The final chapter of our “Why Manual Therapy” blog series has arrived! Thanks for following along throughout the year. If you missed any check them out (HERE).
The future of manual therapy (MT) has never been brighter (HERE & HERE) Thanks to brilliant researchers and thought leaders the evidence supporting MT as a pain modulation option is unquestionable. We live in exciting times for understanding and effectively applying MT.
As professionals, we have the responsibility to provide the most effective and evidence-informed care for our patients. We take great pride in our work. However, sustaining a high level of care throughout a professional career is a challenge we all experience. I believe this is particularly true regarding manual therapy skills.
How can clinicians keep their manual therapy skills sharp throughout their careers?
While I can’t say what is best for everyone, in this blog I will present the top 5 methods I implement to keep my MT on point.
1. Develop a “Personal Model of Care” that helps guide your evaluation and treatment options.
If you are like me, the busyness of working full-time in the clinic can lead to treatment ruts. A treatment rut to me is too much reliance and focus on any one intervention. The complexity of clinical care creates mental fatigue and physical fatigue leading to treatment fidelity issues (HERE).
A perfect example of a clinical rut is taking an exercise-only approach with all of my patients. While exercise is needed for every single patient I see, too much focus may lead to suboptimal care. This was highlighted in a previous blog (HERE) where taking an exercise-only approach led to worse outcomes in lower back pain.
The current evidence supports taking a multimodal approach as one of the best ways to practice at a high level. My multimodal model of care, represented in the below image, helps keep my evaluations and treatments focused.
Put to words, this model says to me.
- Let clinical reasoning guide all that I do; stay centered in clinical reasoning to promote function and strive toward person-centered goals. Always look at the whole person including pain mechanisms, personal factors, social determinants of health, and environmental variables.
- Taking an exercise approach is always vital. This approach is likely the best long-term way to keep function high and pain low.
- Use psychologically informed education topics to shift cognitions and maladaptive beliefs to move beyond stubborn yellow flags when needed
- Teach patients to listen to their bodies while setting boundaries for activity to keep pain flare-ups at a minimum.
- Use MT to modulate pain and drive afferent sensory input into the nervous system to facilitate neural plasticity if possible. Focus on symptom modification early and often to decrease pain and move towards focused movement strategies.
I imagine each patient has the potential to require some care from each quadrant. However, each patient will have an individual “radar plot” that represents their best avenue to success. My challenge is to create an N=1 optimal “radar plot” for each person to ensure their best multi-modal approach.
(The below example would be a person with nociceptive pain classification who is a responder to MT that improves and meets clinical goals in 4-6 visits)
The best therapists I have ever worked with match the patient to the correct quadrant and “radar plot” early in care. Further, if they start in an ineffective category they realize it quickly and shift their strategy to a more effective one.
2. Set Continuing Education Goals and Execute Them.
What does your continuing education plan look like? If you don’t have one, make one now!
Set goals. Make a plan to work towards those goals. Find a MT class you love. Get good with your hands. Take all the courses. Get certified. But, please don’t do it for the letters after your name. Instead do it to create a deep foundation for clinical success. Take the long road and don’t try to master it all too quickly. Be like the slow-growing oak tree - grow deep roots and find joy in learning.
3. Find Honest and Reliable Sources for Research.
There is no way to keep up with all the research coming out. Social media is a great place to hear from thought leaders, but only going there for all your content can create narrow echo chambers of confirmation bias. Go beyond social media. One website where I find consistently honest and credible content is (HERE). It blends research thought leader opinions and vetted research articles on MT. Check it out.
4. Take Care of yourself.
It is hard to care for others if you do not mind your self-care and fitness you enjoy. Prioritize your sleep hygiene. Engage in movement that makes you feel good. Find things outside of work that brings you joy. Invest your time and money in things that care for your body and mind.
5. Don’t Let Any Brand of Manual Therapy Become Your Clinical Identity.
The Mulligan Concept is arguably the most evidence-based hands-on symptom modification approach available. I love it! I teach it! I can’t imagine practicing without it. However, instead of viewing myself as a “Mulligan Therapist”, I perceive myself as a physical therapist with many options to help an individual meet their goals.
Manual Therapy pioneer Freddy Katlenborn is credited as being one of Brian Mulligan’s most influential manual therapy mentors. Freddy passed away in 2019. One of my favorite Kaltenborn sayings from 2014 states:
“Perhaps the time has come for OMT practitioners to cease naming treatments according to a school of thought. The principles of treatment are far more important than the name of the practitioner who first developed the technique. It is not important that a technique, for example, was originally part of the “Kaltenborn”, “Cyriax”, “Maitland”, or any other method. Such compartmentalization of clinical practice hinders the development and growth of the OMT profession. The best OMT practitioners do not restrict their practice to a single approach or school of thought but rather develop expertise in many systems. Master clinicians utilize techniques derived from many sources, modifying, combining, and refining their repertoire of techniques into a unique application for each patient. As OMT practice so evolves, the principles of treatment which encompass all schools of thought will more clearly emerge.” (HERE)
Conclusion:
Manual therapy techniques have been used since antiquity by caring individuals to help people in pain (HERE). Along this timeline, research focusing on the effectiveness of manual therapy is in its infancy.
The future of MT resides within you! Be open to change, follow the research, and don’t neglect your manual therapy skills! Practice within the confidence that supports manual therapy as a pain modulation option.
The Mulligan Concept Teachers Association looks forward to seeing you at a live in-person course soon!
Stay tuned for our 2024 Newsletter content!
Have a blessed New Year!
Jarrod Brian