Manual Therapy Forum

Hi everyone!  Nothing like a world-wide pandemic and shelter-in-place orders to free up some time to record a podcast.  This is actually something I’ve been thinking about for a while.  As an instructor and previous examiner, I’ve been asked by clincians how to best prepare for a rigorous examination process for an advanced certification.  What follows is my advice after going through two examination processes myself, serving as an instructor for various courses, and serving as an examiner.  Hope you enjoy!

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One of the biggest things is using appropriate body mechanics.  Not over-resisting, and really looking at what is the patient doing well.  Because again, it’s very easy to say “Okay, this is what they’re not doing.  This is what they’re having dysfunction with.  This is where they’re having increased spasticity.  They’re not having active, isolated movement.  They’re pulling into pathological synergies.  They have significant difficulty with transfers.  They have significant difficulty with standing balance or sitting balance.”  That’s easy to pick up.  What’s maybe more important is, what are they doing well, and how can you use what they’re doing well to enhance and facilitate what they’re not doing well.  Enhance they’re function.

– Mike Baum

Recently, I got to sit down again with Mike Baum at a PNF II course that he taught.  If you haven’t heard our first podcast with Mike, check it out here.  When I found out that Mike would be coming to California to teach this class, I had to take it.  Honestly, I’ve been wanting to take this from him for years, but it was lower than some other things on the priority list.  That makes it difficult because the course is only taught once (maybe twice) in a year.  You’ll learn why that is so in the podcast.  For this episode, we get to hear more about Mike’s use of PNF, his training time with it in Vallejo, CA, and much, much more.  Please enjoy this latest episode with Mike!

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Links of interest:

Institute of Physical Art

Oregon Neurosport Physical Therapy – website

Oregon Neurosport Physical Therapy – Facebook page

The vagus nerve (/ˈveɪɡəs/ VAY-gəs), historically cited as the pneumogastric nerve, is the tenth cranial nerve or CN X, and interfaces with the parasympathetic control of the heart, lungs, and digestive tract. The vagus nerves are paired but are normally referred to in the singular. It is the longest nerve of the autonomic nervous system in the human body. The ending part of vagus nerve is known as spinal accessory nucleus.[1]

Wikipedia

It’s been quite a while since we’ve done any here at the Forum, but we’re back!  Recently, I had the honor and pleasure to teach Functional Mobilization of the Upper Quadrant (FMUQ) with my friend and mentor, Gregg Johnson.  Coincidentally, this was his last FMUQ that he would teach because, beginning next year, the Institute of Physical Art will be re-organizing their upper level courses.  So, like I said… an honor and a pleasure.  When planning for this trip, I selfishly packed my podcast equipment in hopes we could sit down and record a conversation.  After speaking with Gregg for a bit, it was evident that we needed to talk about his latest passion, the vagus nerve and the autonomic nervous system.  In this conversation, you will hear Gregg’s thoughts about the epidemic that is chronic pain, how our autonomic nervous system is affected, and what we as manual therapists can do about it.

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Links of interest:

Institute of Physical Art

Accessing The Healing Power Of The Vagus Nerve:  Self-Help Exercises For Anxiety, Depression, Trauma, And Autism

Activate Your Vagus Nerve:  Unleash Your Body’s Natural Ability To Heal

The Polyvagal Theory:  Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation

There’s no question about the fact that, to do the skill is not that hard. Anybody can learn to manipulate, or mobilize, or do just about anything. I’ve always said you can teach most animals to do these things as well, but being able to determine who needs what and whether or not it’s safe to have that applied to them.

The way we approach patients, and the way we think about them as a whole human being, and not just a tendinitis or a discal problem or whatever… we need to consider the whole individual, and treat the whole individual… and develop your expertise as best you can to be able to do that. I think manual therapy gives us the great opportunity to do that.

You’ll know that you’ve really come a long way and developed a great deal of skill when you’ve been told by your patients that “you have very soft hands”. And whenever someone says that to me, I always think “I’ve come a long way!”

Welcome to our latest podcast featuring Bill Temes! I first met Bill several years ago while taking a NAIOMT class he was instructing with my friend Kent Keyser. It was most certainly a wonderful time as Kent and Bill are good friends and teach well together, but also because of the knowledge and skill they possess. As you will hear, Bill is an instructor and examiner for NAIOMT (and has been for many years). He recently retired from direct patient care, but still mentors and teaches. This podcast is filled with some great wisdome and advice as you can tell from the quotes on this page, so listen and enjoy! Cheers!

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The more chronic the case, the more issues we have to be able to look at.

