Manual Therapy Forum

“The noiseless, painless, restoration of maximum function.”

– Tim Flynn quoting Paul Kimberly, DO, FAAO for his definition of ‘manipulation’

Passion for the patients that we are able to work with… curiosity… humbleness… an open mind… and a commitment to always improve your skill set.

– Tim Flynn

The thoracic spine and ribcage… at the end of the day, breathing and dialing down the sympathetic nervous system is a game changer for the vast majority of patients.  So, if your thoracic spine and ribcage is not mobile, you cannot breathe.

– Tim Flynn

Today, we have the fortune to speak with Tim Flynn.  Tim is a well known figure in manual therapy, research, and education.  He is a former military man as well.  While Tim has received extensive training in traditional forms of manual therapy, and is open about how his overall manual therapy approach has evolved with reseearch findings over the years.  Recently, Tim has been an amazing advocate for our profession to be the front line of musculoskeletal care, especially as the opioid epidemic has become fully exposed for what it has done to patients.  Tim shares his wisdom with years of experience in multiple areas of physical therapy and manual therapy.  I hope you enjoy this time with Tim!

Pain does not equal damage.

– Tim Flynn

Never underestimate the power of the medical system to make you worse.

– Tim Flynn

Yes, we get together at conferences such as AAOMPT, CSM, etc.  We get together and that should nourish us, but if we’re only talking amongst each other we’ve literally failed to do what we’re called to do.  We should spend 95% of our time talking outside our profession and 5% of time within.  And of that 5% maybe arguing about 0.5% and the other 4.5% of that collaberating on how we’re gonna make this dysfunctional thing we call a heatlhcare system better for society.

– Tim Flynn

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/05/timothy-w-flynn-pt-phd-ocs-faaompt.mp3

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Links of interest:

Michigan State University – College of Osteopathic Medicine

Colorado In Motion

Evidence In Motion

American Academy of Orthopaedic Manual Physical Therapists

South College

Baylor University

Pain Neuroscience Education

Tim Flynn (twitter)

Pain Reframed Podcast

Previously, Ray and myself sat down and talked about new trends within the nutrition realm regarding a growing movement of limiting carbohydrate and increasing fat intake.  This has been labeled as “Low Carbohydrate – High Fat” lifestyle.  More strict forms of this is also known as “Keto” which is short for ketogenic, meaning that limiting carbohydrate intake reduces the body’s ability to utilize glucose for energy.  Therefore, ketone bodies are produced and utilized for energy.  However, this lifestyle is not without controversy.  Many individuals and organizations are fighting hard to preserve a traditional macro- balance, primarily of carbohydrates with limited amounts of fat.  The pendulum doesn’t stop there though.  As further extremes are growing more popular.  Those are a “carnivore” lifestyle in which a person eats nothing but meat and fat, and veganism in which a person eats no animal products in any fashion.  These topics and more are discussed between Ray and myself in this conversation.

If you’d like to review previous conversations we’ve had, you can find them here… and here.

For the current conversation, listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/04/ray-klepper-pt-dpt.mp3

Or tune in down here:

Links of interest:

New Atkins for a New You:  The Ultimate Diet for Shedding Weight and Feeling Great by Eric C. Westman and Stephen D. Phinney

Carnivore Training Systems

N Equals Many

Meat Heals:  Revitalizing health and performance through carnivory

Shawn Baker, MD (instagram)

Shawn Baker, MD (twitter)

The China Study:  The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term Health

Denise Minger

Dr. Michael Eades

MTHFR and Dr. Ben Lynch

Weston A. Price Foundation

Chris Masterjohn, PhD

Rhonda Patrick, PhD

Dominic D’Agostino, PhD

Dave Feldman

Gary Taubes

Gary Fettke

Nina Teicholz

Professor Tim Noakes

Diet Doctor

Research mentioned:

Campbell,  C. The China Study: Startling Implications for Diet, Weight Loss, and Long-Term Health; Review by Masterjohn, C. (2005) Retrieved January 14th, 2010 https://www.westonaprice.org/the-china-study-by-t-colin-campbell/

Casavalle, P., Lifshitz, F., Romano, L., Macerna, M., Gonzalez, C., Bordoni, N., Boyer, P., Rodriguez, P., Friedman,M. Gingivits and Insulin Resistance in Obese Children. 10.2337/dc16-0708

Fest, A.,  D’Agostino, R.  Jr. George H., Mykkanen, L., Tracy, Russell., &. Haffner, S. (2000) Chronic Subclinical Inflammation as Part of the Insulin Resistance Syndrome: The Insulin Resistance Atherosclerosis Study.   102: 42-47

Fung, J. Intensive Dietary Management; End Organ Damage; (2015) Retrieved on June 30th, 2016 http://intensivedietarymanagement.com/end-organ-damage-t2d-17/

Seung-Hwan, L., Zabolotny, J., Hu, H., Hyon, L., &Young-Bum, Kim. (2016) Insulin in the nervous system and the mind: Functions in metabolism, memory, and mood Molecular Metabolism. Aug; 5(8) 589-601; 2016 Jun 29. Retrieved December 15th, 2017.

