Tag Archives: Physical therapy

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

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.”

Mobility vs. Stability: A guest blog from Mitch Hauschildt

I’d like to introduce you all to Mitch Hauschildt, MA, ATC, CSC. Mitch is a great friend but also one of the best clinicians I have ever met. Hands down. Mitch is the Rehab Coordinator for Missouri State University and is the Founder of Maximum Training Solutions. You can reach him at mitch@maximumtrainingsolutions.com. Here is Mitch’s take on Mobility vs. Stability!

Mobility.

Stability.

Both are needed for proper movement and function. Without both, authentic movement will never be achieved and injury risk will rise as a result.

Let’s break it down a little bit further…

Mobility has been defined as “the ability to produce a desired motion” (via Bill Hartman). The key word in that basic definition is “ability.” If someone doesn’t have the ability to produce or reproduce a specific movement pattern (due to lack of range), then they are inherently immobile.

Stability has been defined as “the ability to resist movement.” Without the ability to resist poor movement, one will never be able to create truly authentic movement and will always have compensatory patterns.

Be careful with this, however, because it can be very easy to confuse joint stiffness with joint stability. They are 2 very different things according to the nervous system. If someone only has joint stiffness, at some point they will be stretched to the end of their limited range and they will collapse and sustain and injury because they don’t have true stability.

So, how do we train mobility and stability? Gray Cook makes it very clear that you ALWAYS train mobility before stability. That is to make sure that you avoid the joint stiffness scenario that we just discussed.

I agree with Gray on this point almost all of the time when we are talking about relatively healthy individuals with relatively “normal” mobility (whatever that is). I have found that there are some occasions where it make sense neurologically to challenge the body via stability training within an available range of motion as you continue to improve their mobility. There are also some instances where it works well to improve both mobility and stability simultaneously. As with all situations, the rules are the rules, but they can be broken from time to time.

There is one area where this rule cannot and should NEVER be broken. That is the post surgical rehab patient. Mobility and joint range of motion MUST always be the first priority immediately following a surgical intervention. Without full range of motion, performing simple ADLs becomes problematic for patients.

Neurologically, activation patterns are significantly altered with poor range of motion. Because the nervous system controls every aspect of the body, the ripple effect that poor range of motion has on the body is immeasurable.

First, joint stability will never be realized with a limited range of motion. When muscles only work in a shortened position, they lose their mechanical advantage and can’t create the appropriate torque needed to keep a joint stabile in an unstable environment.

This leads to larger issues elsewhere. When the local stabilizers can’t keep a joint centrated, prime movers take over because they are typically larger muscles that are in a position to greatly improve joint position, even though that is not their intended role. This leads to decreased performance, especially if they are an athlete, because the prime movers are tied up performing stabilizing duties instead of moving the body. For the same reasons, this will also lead to overuse injuries.

These same poor activation patterns also impact other joints in the body. For example, the rotator cuff is specifically tied to grip strength. It is a protective mechanism that is used by the brain to protect a damaged shoulder. Thus, if the rotator cuff can’t work correctly due to a limited range, that person’s grip will be compromised.

Going further, that same patient with a poor functioning shoulder will have problems in the lower extremity. It is rather obvious that the Lats play an important role with the shoulder joint. Many people forget that the Lats are directly tied to the Gluts in a crossing pattern in the low back. Thus, if one Lat isn’t working well (because of a compromised shoulder), the opposite glut won’t function properly. This can lead to knee pain because the Gluts are a powerful external rotator of the femur, keeping it in an advantageous position for the patellofemoral joint.

Continuing on down the chain, when that glut doesn’t work, it will likely be correlated with an anterior pelvic tilt. An anterior pelvic tilt is associated with a number of issues, including an ankle dorsiflexion restriction. This can lead to ankle and foot problems. And, I can keep going…

Moving away from activation patterns, we also have to keep in mind that a poor functioning joint will have other effects on the joints around them. Looking at the joint-by-joint approach (Cook and Boyle), we understand that the human body is simply a series of stacked joints which alternate between needing joint mobility and joint stability. So, if you lose joint mobility in one joint, you are going to be asking another joint to make up for it. The body will find the motion somewhere. Unfortunately, the motion will have to come from a joint that is intended to provide stability.

As an example, if an ankle patient doesn’t regain full range of motion, they will develop knee or back pain. This is because the knee and low back are intended to be stable joints, but when presented with a lack of mobility below them, these joints become unstable and painful. It is consistent and predictable.