The most important thing is to be able to see what’s in front of you. Be able to look at it. And I think, getting back to what we started with earlier, about gait. You can look at someone and get a pretty good idea what some of the biggest issues are. Just evaluating what they’re using to moving forward with, and a lot of people don’t move forward normally. You’ve got to be able to take that apart.

Make sure you spend time listening to what you’re patients have to tell you, and don’t jump to conclusions about what you think you believe is the problem. The more you talk to them, the more you learn. The more you learn from them each time, the more it’s going to help them as far as being able to walk away much improved… I think we can’t spend enough time in the subjective, and I don’t mean just sitting and talking to them. Even as your continuing to work with somebody, keep asking questions and find out more about the individual themselves.

Links of interest:

North American Institute of Orthopaedic Manual Therapy

Bill’s NAIOMT email – [email protected]

Bill’s personal email – [email protected]

That to me, is what is so exciting to us as physical therapists.  Because we’re the people that can treat cause rather than consequence.  We’re the people that can help take away the cause rather than treat the symptoms.

– Shirley Sahrmann

I think anything that changes a pattern makes people better.

– Shirley Sahrmann

Welcome back to the podcasts!  This episode features Shirley Sahrmann.  Many of you likely know of Shirley from her research, teachings with Washington University in St. Louis, or her texts for Movement System Impairment Syndromes.  I wanted to speak with Shirley to gain a better perspective on her background and thoughts regarding her point of view.  I’ve noticed more in more in my own practice how much the neuromuscular system and create illusions of mechanical dysfunctions, so had thought that maybe Shirley could provide perspective on that.  Fortunately, Shirley corrected me on my perceptions about what Movement System Impairment Syndromes are.  I’d certainly love to speak with Shirley again about these topics, and more.  Please enjoy and let us know your thoughts!

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It’s the adaptations in the periphery that bias the activation in the nervous system.

– Shirley Sahrmann

Having your hands on people is an essential part of the examination and the treatment of the patient.

– Shirley Sahrman

Links of interest:

Diagnosis and Treatment of Movement Impairment Syndromes

Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines

Washington University in St. Louis MSI Resources

I think the on-going challenge is to get better at how I speak to my patients, how I educate them, and how I help them understand their condition.  Maybe how I motivate them.  All of that is a little bit of the art of what we do.  Trying also to look to the science of what are we supposed to be saying, or what sort of things should we stay away from, in terms of our explanations.  Are we doing harm with how we’re explaining what we think might be wrong?

– Ken Olson

Welcome back everyone!  This conversation is with Ken Olson.  If you are at all active within the manual (physical) therapy community, or have attended a conference of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), you have likely heard of Ken.  He has been heavily involved in all depths of the AAOMPT and the International Federation of Orthopaedic Manual Physical Therapists (IFOMPT).  Ken is past president of the AAOMPT and is currently the president of IFOMPT.  Ken also is co-owner of Northern Rehabilitation Physical Therapy Specialists and has multiple clinic sites in the Northern Illionois area.  If you’d like to learn more about Ken and what he is up to, check out the links below.

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Tuning in to the patient and asking the right questions, then asking the right follow up questions.  Some of those skills, I think, for the expert clinician, that’s where the development often times lies… is with that interaction with the patient.

– Ken Olson

Links of interest:

American Academy of Orthopaedic Manual Physical Therapists

International Federation of Orthopaedic Manual Physical Therapists

Northern Rehabilitation Physical Therapy Specialists

Manual Physical Therapy Of The Spine

“When we got to see them [pioneers in the field of manual therapy], what I realized was, they all asked the question ‘What if?’.  And that ‘What if?’ question normally came when they made a mistake with a patient.”

– Jack Stagge

“Very few of them were full of themselves.  The majority of the ‘greats’ that I was around felt that they were given a gift, and felt that they weren’t that special… they just didn’t stop looking.”

– Jack Stagge

“As a profession, we have two kinds of people in physical therapy.  Those that have a job, and those that have a profession.  If you’re going to be a professional in anything, I don’t care what it is, it’s going to take more time and more effort… and sacrifice!”

– Jack Stagge

Welcome back everyone!  This conversation is with my friend Jack Stagge.  As you will hear, Jack has a lot of training with some of the best in manual therapy history.  You will also notice rather quickly that he is a wonderful story-teller.  As with many of our other podcasts and conversations, Jack has incredible insight when it comes to life as a professional, as well as balancing that with personal life.  One unique aspect of our friendship is that I’ve gotten to know Jack somewhat personally for a short time as I was a student intern and he was my clinical instructor.  So, I can personally attest to Jack’s skill as a clinician and how great of a guy he truly is.  Please enjoy this conversation with Jack Stagge!