Teng, K., Chang, L., Vethakkan, S., Nesaretnam K., &Sancers, T. (2017) Effects of Exchanging Carbohydrate  or Monounsaturated Fat with Saturated Fat on Inflammatory and Thrombogenic responses in Subjects  with Abdominal Obesity: A randomized Controlled Trial Clinical Nutrition 36. 1250-1258

You can be, I think, a really good therapist but become a really great therapist by sticking it out and learning the basics from very knowledgable people.  And then, continuing to ask the question ‘But, why?’

– Cheryl Wardlaw

I’m not sure what sitting around [and] doing nothing is… it’s just not what I do.

– Cheryl Wardlaw

My Dad always told me that female or not, there’s nothing that you can’t do.  There’s nothing that you can’t learn.  And if anyone tries to hold you down, you just punch ‘em out…  So, I never saw being female as any determinant to a limitation in what I could do, and still to this day I don’t.

– Cheryl Wardlaw

Today, the one-and-only Cheryl Wardlaw spends time with us.  If you have not had the pleasure of meeting her, then you’re welcome for this first introduction.  Cheryl is an inspirational figure to many of us within the Institute of Physical Art with her grace, humor, intelligence, skill, etc., etc., etc.  This was a fantastic conversation with her because we get to learn how her work ethic was born, who has inspired her through the years, her thoughts on “acting” for our patients, and much much more.  Enjoy this time with Cheryl, because I sure did!

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/03/cheryl-wardlaw-pt-mmsc-cfmt.mp3

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If I can only think the thoughts that have already been thought, where do we go from here?  If we said that in the ‘50s, we wouldn’t have gone to the moon.  It’s my responsibility to think thoughts that have never been thought before.

– Cheryl Wardlaw

I think good therapy is good theater.  I think that I play a role for that person that helps them move to where they need to be.  So, you’ve got to know your audience.  Every patient is an audience.  Every class is an audience.  Every student is an audience.  And you have to know what kind of theater they need…

– Cheryl Wardlaw

What is often said is ‘Full strength Cheryl will probably dissolve you’.  (Haha) I’m a very concentrated form of an individual.

– Cheryl Wardlaw

Links of interest:

Emory Healthcare

Institute of Physical Art

Specialized Educational Experiences

This post is a compliation of the short recordings we did at Combined Sections Meeting back in February.  This way, listeners can enjoy those interviews on podcast apps.

Heather Purdin MS, PT, CMPT –  3:28

Functional Movement Screen & Selective Functional Movement Assessment (Aline Thompson PT, DPT, OCS) –  13:38

Postural Restoration Institute (Jennifer Platt DPT, ATC, PRC) –  25:07

Myofascial Decompression (Christopher DaPrato PT, DPT, CSCS, PES) –  38:30

USC DPT Students at APTA CSM 2018 (Nicole and Fletcher) –  47:47

Foundation for Physical Therapy (Barbara Malm, MBA) –  1:03:16

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/03/apta-csm-2018.mp3

Or tune in down here:

Thanks for listening!

I think one of the best things PTs can do when they come out of school… go in a hospital.  Work inpatient/outpatient.  Learn the medical side of things.  Learn things about illness, learn things about other disciplines…

– Mike Rogers

Pain arising from the SI is as rare as pain in the buttocks is common.

– James Cyriax (paraphrased by Mike Rogers)

We are fortunate to speak with Mike Rogers today.  Mike is another important figure in the manual therapy education of physical therapists in the United States.  He has quite the interesting story to tell, consequently!  Mike has personally learned from Cyriax, Mennell, and Kaltenborn to name just a few mentors.  Another great thing about speaking with Mike is that he is also a founding member of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/03/mike-rogers-pt-fmaaompt-hon-faaompt.mp3

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People need to be independent thinkers and use the laboratory that’s in front of them, which is the patient.  If you know your ABC’s… Anatomy, Biomechanics, Clinical sciences.  A lot of times you can solve problems that aren’t solved by all the research in the world.

– Mike Rogers

 I can’t say enough about those seven people I met with [fellow founding members of AAOMPT].  Working with the founding members was probably one of the best things in my career that ever happened.  Because so much came out of that.  You just have to go to an Acadmey (AAOMPT) meeting to know.

