As a Red Sox fan, it is painstaking to put a picture of pinstripes on my blog, but the recently retired, future Hall of Famer and best closer in the history of Major League Baseball needs to get some love, no matter who you root for. How does this relate to physical therapy?…
After showing my last intern the talocrural distraction manipulation on a patient who had 2 years of ankle pain with immediate improvement in ankle DF from 5 degrees to 15 degrees, she slated to throw out obscene words from the results, but instead politely uttered a phrse to the extent of:
If I would have known that, I would not have sweated for 20 minutes at my previous clinical to mobilize someone’s ankle.
I verbally express something to the ring of:
Sometimes you have to be like the New York Yankees and bring out the closer
Bottom line, sometimes you have to bring out Mariano Rivera to get the job done. You don’t need to beat around the bush, but bring in the guy to get results and move on with the treatment. Okay, it sounds better in context but hope you know what I mean.
Most physical therapy training, academically or in continuing education, puts thrust joint manipulation at the bottom of force progression. It is taught to, “always use as last resort”, “don’t use manipulation if mobilization can suffice”, “patient generated forces are better than clinician generated forces”, etc. The finger gets pointed and shaken your way as if it is shameful of you to use manipulation before mobilization.
Now don’t get me wrong, I am not saying to be a cowboy and manipulate everyone. But, some joints respond better to mobilizing, and some to manipulating. Your clinical expertise, the patient’s preference / values in front of you will tell you what is best. Just don’t always follow the previous image, in many instances, the force progression can be sorted differently.
What do you think? I would like to hear from McKenzie and Maitland trained therapists at least !