Welcome to our first technique video!
The talo-crural distraction thrust is a technique that is utilized often for patients with ankle dysfunction. However, have you learned the biomechanical rationale and reasoning as to why this technique works? Or, what types of patients it will benefit the most? Dr. Thomason demonstrates which patients are appropriate for this technique and little modifications of patient positioning to make it more safe. Please comment or reply with your thoughts below!
Welcome to our second interview! This time, we speak with Erl Pettman. Erl is a former senior lecturer and chief examiner for the Orthopaedic Division of the Canadian Physiotherapy Association (CPA). He is also a co-founder of the North American Institute of Orthopedic Manual Therapy (NAIOMT), for which he still serves as senior instructor and chief examiner. In addition, Erl is an instructor for the post-professional Doctor of Science in Physical Therapy Program (DSc) at Andrews University, Berrien Springs, Michigan.
During our interview, we learned of Erl’s influences from a young person to pursue physiotherapy as a profession and how he got involved into manual therapy. Erl is a passionate individual for his profession, not just for treating patients, but for instructing other therapists as well. If you have not had an opportunity to learn from him, please consider as he has a wealth of knowledge not often seen in manual therapy. His approach to manual therapy is one that consistently uses biomechanical principles and functional anatomy to create the safest techniques of mobilization/manipulation, while being gentle and highly effective.
If you would like to learn more about Erl, please visit his website at http://www.erlpettman.com. On there, you will find a book that he has written on manipulation (DVD included). If you haven’t come across this book yet, check it out! I would highly recommend purchasing one to have in your clinical library (I do). Also, you could find out where he is teaching next on http://www.naiomt.com.
I hope you enjoy this interview. As always, please reply if you have any comments or questions!
Ever hear of the saying “The masters do the basics well”? I’ve certainly heard it quite a bit over the years. However, have you ever thought… ‘well, what are the basics?’
To me, the basics have to start with anatomy. We’ve all heard it, “you’ve got to know your anatomy!” If there is ever a common theme of all the expert clinicians that I have ever taken a course from, met personally, or heard speak… it is this one. Several points could be made about this, but one of the biggest reasons for knowing your anatomy well is that it helps your clinical reasoning.
For example, if you know your anatomy well enough, you could differentially diagnose the “carpal tunnel syndrome” patient that was referred to your clinic with an actual C7 radiculopathy; or recognizing the signs or symptoms of a basic posterolateral disc protrusion and prescribing McKenzie passive extension exercises (which will argubaly benefit them the most in the long run) at the initial visit; or perhaps even more important, understanding that the patient in front of you is not demonstrating a usual musculoskeletal presentation, and you are able to recognize this quickly and refer them back to their physician!
Please don’t misinterpret this post as lecturing readers as if I have a vast amount of knowledge of anatomy. I will be the first to tell you that I am no expert in it. However, I can say that I have a decent knowledge of anatomy. Also, I can tell you some of the habits that “experts” have in our field, so that hopefully you can be inspired to incorporate them into your own life.
First, everyone reading this post should own a Gray’s Anatomy. I do NOT mean the Gray’s Anatomy that is in some special collector’s packaging and is sold for $30 down at the local Barnes & Noble. That is an old version (the last American version made actually, circa mid-1910s) and is obviously outdated. No, the version I’m referring to is the British edition. It is in it’s 41st edition at this point and can be found here (https://www.amazon.com/Grays-Anatomy-Anatomical-Clinical-Practice/dp/0702052302/ref=sr_1_3?ie=UTF8&qid=1495605232&sr=8-3&keywords=gray%27s+anatomy). If you only have one anatomy book… this is the bible. While we are on the subject of books, I much prefer the Atlas of Anatomy by Theime over Netter’s. The pictures, information, and clinical pearls are much more helpful to me. You can find the latest edition of that book here (https://www.amazon.com/Atlas-Anatomy-Anne-M-Gilroy/dp/1626232520/ref=sr_1_1?ie=UTF8&qid=1495605330&sr=8-1&keywords=atlas+of+anatomy).
