A Functional Shift
For the last few years the concepts of regional interdependence and treating movement have been taking off. It seemed every course you went to, article you read, and blog you followed were promoting treatment away from the site “in pain” and using movement to guide assessment and rehab. While this was very effective for a lot of people, it is easy to see how we began to lose site of the actual tissue or injury the patient was coming in for. The belief that if we simply found the “cause” of the patients pain (i.e. what began the compensation process) the symptoms of their issue would go away regardless of any histological changes that had occurred. We were shifting into a “macro” world and the thought of going back to “micro” based thought process just simply did not make any sense. How could we possibly know what we are touching when we evaluate a patient? How could we really have any impact on underlying tissue healing? What were we doing when we put our hands/tools/tape/etc on another person? The more you tried to find these answers the more it seemed that the answers to these questions were not really evidenced based, or worse did not exist! As you dissect the evidence, we come to realize that most processes are simply a product of individual interpretation and experience. That was until we had the opportunity to take Functional Range Release with Dr. Andreo Spina.
His knowledge, understanding and overall thought process of functional anatomy and treatment were not like anything that was previously explained in the past. Through skillful and deliberate palpation Dr. Spina demonstrated how we can evaluate specific tissues, identify areas of “fibrosis” within connective tissue and perhaps most importantly “communicate” with cells through load/force to allow for proper healing and restoration of said tissues. This then would lead us into a “regional approach” by clearing tissues and joints around the area of pain (starting with the joints above and below) which would then allow us to more deliberately look at movement. Instead of looking at patients from a GLOBAL → LOCAL standpoint it seemed better to go LOCAL → GLOBAL. There were no parlor tricks, no gimmicks - connective tissue needed adaptation to truly reorganize into healthy tissue and that would take skill of the practitioner and commitment from each patient. In Dr Spina's words: No SINGLE treatment can alter tissue forever. Our manual therapy needed to be based on two key concepts: Application Time and Intent. Application time required no less than two minutes of “input” to targeted tissues and our intent to “remold” the targeted tissue would be accomplished WITH movement. Distinguishing between neuromuscular tightness or mechanical tension would deepen this thought process further and allow us to pick the correct treatment for the patient in front of us - not simply pressing on what “hurts” and hoping for the best. So has this worked? YES! One of our patients coming in with a GD II RTC tear of the supraspinatus (many of which continue to progress to GD III) and evidence of labral fraying was essentially on her way to surgery. She was simply using us a "last stop" as she had been dealing with chronic pain and dysfunction for over a year. Long story short she has since cancelled her surgery, and her latest MRI taken showed healing of her tear with evidence of labral fraying no longer present.
It is rare that a continuing education course attempts to introduce and deepen thought processes while challenging your current treatment methods (especially with RESPECT) but this is exactly what this course was able to accomplish. If you have not had the opportunity to take Functional Range Release/Conditioning with Dr. Spina we strongly recommend doing so. We look forward to having him back in our office for Functional Range Release of the Spine in December 2015.
What courses have you found most beneficial? Have you ever had a course completely alter your thought process in one weekend? How long do you typically try any “new” technique that you learned at a course before deeming it successful?
Until next time, happy rehabbing!