UPComing LONG-TERM Manual therapy Courses

These two courses cover key concepts and techniques necessary to be able to effectively rehabilitate all kinds of musculoskeletal disorders. The courses have a manual therapy emphasis, but also cover evaluation, clinical decision making, education and therapeutic exercise. The courses can be taken individually or as a series.

These courses teach the most important theory and techniques covered in the yearlong course. Over the years Roland and Paul have determined that some of the material in the prior Yearlong course was too complicated or too theoretical to be of clinical use to participants. We expect the two three month Manual Therapy and Rehab courses (Spinal and Extremity) to meet the educational needs of the vast majority of clinicians working in outpatient orthopedic and sports PT. However, we will likely offer advanced courses for those interested in understanding the full complexity of orthopedic manual therapy.

top Five reasons why clinicians have poor outcomes with musculoskeletal disorders and how our courses help*

1) the therapist thinks that pain is mostly due to inflammation and therefore overly FOCUses on anti-inflammatory treatments and the avoidance of STRENUOUS movement.

Although inflammation does cause pain, it is not necessary to have inflammation for pain to be present. In many patients the musculoskeletal pathology is non-inflammatory (mechanical) and therefore will not respond to treatments intended to reduce or prevent the development of inflammation. Our courses help clinicians differentiate between inflammatory and mechanical disorders and provides a paradigm and range of treatments that assist in the resolution of mechanical pathology.

2) Treatment primarily focuses on potential risk factors instead of rehabilitation of symptomatic tissues.

Poor quality movement does increase the risk of muscuolskeletal injury and correcting movement abnormalities should be a goal of PT. Unfortunately, many therapists fail to rehabilitate the symptomatic tissues and make the correction of potential risk factors their only goal. For example, working on scapula stabilization and posture in someone with subacromial pain syndrome (aka “impingement”) and ignoring rotator cuff strength and glenohumeral passive mobility is like treating an individual’s lung cancer with advice to quit smoking only. The primary objective of our courses is to teach PTs how to rehabilitation musculoskeletal pathology so that patients can be physically active with less pain.

3) Manual therapy use is limited, lacks variety or is INAPPROPRIATE in intensity.

Many therapists have had limited training in the theoretical and practical aspects of manual therapy and therefore under use it. Although manual therapy is only one third of what we need to know to successfully rehabilitation musculoskeletal disorders (the other thirds are patient education and therapeutic exercise instruction) it tends to be the weakest area for most PTs and it is also the hardest to learn. Therefore during our courses we spend a lot of time teaching and refining a range of thrust and non-thrust manual therapy techniques for all body parts. We also teach strategies for therapists to appropriately dose manual therapy vigor, depending upon the clinical presentation each patient.

4) The therapist believes Good treatment should result in the minimization of symptoms and/or that good treatment should not cause pain.

When symptoms are severe, treatments intended to reduce symptoms can provide significant benefit in the short term. However, for many patients residual mild symptoms are common and in these individuals it is better to focus on the application of physical stress (e.g. manual therapy and exercise) to help optimize tissue quality and activity tolerance. Graduates of the yearlong course should expect to be able to identify when pain control strategies will be more successful than traditional rehabilitative exercise and manual therapy.

5) The therapist believes that the presence of pain justifies the restriction of physical activity.

As mentioned earlier, many therapists believe that pain is an indication of harm and therefore they instruct patients to avoid physical activity that causes pain. Restriction of physical activity due to pain is appropriate in the acute phase, but very likely harmful in the chronic phase. With a better ability to identify the type of musculoskeletal pathology, course participants are more selective in their advice to cut back on exercise, and help patients maximize their physical activity in spite of pain. Maximizing physical activity is one of the primary objectives of physical therapy.

*According to Roland