The Manual Therapist Blog recently had a blog post that talked about using manipulation as a method to help our patients get better. This reminded me of how I started rethinking my views on manipulations and high grade mobilizations (mobs). After my trip to Haiti, it really made me reconsider these treatment strategies.
Most of my continuing education has focused on muscle energy techniques (METs) and myofascial techniques (MFR). However, many of the clinicians in STAND were more likely to employee manipulations or high grade mobs. My preferences for METs and MFR stemmed from the opinion that these techniques are often associated with a lower level of threat compared to other techniques. From a pain science perspective, it made sense that low threat techniques would be ideal to decrease the body’s perception of damage. By low threat, I mean that most people would feel less likely to feel pain or fear getting hurt with an MET over manipulation. Perception of damage is essentially the definition of pain.(If that still does not completely make sense, I promise you that will make more sense when I produce additional pain science posts.)
In hindsight, I did not consider a few factors. The strength, novelty, and patient expectation of benefit from the stimulus all play a pivot role all play a role in treatment. How many times have we seen a patient have a greater response to a “deeper” massage compared to a more “superficial” one? During a successful treatment session, have you ever heard a patient talk about how no one else has ever done that before? Or have you had a patient who says he or she needs to be treated in one specific spot, then improve with treatment at that spot? This illustrates how high intensity, new, or expected interventions can benefit our patients.
This makes me think I may under utilize some of these techniques, which in some situations could lead me to better or faster recovery. I do not think I should completely abandon METs, MFR, or therapeutic exercise all together. I should just reconsider my use of high grade mobs, particularly when and with whom I use them with. Like many of our therapeutic tools, there is a time and a place for almost everything. All of us just need to keep tinkering to find out that perfect time and place for our diverse clientele.
Hope that Helps,