Honestly, these examples are just the tip of the iceberg. As you read this, you may be thinking to yourself, “I know Mitch, this is common sense.” And you are right. Unfortunately, I can’t tell you how many young athletes come into my practice from other therapists who are cleared to return to play missing 10, 20, sometimes 30 degrees of motion. Then, I get to tell the kid and their parents that they can’t play because they aren’t ready and then I get to spend the next few months fixing what should have been done early in the rehab process.

It’s honestly not about me though. None of us got into this profession for us. We love our patients and want the best for them. So, lets start doing just that. Give them the best treatment available. Today. Tomorrow. Next week. Next year.

Mobility precedes stability in the post surgical patient. ALWAYS!!

We could spend hours going into the diaphragm if we wanted to. For the purpose of today, I’m using the KISS principle (Keep It Simple stupid). Lets just start with the anatomy…

Diaphragm Anatomy

Think about some of the attachments for a second… Xiphoid Process, Inner Surface of Lower 6 ribs, Upper 2 or 3 Lumbar Vertebra… There are even some fibers that his Psoas Major. The point is as follows: If you are NOT looking at breathing at the very beginning of treatment, you are probably missing something huge. If you are NOT using breathing as the start of core stability- guess what… Your not doing right by your patient client. The diaphragm is an integral part of the “inner core”- Diaphragm, pelvic floor, multifidi and transverse abdominals. If any of these aren’t working- you’re dead in the water.

We must use the philosophy of regress to progress and what is the most basic of tasks that we do as human beings. Breathe. Start there, assess the persons ability to utilize their diaphragm and then move on. Some ideas- start by assessing in supine with their knees flexed and feet flat, move to legs elevated at 90/90, assess in sitting, assess in high kneeling, assess in half kneeing, assess in tandem stance, assess in single leg stance. Get the point here?

Now, let me preface this next part with the fact that I fully understand every individual has their own strategy for breathing based on the activity that they are doing, their body type, their history and how their nervous system functions… BUT- every single person should be able to lie on their back and isolate out the diaphragm and “belly breathe” without excessive use of the accessory muscle groups. This is basic core 101. If you cant isolate the diaphragm you have no business doing planks, get ups, or any other type of core work for that matter.

Most of the time all it takes is a little manual therapy to release the fascial surroundings of the lower ribs, abdomen and then some cueing for retraining to correct the neural pathways and BOOM- it will come back online and they will start to learn new strategies…

Now- take it a step further. What if you have T-Spine and/or L-Spine Mobility issues? Or Hip mobility issues? You’ve got to fix those first because as in my previous blog- mobility needs to come before stability. Once you have fixed all of the mobility (true mobility” issues (see the previous blog), get back to retraining the diaphragm, teaching proper strategies and initiating the progression of movements. One awesome way of locking in fundamental core stability is simply by using segmental rolling patterns and crawling patters… Stay tuned for the next blog which dives into ROLLING!

I hope this helps some of you and I hope this gets people thinking. And don’t forget to go visit and like the Medical Minds In Motion FB page:https://www.facebook.com/MedicalMindsInMotion?ref_type=bookmark

It’s basic, it’s simple, there are never any absolutes but when push comes to shove- just breathe.

When is a mobility issue not a mobility issue?

Say what?!?!  When is a mobility issue not a mobility issue?  You read that right.  A mobility issue is not a mobility issue when it’s a stability issue. There I said it.  Soak that statement in and think about it for a few seconds before making any judgments (in either direction).

We know the human body is a wonderful and powerful tool.  We also know that the human body is the great compensator.  When you cannot move properly, the body will get it from somewhere else.  The epitome of robbing Peter to pay Paul.  The human body will also sacrifice quality over quantity.  I bet you that right now, you have movement dysfunction that you have no clue exists and there is a good chance you don’t have any pain associated with it…  Yet…  Eventually you will.  You can take that to the bank.

When the body reacts with pain signals- basically it’s saying to you, “Hey Idiot, do something. There is a problem somewhere”.  The problem is that a lot of practitioners are tricked by the pain and they start to “chase it”, as my good friend Perry Nickelston likes to say.  Just because there is pain in one location with a potential tissue lesion, does not mean that is the root cause.  We have to look at everything in order to understand 1 think.

Janda was way ahead of his time.  He stated that you must understand the motor system as a whole in order to understand individual impairments.  Damn that dude was smart.

So back to mobility issues not being mobility issues.  Do NOT take this as an absolute.  The only absolute is that there are NO absolutes (I can thank one of my students for that line).  Mobility issues must be consistent.  We know that and we understand that.  So having a patient/client fail a toe touch and then assuming they have tight hamstrings is putting the cart before the horse.  That’s only one way to look at movement.