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“As a profession, we are the most gifted.  We have a lot of scientific backing… we’ve been gifted with this huge thing!  […] We have the ability to impact people on all levels.  Physical, emotional, spiritual, whatever!  […] Beceause we give all the time, there’s a giving and a connection.  We can make an impact on a person… a whole person.”

– Jack Stagge

“As a therapist, always be looking for a place you can give and get nothing back.”

– Jack Stagge

Links of interest:

International Manual Therapy Seminars

Faces 4 Hope

There’s always a third-degree black belt out there to let you know you don’t have it figured out!

– Eric Hitchcock

Today, we get to speak with Eric Hitchcock.  Eric is a friend and very well respected work colleague with us here in Chico, CA.  I’ve actually been wanting to record something with him for a long time.  However, as you will hear from Eric, he had hesitations for quite some time.  Thankfully, he succumbed to peer pressure!  Aside from speaking with a great person like Eric, this podcast is unique because it is more of a freestyle episode where we didn’t have a set list of questions.  Instead, we actually get to discuss some topics that weren’t brought up in previous episodes.  So, I hope you enjoy this time spent with Eric.  He’s a special guy and I believe all who listen will learn a lot!

What are you doing, and why are you doing it?  Have purpose with everything that you do.

– Eric Hitchcock

I can’t believe how many times I have belly laughs every day.  That’s a wonderful thing in my life.

– Eric Hitchcock

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I think we are all brothers and sisters on this planet.  I think we are here to help each other.  And I think everyone in this room, individually, and as a group, we are all situated in this time and space to fulfill that part of our human destiny.  To help others.  So, get out there and keep on doing it.

– Bill Snyder (as quoted by Eric Hitchcock)

Since the onset of this website, I’ve occasionally gotten questions from individuals about varoius topics.  Recently, a student had emailed me with a set of questions and instead of just responding to that email like I usually do, I decided to record a podcast out of it in hopes that many more people may benefit from these thoughts.  I really do hope this creates a dialogue though as I know many of you may have differing opinions.  Please share your thoughts in the comments below, or on any of our social media accounts.  And don’t forget iTunes!  We would seriously appreciate your feedback there in terms of leaving a review.  Thank you all for listening and I hope you enjoy!

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I’ve always been a bit of an opportunist, looking for where the opportunities lie.  Not just going with the mob.

– Stanley V. Paris

I have, throughout my career, been disappointed many times in the therapists who let’s say they’re trained in McKenzie (and think everything of it).  But then they take a Maitland course, and they think that’s great and drop everything that they’ve ever learned from McKenzie.  Or next year it might be a Mulligan-type course, and they drop everything else.  Haven’t they learned?  Can’t they integrate?  No, they’re just followers.  They don’t have enough depth of background in the basic sciences of anatomy, physiology, biomechanics (and psychology if you like because it gets in there too) to be able to synthesize this and come up with something that suits their personality and the patients that they are treating.  No, they do it the way according to their latest impressive mentor.

– Stanley V. Paris

Alan Stoddard… I always regarded as the greatest manipulator I’ve ever worked with.

– Stanley V. Paris

I discouraged my faculty from doing research.  Because you can’t be a researcher, a clinician, and a teacher.  I think you need to come into the profession with clinical skills.  So, I wanted my faculty to be mainly clincians and teachers.  Researchers would be third.

I feel that if you look at the quality of most of our research in the last twenty years, much of it, it cluters up our conferences and poster sessions with stuff that we see over, and over, and over again.  Whereas the big questions have not been tackled.  That’s why I’m involved with the Foundation (Foundation for Physical Therapy) today.

– Stanley V. Paris

What could I say about Stanley Paris that some of you don’t already know.  Well, after speaking with him for this conversation… a lot!  Stanley was gracious enough to spend quite a bit of time with me earlier this year and… WOW… just, WOW!  If you think you knew who Stanley was in the history of our profession, you will be surprised by some of the stories he tells.  In hearing a lot of what Stanley was talking about, I couldn’t help but have the feeling like I’m a slacker.  Seriously, just hear all of the things he had done before he was 30 years old and I’d venture a guess that you’d feel the same way.  Yes, he is quite the inspirational figure for so many in our profession and will go down in history as one of the biggest influencers of our craft that is manual therapy.  Please enjoy this conversation with Stanley Paris.

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We need the occasional passionate teacher who can inspire students to excellence.

– Stanley V. Paris

You do your best at your phase in life and then you have to move on and leave it to others.

– Stanley V. Paris

A leader is a person who will bring together the best talent for what it is we’re trying to do.

– Stanley V. Paris