well and value their opinion.  HUGE.

5- Strengthen your other referral networks.  Maybe the patient would benefit from seeing a Chiropractor, a Massage Therapist or maybe they need a Personal Trainer.  Now you can refer there patients to the appropriate professional, again that you trust and know will do a great job.

6- Your patients will thank you.  They will thank you for caring, they will thank you for helping them and they will thank you for taking them seriously.  They will also thank you for not wasting their time and helping them get to the bottom of their issues sooner rather than later.

I take this philosophy as very much the philosophy of “Good to Great”, By Jim Collins.  Don’t try to just be good at a lot of things, rather be great at one thing and then build it from there. Show the market place why you are the best at something and the rest will follow.

I hope this helps someone people think about some new marketing strategies and some new methods of how to get patients in the door.  The old school model was to visit MD after MD after MD and hope that you were able to convert a few patients from those cold calls.  The new school version is thinking outside the box and thinking like a professional.  Show value in your skill set and show how you can bring value to your referral sources.  In other words, work as a team.

-Rick

Rick Daigle, PT, DPT

Ankle Dorsiflexion

Who do people lack ankle dorsiflexion?  Well, the answer here is quite simple:  There are a ton of reasons.  I’m going to outline for you here some of the biggest reasons a person will lack mobility of ankle dorsifelxion.

For starters, why is this motion so important?  Well, gait for starters…  Kind of hard to walk with a proper push off…  Also a little difficult to swing through without enough DF to pull through.  When an individual lacks proper DF range, we’ll see a multitude of compensatory patterns- especially at the hip/pelvis.  That excessive hip hike on the swing leg to give proper clearance to the foot can lead to bilateral hip dysfunction coming from the potential creation of a pelvic issue, it can cause QL to go into spasm leading to lumbar dysfunction, etc, etc, etc. This list can be endless…

With all of that being said- here are my top reasons what might be causing the lack of ankle dorsiflexion when it’s determined a mobility issue is present. (For the purpose of this little blog, we are ruling out any neurological issues or motor control issues)

1- Decreased posterior glide of the distal tib-fib joint.

2- Hypo-mobile Great Toe-  This and DF go hand in hand.

3- Restricted Soleus

4- Bony Lesion to the Talus causing a “block”

6 Principles To Prevent Injury

This is going to be an opinion post… That being said, I fully expect some people to not agree with what I am saying here. Keep an open mind when reading this and remember- this is not for everyone.

I have been seeing a lot of blogs lately with specific do’s and do not’s, which has got me frustrated. It is haphazard to generalize and put a large group into the same exact category. What I am doing here is a combination of global principles and utilization of the KISS Principle. (Keep It Simple Stupid) and hopefully this will resonate with some individuals.

1- Mobility before Stability: If you can’t move, figure out why you can’t move and then fix it. The caveat here is when is a mobility issue really a stability issue? When do you mobilize a joint? When do you stretch some soft tissue? When do you perform other manual therapy techniques? The big point here is that a lot of people try to put load on top of a mobility issue that is present. Great way to ask for an injury.

2- Proper Assessment and Creation of Goals: Each patient/client/individual is an individual and their prevention programs must be specific for that person and their goals. Don’t just throw crap up against the wall and hope something sticks. Have a reason for everything that you do and use the specificity principle.

3- Corrective Exercise Is Great- But Should only be used as a corrective: I see a lot of individuals only work on correctives. While this is not bad, it’s not good. Once the correctives have “corrected”, move on to the next step of adding some load and locking in this new found stability.

4- Teach a Proper Hip Hinge: I personally think the Hip hinge is one of the most important movements in the human body, but unfortunately it’s taught wrong or not focused on. Getting the person to disassociate hip from lumbar mobility is huge with creating great lumbo-pelvic movement and stability.

5- Technique, Technique, Technique: No slop. Do the exercise right, or figure out why the person can’t do it right. Regress to Progress. Simple principle, yet a game changer.

6- The only absolute is that there are no absolutes: Stick to principles and vary your techniques based on individuality and the needs of the person sitting in front of you. Understand that you need to think outside of the box and be creative to not only keep people interested but also to train the neurological system with some variability.

Those are my 6 Keys to Injury Prevention. Is this the best list ever? No. Is it the worst list ever? No.

-Rick

“Rick Daigle, PT, DPT is the Founder and President of Medical Minds In Motion, LLC and has been educating health and wellness professionals all over the US on Injury Prevention, Rehabilitation Techniques and Movement Dysfunction.”