1- Check toe touch in standing

2- Check toe touch in long sitting

3- Check active straight leg raise (needs to be greater than 70 degrees)

4- Check passive straight leg raise (needs to be greater that 80 degrees)

If you FAIL all 4 of those, guess what, there is a good likely hood you have a mobility issue or issues limiting you.  If you pass even just one of those, it most likely cannot be a mobility issue.

So what could it be?  It could be a lot of things but lets use this example.  A patient presents with a limited toe touch in standing and then a perfect toe touch in sitting.  One of the likely scenarios here is that this person has some fundamental core stability issues such as a lack of pelvic stability or diaphragmatic issues which is causing their hamstrings to contract in standing and stabilize the pelvis, thus causing a compensation.  You then have the person long sit- and BOOM they touch their toes.  What’s stabilizing the pelvis in this position- the FLOOR.  Hamstrings shut down, stop overworking and bingo, the person touches their toes.

Now- how do we go about fixing their toe touch in standing?  Stretch their hamstrings?  Mobilize their l-spine?  Nope. Not going to work.  Go to your days of Pediatric development and focus on rolling, crawling, half kneeling balance.  Maybe even before that you need to assess their breathing and teach proper diaphragmatic strategies.

One of the most powerful options to fix this issue is segmental rolling.  The next blog coming out soon is titled “This is How I roll” and will go in depth into segmental rolling.  Think about how we develop and think about what needs to stabilize properly in order to roll from your back to your stomach.  I have a few good videos that will accompany that blog which will demonstrate this.

The point is- develop proper fundamental core stability and you will clear up a lot of “mobility” issues.  Just remember this:  Mobility issues will be consistent.  If it’s inconsistent, you need to look at what stability problems are present.

 

My Movement Philosophy…

I’ve been thinking for a long time now how I should write this post. This is kind of a play on one of Gray Cooks audio lectures on having a movement philosophy (www.movementlectures.com) I’ve thought about tailoring into specific categories… I’ve thought about taking it the direction of comparing philosophies… I’ve thought about how can I make this post different than other that have posted similar related blogs…

After thinking about all of that I decided to do what I do best… WING IT and just type away with what goes through my head when I am either looking at a patient move or I am teaching movement strategies to a class of clinicians. I get asked all the time to describe what’s going on in my head when I look at patients, so here it is. A glimpse into the mind of Rick Daigle- and fair warning that there is a lot of madness going on! I’m going to do my best to organize what goes on in my head, but those of you who know me, realize that this will be a TALL task. Can you say ADD? Oh my god, look there’s a squirrel!

For starters- there is no cookbook here and what I am going to tell you is how I do things. It does not mean it’s the best way or the only but rather it’s my way! How I treat patients is from a combination of all the people I have learned from. Here are a few (but not all)- Gray Cook, Tim Heckmann, Kai Aboulian, Gary Gray, Perry Nickelston, Mike Voight, Tom Myers and my mom. (Mom taught me how to listen- we’ll talk a lot about that in this blog).

When I first meet a patient I place them into one of three categories:
1- Post-op
2- Traumatic Injury
3- Overuse/Repetitive Stress Injury

For the purpose of this blog; we are going to focus on the third category. With regards to the first two; I won’t look at their movement until all restrictive phases are gone and I know I am clear. THOUGH- I will without a doubt be looking at and treating other parts of their body (IE working on hip mobility when I patient is still in the shoulder sling post-op). By focusing on the third category, my hope is that you can see where my head is going with treating patients.

Day 1- Initial Evaluation
This is where I do my standard evaluation and figure out why they think they are in PT. I’ll use methods to diagnose their pain and work at trying to calm their pain down with a multitude of strategies. If they are VERY acute, I won’t go further on day 1. If I think they can tolerate, I might go into looking at a few key movements. But to me, the most important part of Day 1 with a patient is the HISTORY! Listen (thanks Mom) to the patient and let them tell you their story as you would be surprised how much info you can get. I think most of us reading this know who James Cyriax, MD is and probably know that he formed one of my favorite quotes- “If you listen to a patient they will tell you what’s wrong with them. If you listen to a patient long enough they will tell you how to fix them.” Pretty strong and accurate words. I cannot tell you how many times a patient has told me something that I thought was irrelevant and then BOOM it showed in their movement.

Day 2- This is where the magic starts… Movement baby! When they first walk in on day 2, it’s right to my movement screens. The SFMA, Y-Balance Test, FMS (yes I know this is meant for people without pain, but I still like to look at it for information), gait analysis and of course (drum roll please) rolling and crawling assessments.

