The 20 "Rules" of Manual Therapy

Posted by Brett Windsor, PT, PhD, MPA, FAAOMPT on Dec 29, 2017 9:15:08 AM


OK, so these aren't really rules per se, but a compilation of thoughts I've put together over the years. They seem to be true most of the time, regardless of the type of patient.

  1. The body will always find a way to get where it wants to go and it doesn't worry about what it tears through to get there
  2. Manual therapists – we can either increase stiffness or decrease stiffness. That's all. Most times we are looking for a combination of the two
  3. Junctions (SO, CT, TL, LS) tend to be stiff
  4. Mid-regions (C3-5, L2-4) tend to be hyper-mobile
  5. Wherever there is something stiff, there will usually be something loose close by
  6. Wherever there is something loose, there will usually be something stiff close by
  7. Stiff areas usually aren't painful
  8. Stiff areas, if not addressed, will usually cause painful compensations elsewhere
  9. Hyper-mobile areas usually are painful
  10. If you don’t treat both, ultimately you won’t be successful
  11. It’s impossible to conceive of treating any patient with neck pain without addressing the sub-occipital and cervico-thoracic junctions
  12. It’s impossible to conceive of treating any patient with low back pain without addressing the pelvis and hips
  13. It’s impossible to conceive of treating any patient with spinal pain without addressing the thorax
  14. It’s impossible to conceive of treating any patient with peripheral joint symptoms (even post-operative) without at least looking at the joint above and the joint below
  15. Techniques performed to decrease stiffness should immediately be followed by techniques that can retrain and stabilize motor patterns – otherwise problems simply recur
  16. Manual therapy without exercise is usually useless as a method of increasing mobility
  17. Exercise without manual therapy is usually useless as a method of increasing stability
  18. Time is your best friend and often your most effective management technique
  19. Sometimes, doing nothing is doing everything
  20. We all thought when we finished PT school that we were done with neuro forever (haha)

What do you think? Any others that you'd add? Want to know why so many of these apply? 

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