A couple months ago, I subscribed to the premium portion of The Manual Therapist. Dr. E presents a very eclectic approach with various techniques with which I had not been familiar. One of the prime components of Dr. E's assessment and treatment techniques includes repeated loading. While this might be associated with the McKenzie school of thought, his reasoning has more of a neural approach. Since my neck hurt more on one side, I wanted to look for an asymmetry to treat. With cervical retraction and sidebend, both sides were painful, but I was especially limited to the R. Noting the asymmetry, I proceeded to perform repeated motions in the limited direction which resulted in increased range and decreased pain. Part of the theory is that by getting to the end-range repeatedly, we can re-teach the nervous system that it is okay to go in that direction and possibly others. A common saying for McKenzie type exercises is 10 repetitions 6-8 times a day. With Dr. E's approach, the more the motion is performed, the better. This applied to me. I noted the more I did the exercise, the longer I could go without pain and with increased motion. That evening I had my girlfriend do a cervical manipulation and thoracic manipulation which helped my pain, but within 30 minutes, I was back to the prior levels. The next 2 days, I did the cervical retractions and right sidebend 10x every 30 minutes throughout the day (give or take). Each time I did the exercises, I found I could go longer before the pain and stiffness returned. After 48 hours, I was 95% better.
There are two important components I took from this experience. First, repeated loading can be an incredibly useful assessment and treatment technique, when applied properly. With the majority of people being rapid responders, we should get almost immediate changes with pain and/or motion. Secondly, it is frustrating how long we often have to wait for patients to be evaluated due to length of time after referral, lack of awareness of what PT can offer, or other reasons. The sooner patients can access physical therapy, the sooner physical therapy can begin to help patients on the road to recovery.
7/21/2014 06:21:04 am
I am completely new to this idea of MDT and repeated motions. I have heard of the McKenzie method and all I know about it is the prone press ups and how it was accidentally discovered. I am now researching repeated motions due to your article (and other articles). I could not agree with you more on the statement about how frustrating it is to see a patient so long after they are injured. Fear avoidance is a big thing and chronic pain is much more difficult to treat than acute pain. Thanks for all the hard work you guys do and all the great information you provide. Keep up the good work.
Thanks for your comment! With how expensive McKenzie courses are, I have been hesitant to sign up for one just now. I recently wrote a post on repeated motions that links to a lot of different posts by Dr. E at the manual therapist. It really helps explain how to apply the principles. Be sure to watch the linked videos for a better understanding. Hope this helps!
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