Now before I go any further, I’m going to focus on the SFMA (Selective Functional Movement Assessment) and Rolling patterns for this post. I’m going to talk about how I use it, which might be different than some people, but again, this is my opinion and what works best for me. The best part of the SFMA is that it give you a systematic approach to looking at movement and while it is not the end all be all, it sure is damn close and pretty spot on for finding dysfunction that’s hiding from you.

For those of you who have never used the SFMA, well, you need to. Take a look at http://www.sfma.com or http://www.rehabeducation.com to find out about courses coming to a city near you! By far the biggest game changer in my career yet. BOOM!

Ok- the basis of the SFMA is to find where stuff is not working properly and use it to help optimize their function and help create a better system of movement and fix compensation. We place each movement into 1 of 4 categories:

1- Functional and Non-Painful (FN)
2- Functional and Painful (FP)
3- Dysfunctional and Painful (DP)
4- Dysfunctional and Non-Painful (DN)

Where do you think we are going to target? If you said DN, winner winner chicken dinner! That is the movement the person has NO pain with but can’t do it properly. Also, don’t forget- Not bad is not good! Be picky. Just because EVERY movement might be dysfunctional, does not mean the person is a train wreck. They might have 1 or 2 BIG dysfunctions that when fixed will allow the little dysfunctions to go away. In other words a horrible looking multi-segmental rotation might be graded as more important in my head when compared to a mildly dysfunctional cervical extension… Just a little side note- EVERY patient is different and I might think dysfunction A is more important for one patient but dysfunction B is more important for another patient.

So where do we go from here??? We know patient A has 4 DN’s but do we know why yet? Nope… We have to look at specifics and determine if the problem is related to mobility, stability or motor control. That’s where we will get into figuring out what needs to get fixed. Ok, in my OPINION- Mobility has to get fixed first. If you put load on to a mobility issue, well, you’re screwed. If you put load onto someone who has a motor control issue, well, you’re still screwed. Mobility first then motor control and then load it and gain stability.

Remember not to get punked and automatically think it’s a mobility problem until your full assessment is done. Why? Well if there is an inconsistency, it cannot be mobility. Mobility issues (think of a bony block in the hip) is and always will be consistent until you fix it. A lot of times it’s a persons inability to fire the deep stabilizers and sequence that makes them look like they have a mobility issue. Loaded vs unloaded, active vs passive and unilateral vs bilateral need to be assessed before you can determine the true cause. Take that to the bank.

Now- You clear out mobility through each joint (we’ll talk joints shortly) and the soft tissue is clear but the person still cannot move. Get them on the ground and start rolling. To segmentally roll from supine to prone (or vice versa) the inner core (diaphragm, pelvic floor, multifidus and transverse abdominals) need to fire and stabilize. Rolling is my way to assess and then train the brain to fire the inner core. Oh yeah, don’t forget breathing… That’s kind of important don’t you think? Not on the docket for today, but just take a moment and review all of the attachments of the diaphragm- important maybe? Yeah, I think so.

Ok, so what did I just say? The basic jist is find the issue causing the body to compensate. The human body will always sacrifice quality over quantity so you have to fix what it is compensating for. Treat the patients pain with your methods, absolutely, but if you do not find the root cause I promise you the patient will be back to see you again in the very near future. Remember this simple fact and you’ll be fine- Everything is attached to everything and anything can cause anything. Again, take that to the bank. Something else you can take to the bank is the Joint By Joint approach from Gray and Mike Boyle. The body has to alternate joints mobility vs stability. You cannot have 2 stable or 2 mobile joints stacked on top of each other… Unless you are looking for that person to fail miserably at their task.

Have a system… Have an open mind… Have a global view…

Don’t just focus on pain… Don’t cut the patient off… Don’t overthink it…

Do look at patterns… Do listen to everything… Do right by your patient and promote proper movement…

So that’s a brief glimpse into my mind… That only scratches the surface of what goes on in my head when treating patients. One thing I can promise you is that I function different from patient to patient and day to day. There is no cookbook and there is no standard way of doing anything in my opinion. I do what works for me and I get results- that’s what matters. Keep putting more tools in your tool box and be the best clinician you can be by pulling the right tools out at the right time.

Oh yeah, DON’T OVERTHINK IT! If you aren’t sure- it’s dysfunctional.

And a little side note- If there is a T-Spine mobility issue, I’ll usually start there. The t-spine is somewhat important to human movement.

I hope you all enjoyed this little tidbit of info and trip through my crazy head. Remember that these are my opinions and they might not work for you. Find your own Movement Philosophy and stick to it, keep learning and have some fun!

– Rick