What are the benefits of manual therapy?

Manual therapy is a term physical therapists use when we talk about doing a hands-on service to our patients. This can look like soft tissue massage, joint mobilizations, “adjustments”, nerve mobilizations, stretching and so much more. Manual therapy is a skilled and trained procedure your physical therapist may perform.

Recently many physical therapists have moved away from manual therapy because they feel it gets over-perscirbed and their patients feel reliant on them. While that may be true it is still a very useful and power asset to the rehabilitation process.

Manual therapy has a lot of benefits but should be done when your healthcare provider deems it appropriate. Not everyone should receive the same kind of manual therapy because everyone has a different context, status, and goals with their health. For instance, two people can both have limited hip mobility, but one person may need stretching, and the other person may need joint mobilizations. The physical therapist should be able to run tests to differentiate which ones will help.

Now let’s address some of the benefits of manual therapy.

Reduced pain

Improved flexibility

Decreased swelling

Improved nerve mobility

Improved joint play

Muscle inhibition/excitation

Decreased muscle tension

Improved bloodflow

There are so many benefits to manual therapy, specially if it’s target at specific needs and matches your current presentation. Physical therapists can be excellent providers for manual therapy as they have a great understanding of anatomy and biomechanics.Talk with your physical therapist if it’s appropriate for you.

Master this exercise to live longer

Squat! This exercise although super simple is very popular because quite frankly it’s very important and targets a lot of key muscles. Why is it important, well because if you try to lift something heavy off the ground (which we all need to do) without bending your knees, there is a good chance your going to hurt yourself. If you want to sit down into a chair, get off the toilet, or travel guess what? You’re going to need to do a squat. In fact, A 2014 study found that being able to get up and off the floor with as little support as possible was a predictor of mortality. Those who need less assistance from different parts of their body on average lived longer. In Eastern countries like China and Japan, they on average show much less prevalence of Hip osteoarthritis. Now we don’t know exactly why but one prevailing theory is that it’s because in those countries they squat very low as part of their day to day life. 

So how do we build a good squat. First we need to make sure we have enough mobility, specifically in our knees, hips and ankles. If you don’t have the mobility you may still be able to squat low but you might compensating with rounding your low back and that overtime can lead to some pain.

Secondly we need to make sure we are turning on the right muscles. Are we activating our quads, glutes, and abs. A lot of people have a hard time with last two and there are a lot great exercises that can help you get there if you are struggling with that.

Third, we need to make sure we are strong enough. And in my opinion, just being able to get up and down isn’t enough because over time we will get weaker and we want to set ourselves up for success in the future, so let’s get a higher baseline now.

Lastly, if we have all those building blocks we just want to do it with good form. We should always lead with our hips because they are the strongest part of the body. If you are unsure, hire a physical therapies or coach to look at it for you! 

Let’s squat to feel better, look better, do more, and for our loved ones so they don’t need to help us get up as we get older. 

Dudda M, Kim YJ, Zhang Y, Nevitt MC, Xu L, Niu J, Goggins J, Doherty M, Felson DT. Morphologic differences between the hips of Chinese women and white women: could they account for the ethnic difference in the prevalence of hip osteoarthritis? Arthritis Rheum. 2011 Oct;63(10):2992-9. doi: 10.1002/art.30472. PMID: 21647861; PMCID: PMC3178680.

How to treat low back pain?

In order to treat low back pain, we first need to see if there are any red flags or dangerous signs. Usually by asking some questions and running some tests, we can determine if we need to follow up with a medical doctor for more tests or are we safe for physical therapy.

After that we want to categorize our patients based on how they present. The American physical therapy association has four classification categories. A manipulation category, a stabilization category, a directional preference category, progressive exercises and fitness activities for chronic back pain 

Classifying our patients in the correct category allows us to treat them properly so they get better results faster. 

Should you get your neck adjusted?

There definitely is a risk with getting neck adjustments. Sadly some people have been paralyzed after or even passed away. However, they can also be very effective. In order to minimize the risk of a neck adjustment it should really be done if there’s no red flags in the medical exam and if the patient presents with the following signs and symptoms.

1. positive expectation manip will help

2. duration of symptoms <38 days

3. cervical range of motion difference >/= 10 deg (strongest predictive value)

4. Pain with PA spring test of mid cervical spine 

greater than 3/4 items on this brought the success from 38%-90%

If present with the signs and symptoms they’re usually a good candidate for manipulation and will benefit from the treatment. In my opinion, only when there’s no red flags and they fit that category then is a neck manipulation warranted. 

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome is a fancy word for pain around the kneecap. Although we’re not 100% sure about the mechanisms of pain we do have a few classification categories to help us get effective treatment.

Patellofemoral pain syndrome with mobility deficits: You can be either really stiff around the knee or too mobile in the foot.

Patellofemoral pain syndrome with muscle power deficits: You can have some quad and glute weakness .

Patellofemoral pain syndrome with overuse and overload disorder: You could just be training too hard causing knee pain.

Patellofemoral pain syndrome with movement coordination deficits: You could be doing some movements wrong causing the pain.

Once we can come up with the appropriate classification then we can figure out how to treat it best. 

