Written by Last week, I posted the first part of this series about using the Edge Tool, created by Dr. Erson Religioso III, to assist in helping a patient get results. Make sure you read Part 1 here prior to going further.
If you have read my approaches in the past, I am not typically a ‘soft tissue guy’ but definitely keeping an open mind as I know this avenue has its benefits. After a directional preference and joint manual therapy service failed, it was time to bring out the Edge, which I purchased over a year ago.
The treatment:
I went to the adductor magnus. Palpation to the approximately middle third of this muscle on the inner third of the thigh sent concordant symptoms to the patient’s brain (not the entire ‘referral’ pattern but patient noted this felt like her pain while in vehicle). Just a myofascial trigger point is not enough to give me diagnostic properties but the concordant symptoms is what led more into this treatment.
We know the origin of this muscle is at the ischial tuberosity and inserts on the medial aspect of distal femur. Was I on the medial hamstrings (semitendinosus and semimembranosus) too? Yes.
Myofascial trigger points in these three muscles pulling on the ischial tuberosity can be reason for pain referral to mid-thigh posteriorly.
I treated this patient for two more visits and after the first visit, she reported she could drive or ride for over 3 hours, therefore discharging her after the 2nd visit. I haven’t seen her back yet so I hope she is doing well 🙂
If it wasn’t for the Edge, who knows what would have happened…
What did you think? Do these results match up with what you see in the clinic?
PT Blog, Mentoring and Consulting of Harrison Vaughan, DPT 
I have to be honest, I love the EDGE and use it regularly. But I don’t find it beneficial with treating MTrPs. If I suspect MTrP referral patterns I will usually do some Dry Needling instead and get a twitch response. I’ve found that to be more effective for me personally.
Hey Jon,
At the time of this case, I did not have enough hours to perform dry needling yet in the state of Virginia. We have crazy rules over here and I needed 54 hours to begin practicing DN…so the Edge was pulled out (I am now ‘certified’ so should be able to post some good results through DN on this blog too soon). I think it is good to have both tools as contraindications may limit use of DN.
Thanks for commenting and I appreciate your personal results.
Harrison, I’m curious in regards to your statement that “your not a soft tissue guy”. How has your treatment paradigm shifted to begin to appreciate and include more soft tissue work and/or trigger point work?
The reason I inquire is that when I graduated from school a few years ago, I was heavily biased to ‘joint work’, with little appreciation for myofascial influences (bias taught in school). I’ve found that my current bias has shifted to include more soft tissue work over the past few years, most notably after incoporating functional dry needling and use of the EDGE. I’ve been finding that often times (not always), that the inclusion of soft tissue treatments will often improved perceived joint mobility restrictions (appears to be more frequent with multifidus needling).
Ultimately I think having a good skill set in both domains is important, and in that light I’m looking forward to taking Dunning’s level 2 course in the Spring now.
Hutch,
Thanks for the comments. I am glad you are taking Dunning’s courses as I have gone through SMT and both DN, and really enjoy his teachings!
As for ‘not a soft tissue guy’, my history has too been mostly from the joint. I’ll be honest, I still am and think this still gives me the quickest results. However, just as you said ‘having a skill set in both domains is important’, I agree. I don’t want to limit the patient of results if I ignore the soft tissue piece.
Dunning quoted : “The joint is the employer and the soft tissues are employee”. Meaning, the joint will control the mechanisms from a neurophysiological aspect for the soft tissues.
In my opinion, I wouldn’t shy away from the joint to just treat soft tissues. It doesn’t sound like you do and this should make you a very rounded clinician.
Does he expand more on that quote in his courses? It sounds interesting and familiar to concepts of instantaneous center of rotation and/or joint centration. I’ve only taken his level one course, but I tend to revert back to previous training with some of my thrust techniques.
Are you finding with the inclusion of both treatment techniques, you’re achieving more rapid changes in treatment results? I’ll use a brief example of subacromial pain, my bias would be to address tension / restriction in the pectoralis minor and subscapularis (among others, and if present, which usually is), then address joint mobility restrictions which may affect the shoulder. I’ve personally found inclusion of soft tissue techniques in this region to have a more profound effect versus just manipulation the thoracic spine / ribcage and/or cervical spine, and mobilizing the shoulder.
I enjoy these discussions regarding treatment ideas and concepts, as it challenges my thinking and helps me grow as a clinician, thanks for the outlet.
HV, your success with joint techniques is most likely clinical equipoise. Basically why Dunning has better success with thrust than mobs and why I have better success with STM than joint work (I do almost no “joint” mobs anymore).
Yeh I do like this term of clinical equipoise (good thing you don’t have a southern draw as it doesn’t come out ver clear!) and really believe it has implications in clinical care
I have a question though…do you think it’s mainly the clinical beliefs and then education on the problem, that leads to better results with the patient?
I am still wrapping my head around it.
Great job HV! I also do not use the EDGE for TrPs, but more along entire ST patterns (or lines as others call them). Whatever the mechanism it helps and there are people who will want ST work, people who will respond to TDN, and others who have contraindications to tissue work. It’s all about the tools! Glad you finally used it!
Thanks Erson! I haven’t written much on it before as I haven’t even taken any other soft tissue courses, so couldn’t give a very precise constructive feedback (I’ll leave that up to others and sounds like your tool is definitely the way to go).
Harrison,
Sometimes a direct approach to the site of pain and local myofascial work has a good effect. I have used the edge on adductors, glute medius, and Quads/TFL on a patient with Hip pain recently (X-rays did show some early signs of OA). The patient had improved range and pain reduction after 1 visit and no joint work was done despite a capsular pattern of limitation!
Awesome Tommy! It’ll be interesting to see the feedback from that patient if you try soft tissue one visit, then joint another…see what the between visit outcomes are…
Or, just needle them! You can do it now 🙂
That’s most likely b/c there are no “capsular” limitations other than the true dysfunction syndromes or the slow responders. All of our derangements or rapid responders I just call movement dysfunction as any way we get them to move whether it’s mob/thrust, STM, neurodynamics, or repeated motion are all really doing the same thing.
HV,
I am preferring to focus still on SMT for most spinal pain issues (as appropriate per the patient) but I have to admit the DN has a great effect too. I am hoping to get a electro stim unit too and work more on what we learned at the Cert. DN course. I really like the edge tool and Dr. E’s approach with working soft tissue patterns, Patents so far really like it!