The second thing I’ve learned from those much smarter than myself is that they study anatomy every week, about two to three hours each week. For those who don’t want to do the math, that’s less than 30 minutes per day… doesn’t seem so daunting of a task now, does it?
Third, they usually subscribe to multiple journals, or check the content of their favorite journals and have ways to access articles. If you are wondering how to get access to articles for cheap, go down to your local library for goodness sakes and start there. If you live near a Universtiy… even better! If not, most alumni associations from our graduate schools have some sort of perk where they can get you articles pretty easily (usually they charge a small fee like $5 per article though). Not too bad if you REALLY want to check out something important.
Fourth, if they run into something that is puzzling them in the clinic… they go back to their anatomy books! Or, they search things out on journal search engines (remember Pubmed from school?). This may not be too earth-shattering as I’m sure a lot of us do this, but how many of us actually go back to look into anatomy texts and read information versus going to look at an atlas because it’s easier to just see a picture? I know I’ve certainly been guilty of this one!
Lastly, the great clinicians I’ve met so far are always thinking about what the anatomy of a given individual means FUNCTIONALLY. As an example, it’s of little use to know the origin/insertion of a muscle if you don’t understand it’s true function… let alone how to properly rehabilitate it. Take the hip abductors… is their main function to move the leg away from midline in an open-chain (in the coronal plane)? Many clinicians give patients sidelying hip abduction exercises, or even standing hip abduction exercises to work this muscle. That may certainly help improve the strength of it, if the patient can do it correctly. However, wouldn’t it make more sense that these muscles function in weight-bearing? Therefore, wouldn’t it make more sense to exercise it in weight-bearing through something like eccentric hip abduction? I didn’t figure this out on my own, but had to learn that from a mentor, but it has certainly changed how I think since then!
I know that most of you reading this post have already agreed with me that our knowledge of anatomy is paramount and that we could (and should) ALWAYS learn more. However, my purpose in bringing this up is to make suggestions for ways to achieve that if you haven’t already thought about it. Or, if you are a new clinician fresh out of school beginning to feel overwhelmed by the patients you are seeing. Again, I am no expert in anatomy… yet. But I have learned how to better myself. The rest is just putting in the work to read, listen, and learn.
What are your thoughts? Do you have any suggestions that I have not mentioned? Would love to hear from you!
Our initial interview is with Bruce Franke. He is owner of Desert Palms Physical Therapy /Movement Studio/Institute in Tucson, AZ. Bruce teaches and mentors orthopedic manual physical therapy as well, both locally and internationally. There are a number of good pearls for professional development in this interview that I hope all clinicians (veteran and novice) will enjoy. Of note, the website he mentions toward the end of the interview is http://www.myptdoc.com. I believe I repeated the wrong address (also this site is not operational as of the time of this post).
The definintion of synergy: the interaction or cooperation of two or more organizations, substances, or other agents to produce a combined effect greater than the sum of their separate effects.
One of my biggest mentors often talks about the word “gestalt” in classes that we teach. His main point for using this term is “the sum of the parts do not always equal the whole”, meaning that the whole is actually greater. That is to say (in the world of manual therapy) there are movements or techniques that are actually a combination of multiple things, and this combining has an exaggerating effect on the outcome that would not normally be present were these movements/techniques performed individually. I include this term here in this post in reverence to him.
However, I stumbled onto this definition of synergy a couple of weeks ago and for some reason it really stuck with me. Maybe because synergy just sounds more mystical than a more abrupt word like gestalt. Although, please note that the two definitions are pretty much exactly the same.
I wanted to post this in part because I had hoped to work “synergy” into the title of this blog. Unfortunately, there were so many physiotherapy clinics in the good ol’ USA that I couldn’t separate this site enough from them. So, I decided on the current title (www.manualtherapy.blog). However, my intention for the content has not changed. And that is this… the content of this blog will be a SYNERGY of opinions, cases, technique descriptions (whether video or written), and interviews (whether audio or written) to inspire, educate, and empower those who practice manual physiotherapy.
Therefore, please subscribe to this blog; follow us on Facebook; follow us on Twitter; or just check back on a regular basis to see what is new. And please, comment/respond/share/critique or whatever strikes your fancy so that we can impact more clinicians out there!