3 Mistakes people make when rehabbing an ankle sprain:

1. Not getting on their feet as quickly as possible: Believe it or not after you sprain your ankle it’s a good idea to put some weight on it and walk. Wearing a brace to help support is a good idea too.

2. Not working on balance training: After you irritate a ligament and muscles, they need to be challenged in order to return to the previous function. After an ankle sprain, you really want to work on balance training to get the proprioceptors in the ankle functioning as much as possible.  

3. Not using a brace when going back to training: The research really supports the use of wearing a lace up ankle brace, specially if you’re doing an activity where you’re on your feet and need a lot of agility.

If you suffer an ankle sprain, go get evaluated by a physical therapist so they can help you recover sooner. 

How to be more coordinated?

As a professional stuntman, breakdancer, and martial artists, I’ve spent my life trying to learn how to do weird things with my body. Wether it’s a backflip, spinning on my head, or fighting someone who is 100lbs heavier than me, it’s definitely been years of practice. So how do we get better at skills?

The answer which you can guess is practice. You hear it all the time. “Practice makes perfect”. It’s true except there is a subtle difference that I want to explore more. The challenge is not just practicing, it’s practicing well. What does that mean? I have two important criteria for good practice: First, is the task perfectly hard enough? Second, are you getting feedback?

Let’s break down the first one. I think this is the most challenging aspect of practicing, finding the perfect difficulty. We hear all these motivational speeches about getting outside your comfort zone, failing, get back up and get after it again. Yes that does hold merit but the problem is, if you’re picking up a challenge you’re not ready for, you may be making bad habits, you may get frustrated and give up, or you may even get hurt attempting. Instead we want to find the right level of difficulty. When I was learning how to flip, my coach use to say we want to train in the zone of  “Difficult but possible”. That’s because it requires our attention to focus and sync everything up but it’s not so unreasonable we’re not going to make progress. In my opinion, if you’re attempting something and your success rate is less than 50% per trial, you should make it slightly easier so you can work on building good habits and eventually move onto something harder. Once your success rate is higher, on that task close to 90%, that’s where I would make it a little harder to add more challenge. I think this is a very important nuance that allows us to get more out of each session. If you want to get better at something that seems impossible, try to break the task down to something easier to start, master that fundamental than add a little bit more. I wish someone show’d me this while I was breakdancing and I probably could have avoided a few surgeries and have had a better career.

Once we get the right difficulty, we want to address the second problem. Are we getting feedback? If we want to get better at some skill, we need feedback to tell us if we’re doing it right. At the beginning specially we need lots of external feedback to tell us, but as we get better we can switch to internal feedback (Does this feel good or bad?). If you don’t have a coach to give you that feedback that’s where watching footage of yourself and analyzing it is very helpful. Often times you don’t realize your making mistakes till you see it in third person. However I highly recommend getting a coach or physical therapist to watch you instead. 

I hope this helps you accomplish some skill you’ve been wanting to learn, or maybe something that even hurts and you’re trying to adjust. As always go see a physical therapist to help breakdown any barriers so you can better results, faster.

How to improve your mobility:

First thing first, we need to address, what are the barriers to our mobility: Is it muscle? Is it joint capsule/ligaments? Is it nerve? Is a bony block that won’t improve? In order to get those answers, we need to do a good job testing? That’s where a good physical therapist comes in. They not only cans what your building blocks are but they can document where you at so we can track for improvement. That’s an important step because if we don’t know where we start, we won’t know if we’re getting better, and more specifically what is helping. Often times I see physical therapists just encouraging their patients to stretch without doing two big things: 1) Determining if their mobility is limited by something that needs stretching. 2) Measuring their baseline to know if that stretch is making improvements. Let’s talk about the first problem. 1) Your mobility may not purely be muscular. Often time’s it’s the joint capsule and if you don’t address that first, stretching may make things worse. The second problem 2) If you’re not getting baseline, then you don’t know if you’re making a change, wasting your time, and then inevitably give up. You know what motivates people? Results! If you can measure a baseline, do a treatment and get results, then that gets people excited to keep working harder. 

Once we determine what is the building blocks needed, and what our baseline is. Then it’s time to get into treatment. I always like to do hands on therapy to my patients in the clinic so I can get some dramatic changes in the session and also recheck their levels so I know their home exercise program is going to work instead of guessing. If they have a home exercise stretching program all I ask for is 2 sets of 30 seconds because the research says 1 min a day is sufficient and sometimes you actually plateau afterwards. That’s not a lot of time but what I think is the hard part is the daily discipline to do it everyday. But that’s where solving those two problems I mentioned earlier come in. If you can get down to the root cause of their mobility you will get results faster and that will motivate. If you can prove you’re making improvement that will also motivate to do it everyday. No one wants to waste time. But that means let’s spend the time to get really good answers about what is holding your mobility back so we can make improvements. 

If you want a little extra after a stretching session, I suggest exercising in that new range of motion. An example can look like: You’re working on hamstring flexibility. After your minute of stretching practice some light deadlifts, and leg raises to teach those muscles how to activate in that new range of motion. Remember, before starting an exercise plan I highly recommend you to visit a physical therapist. This is not just a disclaimer, it’s also so you get better results faster.