– Mike Rogers

Links of interest:

American Academy of Orthopaedic Manual Physical Therapists

Michigan State University:  College of Osteopathic Medicine

Dr. James Cyriax

Kaltenborn-Evjenth OMT

Ola Grimsby

Joe Farrell

[This] deep sense of responsibility of having to be the best me that I can be for my patients, for whoever…

– Rebecca Schneider

To me, that was my residency.  Because every week I’d go to work and I’d study for two to three hours in the morning, and I would consult with my different colleagues.  So, even though I didn’t do a formal residency… to me, that was my residency.

– Dustin Krampitz

What fellowship then allowed me to do was… “okay, what do I do with all that information?”  And, how can I refine my thought process, my clinical reasoning and really fortify the structure by which I use that information?  One of the huge things has been just how to be much more meticulous, in terms of my question-asking, my subjective exam…

– Rebecca Schneider

Always nice to have friends join us on a podcast, especially when it involves some nice beer!  Dustin and Rebecca are two friends of mine (and work colleagues) here in Chico.  Among a number of things we discuss in our conversation today, one topic was some of the differences between attaining a high level of skill.  A more traditional route via the continuing education circuit and lots of individual study and the more recent push via post-graduate training in residency and fellowship programs.  These two are relatively young clinicians in their careers, but in my humble opinion, are practicing way beyond their years out of school.  It was a blast to sit down and chat with my buddies over a couple of beers, so I hope y’all enjoy!

I’ve always been somebody that likes to work with my hands.  As a kid, I was always following my dad around the house and working on the house with him… Working with my hands just feels right… I very much value the healing that comes through our hands.

– Rebecca Schneider

PNF IS manual therapy.  You don’t have to be mobilizing joints, but you can use your hands and facilitate the body and that IS manual therapy.

– Dustin Krampitz

Finesse [and] gentleness… There can be plenty of people who are amazing with their hands.  And you can have your OCS.  You can have your FAAOMPT.  You can have all sorts of degrees, but that doesn’t actually make you a good therapist.  You can be a pretty crappy therapist and have ‘X’ whatever credentials… The thought process that comes behind it.  Why you’re using [a technique], when you choose to use it, and when you choose not to use your hands.  I think, is a huge part of being that master manual therapist as well.

– Rebecca Schneider

Being passionate.  When you lose your passion for learning and growing, then you start to get arrogant and complacent and you get yourself in trouble.  When Matt talks about experts (the people I’ve seen) like Laurie Hartman is a great example.  That guy is the most humble guy I’ve ever met.  He’s just so smooth and so gentle.

– Dustin Krampitz

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/02/dustin-krampitz-pt-dpt-cfmt-rebecca-schneider-pt-dpt-ocs-faaompt.mp3

Or tune in down here:

Links of interest:

Institute of Physical Art

Evidence In Motion

Kaiser Permanente Northern California Graduate Physical Therapy  Education

Dunloe Brewing

Regarding David Lamb:

“He had hands that were unbelievable.”

“I appreciated his size, grace, [the] softness of his hands.”

“As a manipulator, he just got your attention, because he could do things where it was artful.”

“He made you feel special, and that was something he did for everybody.”

“He seemed to have ten lifetimes of techniques and skills.”

In this post, we speak with one of my main mentors over the years, Kent Keyser.  I’ve had the pleasure of teaching with Kent for five years now and have enjoyed every bit of it, always learning new things (while teaching the same material over those years).  This conversation with Kent was during CFMT week in August of 2017.  We had some free time after getting to the airport very early, so we got to chat about a different subject.  Two men that were very influential in Kent’s professional (and perhaps personal) life were David Lamb and Jeff Ellis.  Unfortunately, these two men passed away many years ago.  Kent helps us remember a bit about who these men were and what made them special in his eyes.  So listen in to learn more about these influential manual therapists.

Regarding Jeff Ellis:

“For some reason he touched the soul because he covered so many areas.” 

“He ended up having over 2,000 people show up.  In five days.  From all over.” 

“He was truly a renaissance man.  Everything he did, he was good at.  He impacted on people and meant something in their life.” 

“He would’ve been a substantial person in physical therapy and manual therapy…  He would’ve taken things to such interesting places because he was that brilliant in his ability to take information and really bring things to cutting edges. “

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/01/a-side-of-history-with-kent-keyser-ms-pt-ocs-comt-atc-ffcfmt-faaompt.mp3

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There is an art to this, that science has a hard time measuring.  Because there’s so many variables that we have to control or account for… we have to consider in every treatment session.  That’s just a fact of our reality.

– Diane Lee

My courses are not about… here’s how you do this technique, this is how you do that technique.  There’s so many courses out there where people can get the tools in their tool-box for how to do this.  I really prefer to focus on when and why, and how do you know where to go in the body.

