Modern Manual Therapy

12/29/2025

I often post about manual therapy and exercise not having significant differences, however, that's the case when measuring pain and range and function. Maybe we're not measuring the right things when it comes to manual techniques?

Manual therapy for lumbar disc herniation is not about “pushing a disc back in” — it is about sending a powerful safety signal to a sensitized nervous system so your exercise and loading strategies can finally stick.
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If you’re still telling patients you’re “realigning” or “pushing a disc back in,” you’re working with an outdated model.

A 2024 RCT by Taşkaya et al. showed that when manual therapy is added to a stabilization program for lumbar disc herniation, it specifically improves kinesiophobia and anxiety scores, while exercise alone does not change these psychological factors significantly (p < 0.05).

How manual therapy really works

Manual therapy acts as a neuromodulatory input, likely engaging supraspinal regions like the periaqueductal gray rather than mechanically repositioning discs.

In this trial, both groups improved in pain intensity and catastrophizing, but only the manual therapy group showed statistically significant reductions in kinesiophobia and anxiety.

Why this matters clinically

If patients are too fearful or anxious to move, even the best exercise program underperforms; manual therapy opens a “psychosocial window” where movement and loading become acceptable again.

Thinking of yourself less as a spinal mechanic and more as a nervous system “neuro‑modulator” aligns what you say, what you do with your hands, and how you prescribe exercise.

Practical takeaway for clinicians

Keep your manual techniques, but update the narrative: explain touch and mobilization as tools to help the brain feel safer so patients can move with more confidence.

Use that short-lived safety window to immediately layer in graded exposure, stabilization, and patient-led strategies instead of chasing repeated passive “fixes.”

Take my online course to level up your outcomes, get unlimited access and CEUs https://edgemobilitysystem.com/pages/mmtuqlq

12/22/2025

If you are still trying to force overhead mobility by aggressively stretching the latissimus dorsi, you’re likely fighting a losing battle against the nervous system.

We have to stop thinking about "tightness" as a mechanical issue that needs to be pulled apart. Often, that restriction is perceived threat.

When you crank on a hypertonic lat, you trigger the stretch reflex. You create more threat. The brain pushes back, and the tone remains.

The Better Way: Positional Inhibition 💡

In this 3-minute video, I break down why I prefer slacking the muscle over stretching it. By placing the muscle in a shortened, comfortable position, we modulate tone rapidly without the "alarm bells" of a painful stretch.

The Missing Link: Ipsilateral Rotation 🌪️

But a reset without reinforcement is just a temporary fix. To lock in that overhead reach, you have to address the trunk. I use Thoracic Whips to improve rotation to the same side.

The Logic: Unilateral overhead mobility requires the trunk to rotate toward that side to fully clear the range. If you have a lat "reset" but your thoracic spine is locked, that lat is going to tighten right back up to provide stability.

The Final Step: Reload 🏋️‍♂️

Once you have the window open, you have to own it. We use overhead Kettlebell Carries or continuous Kettlebell Circles to strengthen and reinforce this new, threat-free range.

Reset: Positional inhibition by slacking the Lat.
Reinforce: Thoracic Whips to clear ipsilateral rotation.
Reload: Overhead KB Carries/Circles to solidify the gain.

Stop stretching and start treating the system. Watch the full breakdown below! 👇

12/22/2025

🛑 Stop stretching the Achilles (if it's insertional) - https://mailchi.mp/modernmanualtherapy.com/hip-iso-7243503

12/19/2025

If your test is 50% off from the norm, is it significant?

What if the proposed available motion is only 2 degrees? How exactly are you measuring that when standard error of measurement is often 5 degrees? Or does it have to be the FULL 2 degrees?

The treatments we utilize for SIJ and low back pain in general are often great at relieving pain and improving motion/function, but not for mechanical reasons....

12/19/2025

New PT Episodes Dropped: Better training, training your brain, safety and pediatric manipulation, and the sacroiliac joint - https://mailchi.mp/modernmanualtherapy.com/the-latest-podcasts-from-the-pt-podcast-network-7243550

12/17/2025

The "S" in BPS is not a suggestion. 🧠👥

We all love to talk about the Biopsychosocial model. We nod our heads at conferences, we post the memes, and we tell our patients "pain is complex."
But let’s be real: most of us are still stuck in the Bio-Bio-Bio model. We look at the joint, we look at the tissue, and if we’re feeling "modern," we look at the brain.

But what about the Social?

The research is clear: Social isolation and a lack of connection aren't just "lifestyle factors"—they are biological drivers of pain and disability. If your patient is lonely, lacks a support system, or feels disconnected from their community, your Grade V thrust or your perfect loading progression is only going to take them so far.

Why social connections matter in rehab:
✅ They lower systemic inflammation (yes, really).
✅ They improve self-efficacy and resilience.
✅ They modulate the threat response in the nervous system.

As Eclectic clinicians, we have to stop treating patients like they exist in a vacuum. We need to screen for social health just as much as we screen for red flags. 🚩

Check out this infographic on why Social Connections are a vital part of the BPS framework.

https://edgemobilitysystem.com/blogs/updates/social-connections-bio

Are you asking your patients about their "social dosage," or are you just sticking to the reps and sets? Let me know in the comments! 👇

Social support is biological. Learn how a strong social network slows epigenetic aging and lowers inflammation, making it a critical PT intervention.

12/15/2025

The Social IS the Bio: New Science PTs Must See - https://mailchi.mp/modernmanualtherapy.com/hip-iso-7243437

12/15/2025

The Social IS the Bio. 🧬

New 2025 research confirms what we’ve suspected: Social support isn’t just "psychological"—it’s a biological intervention.

A study in Brain, Behavior, & Immunity - Health introduces "Cumulative Social Advantage." The findings? A strong support network leads to:

Slower Epigenetic Aging ("Younger" cells via GrimAge Clock)
Lower Systemic Inflammation (Crucial for recovery)

The Clinical Takeaway: We need to stop separating the "Bio" (tissue) from the "Social" (environment). Building rapport and validating your patient’s experience isn't just "nice"—it is literally anti-inflammatory.

Actionable Steps for PTs:

Screen for isolation in chronic pain cases.
Validate to build the therapeutic alliance.
Consider group rehab to foster community.

Read the full breakdown on the blog: https://edgemobilitysystem.com/blogs/updates/social-connections-bio

12/12/2025

❓Have you considered MSKUS Training? Earlier in my career I would've jumped on that opportunity!

We all love new toys. And let’s be honest, showing a patient their supraspinatus in real-time looks cool. It builds buy-in. It feels high-tech.

But does it change what you do Monday morning?

Does seeing the calcification actually change your loading protocol? Does the image change the fact that you need to treat the human, not just the tissue?

In this week's episode of Untold Physio Stories, we’re breaking down the ROI of Musculoskeletal Ultrasound.

We discuss:

🔵 The steep learning curve (it’s harder than it looks).
🔵 Diagnostic accuracy vs. Clinical utility
🔵 When it’s a "Game Changer" and when it’s just a "Nice to Have."

Full episode of the podcast is here https://open.spotify.com/episode/6vA2wSXJMtqknlODC1LvYm?si=Xtg6lhKKT5iN6lJANWw3Gw

Comment below if you've considered or gone through the training. We'd love to hear from the Nays and Yays.

12/12/2025

New PT Episodes Dropped: Business Growth, Pt communication, MSK US and more - https://mailchi.mp/modernmanualtherapy.com/the-latest-podcasts-from-the-pt-podcast-network-7243400

12/08/2025

Stop Looking for the "ITB Protocol"

I got this question during my live seminar this weekend: "Dr. E, how do you treat ITB Syndrome?"

The clinician was looking for a specific stretch, a certain foam rolling technique, or a "hack" to release the lateral line.

My answer? I don't treat "ITB Syndrome." I treat the human in front of me.

Here is the framework I use to get patients back to running without the fluff:

1. Evaluate, Don’t Assume

Just because the pain is on the lateral knee doesn't mean the ITB is the culprit. Is it a lumbar referral? Is it a distal femoral cutaneous nerve issue? I evaluate the patient thoroughly and treat the findings the evaluation provides, not the diagnosis on the script.

2. Manual Therapy is a "Reset," Not a "Fix"

I use manual therapy sparingly. The goal isn’t to "break up adhesions" (you can't) or "lengthen" the band (good luck with that). We use manual therapy to desensitize the nervous system, create a window of movement, and decrease the threat level.

3. Education > Intervention

If they walk out of the clinic and do the same five things that sensitized the tissue in the first place, we are spinning our wheels. I focus heavily on educating the patient on behaviors they need to change—training load management, sleep, and lifestyle factors.

4. The Recovery Plan

Every patient leaves with a clear, functional roadmap designed to rapidly relieve symptoms and improve function. This includes:

Movement Variability: Getting them out of repetitive, provocative patterns.

Self-Resets: Giving them the tools to manage their own nervous system sensitivity at home.

Open Communication: A recovery plan is a living document. They must have the means to ask questions and provide updates on progress between sessions. If you aren't adjusting based on their feedback, you aren't coaching; you're just prescribing.

The Bottom Line: If you're still just foam rolling the ITB, you’re treating the smoke, not the fire. Treat the findings, educate the patient, and load them progressively.

12/05/2025

New PT Episodes Dropped: The Trait Every Great PT Shares, Clinic Growth, & Low Back Pain Research! - https://mailchi.mp/modernmanualtherapy.com/the-latest-podcasts-from-the-pt-podcast-network-7243272