– Diane Lee

Diane Lee drops in with us this time!  She is a wealth of knowledge, and seeks to impart this to clinicians through her teaching organization “Learn with Diane Lee”.  Diane (with Linda Joy-Lee) created the Integrated Systems Model several years ago as way to organize their vast amount of clinical and educational experience.  Since then, Diane has independently evolved this model and become the sole provider for this material.  Also, most of you are likely to know who Diane is from her textbooks listed below.  She may have been the first physiotherapist to write a clinical text about the pelvic girdle in the early 1980s and afterward wrote another text regarding the thorax and clinical application of concepts regarding movement, diagnosis, and intervention.  Recently, she authored a text on diastasis rectus abdominis, and is currently working on the next edition of her thorax book.  Whew!  To list all of her other accomplishments and awards would be too numerous at this point, and I might run out of room on this page… so, listen and enjoy!

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2018/01/diane-lee-bsr-fcamt-cgims.mp3

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The most toxic thought a young clinician can have is “somebody else can do this better than me.”

– Diane Lee

Gosh this is great!  I love what I do, this is fantastic!  And so the work itself lifts you up, and that’s when you know it’s not time to retire yet.

– Diane Lee

Just play, just play.  Play and be curious and the learning will always be there… right?

– Diane Lee

Links of interest mentioned during this conversation:

Diane Lee & Associates Physiotherapy

Learn with Diane Lee

Diastasis Rectus Abdominis:  A Clinical Guide for Those who are Split Down the Middle

The Pelvic Girdle:  Integration of Clinical Expertise and Research

The Thorax:  An Integrated Approach (currently being revised)

… you can’t let anything stop you.  Ever.

– Theresa’s mom (from Warrior:  A Memoir)

The important thing for me is I’m having fun doing [physical therapy].  I can’t go into a career anymore where I’m just going through the motions, and having an insurance company tell me what to do.  Nope.  Sorry, that’s not gonna happen to me.

– Theresa Larson

In need of some inspiration?  Get it right here.  Theresa Larson is our guest for this interview.  Theresa is currently a private practice owner in San Diego, CA.  She is also co-creator of The Low Back Fix, a website program designed to help the average patient with lower back pain overcome their pain and regain their function.  Theresa has written an auto-biography titled Warrior:  A Memoir, where she chronicles events throughout her life that have led her to where she is today (side note – I read this book prior to our conversation and it is a worthwhile read!).  In addition to all of these things, Theresa has been an instructor for MobilityWOD, a program developed by Kelly Starrett (author of Becoming a Supple Leopard).  She has quite a few other accomplishments that would take a long time to describe, but I can list a couple more:  United States Marine Corps second lieutenant and collegiate/professional softball pitcher.  See what I mean… inspired yet?  If not, just listen below…

Your brain has perceived this movement as a threat for a long time.  You can rewire that.  Let’s slow you down.  Let’s teach you how to breathe.  Let’s load the proper joints effectively, and over time… you will change… and you will be more functional.

– Theresa Larson

That’s what our job is, to empower people to continue moving.  Versus disempowering them and telling them they can’t.

– Theresa Larson

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2017/12/theresa-larson-dpt-cscs-sfma.mp3

Or tune in down here:

Links of interest during this conversation:

Dr. Theresa Larson

Movement-Rx Integrated Health

The Low Back Fix

Warrior:  A Memoir

You are what you do, you are what you eat, and you are what you think

– Ola Grimsby

For our latest conversation, we get to speak with Ola Grimsby.  Ola is a titan in manual therapy education, not only in the United States, but throughout the world.  If you have heard of him, it is probably through his institute, the Ola Grimsby Institute.  A big reason to want to speak with Ola was that he is a co-founder for the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).  However, in getting to speak with him, I soon found out there were much better stories to hear and things to learn!  For instance, we get to learn about the early days of manual therapy education here in the US, and how much of that depended on all the big names you’ve heard of (Mennell, Cyriax, Kaltenborn, etc.).  Also, how Ola came to the US and traveled around the country teaching what he’d learned previously in Norway.  Needless to say, if you are interested in history of manual therapy, or gain more understanding about what manual therapy is and what it can do, you’ll want to listen to what Ola has to say!

I would definitely like to see a consensus, first of all, in the amount of clinical supervision that a training is requiring.  Instead of having research done on topics that is either partly clinically irrelevant or done by scientists who have not treated patients.  That makes the outcome of the research rather questionable.  I’m not opposed to research, that’s not what I’m saying, but it should be done by the specialists in clinical care.  And the consensus should be based upon massive clinical experience and massive clinical repetitions of research projects.

– Ola Grimsby

There is nothing new under the sun.  My contribution is absolutely minimal, and I think that goes for most of these old time gurus that are sitting on other people’s shoulders. 

– Ola Grimsby

Listen in here:

https://manualtherapyforum.com/wp-content/uploads/2017/12/ola-grimsby.mp3

Or tune in down here:

Links of interest mentioned during our conversation:

Ola Grimsby Institute

American Academy of Orthopaedic Manual Physical Therapists

International Federation of Orthopedic Manual Physical Therapists