Modern Manual Therapy

01/28/2026

The "Tightness" Trap Part 2: The Dosing Dilemma

In my last post, we discussed why stretching is often just chasing a sensation, while repeated end-range loading addresses the source.

But there is another critical difference that explains why your patients return week after week with the same "tight" upper traps or hamstrings: Dosing.

If we are going to change how the nervous system governs movement, we have to look at how often we apply the intervention.

1. Stretching: The "Maintenance" Dose

Think about how most patients (and many therapists) utilize stretching. It’s typically prescribed once or twice a day, or perhaps as a quick warm-up before activity.

The Reality: This frequency is barely enough to maintain current extensibility levels, let alone create lasting mechanical change.

The Outcome: It’s a transient neuro-modulatory event. You get a temporary "release" of tone, but the underlying governor of that tension hasn't been reset.

2. Repeated Loading: The "Persuasion" Campaign

Repeated end-range loading (think MDT/McKenzie) is fundamentally different because it’s not about length; it’s about information. End Range Loading in the Directional Preference is key.

The Reality: We don't just do 10 reps once a day. We dose it repeatedly throughout the day.

The "Why": A locked-down area is often the result of a protective nervous system throwing up red lights. You can't convince a terrified nervous system that movement is safe with a single "polite stretch" in the morning.

The Outcome: By repeatedly hitting the directional preference, you are bombarding the CNS with non-threatening input. You are convincing the system, rep by rep, to turn off the threat response and give that area permanent "green lights" for movement.

The Clinical Takeaway

You cannot treat a frequency-dependent problem with a once-a-daily solution.

If you are looking for a temporary window of relief, stretch it once a day.

If you are looking to restore motor control and convince the nervous system to let go of protective tone, you need to dose the directional preference repeatedly until the change sticks.

Dose for the outcome you want.

Earn CEUs and get unlimited access with my flagship course https://edgemobilitysystem.com/pages/mmtuqlq

Learn the Eval, Reset, Stabilize System, easy to implement Clinical Practice Patterns, completely pain free manual therapy treatments, and simple movement screens. The emphasis is on patient education and empowerment

01/23/2026

Hip Distraction & Thrust Manipulation Made Easy - https://mailchi.mp/modernmanualtherapy.com/hip-iso-7244160

01/23/2026

No more wrestling with your patients' legs! 🛑🦵

Manual therapy is great, but let’s be honest—doing manual traction, especially long-axis distraction or thrust manipulation on the hip, can be exhausting for your grip and your back.

If you’re trying to generate enough force to make a change but you're sliding off the ankle or burning out your forearms, you aren't being efficient.

My colleague, Dr. Jeffrey Redenius, invented a simple solution for this: The TR-Action Assist.

I gave it a run in the clinic with Chris (who was pretty stiff), and here’s why I’m digging it:

✅ Simple Setup: Velcro strap, D-ring, done. Takes 5 seconds.
✅ Better Leverage: The handle allows you to lean back and use your body weight, not just your grip strength.
✅ Versatility: Great for gentle oscillations, circumduction, OR high-velocity thrust distractions.

Check out the video to see the immediate pre-test/post-test change in hip mobility. 📉

If you want to save your hands and get better outcomes with less effort, give this a look.

👇

Grab one here: https://modmt.com/traction

01/23/2026

New PT Episodes Dropped: Sleep, Plantar Heel pain, Exercise is not rehab lite and more - https://mailchi.mp/modernmanualtherapy.com/the-latest-podcasts-from-the-pt-podcast-network-7244143

01/21/2026

We’ve all been there—trying to justify why a patient needs to see us 2-3 times a week for that degenerative meniscal tear. We want to believe our "magic hands" or specific supervised progressions are the secret sauce.

But the TeMPO Trial just dropped a major reality check.

The researchers looked at 4 groups of patients (ages 45–85) with degenerative tears and OA:

Home Exercise (HEP) Alone
HEP + Text Reminders
HEP + Texts + In-Clinic PT (Manual Therapy + Supervised Ex)
HEP + Texts + Sham PT

The result? Every single group improved substantially. The clinical difference between a structured HEP and supervised in-clinic PT? Zero. Does this mean PT is useless? NO. It means the value we provide isn’t just in the four walls of our clinic—it’s in the education, the program design, and the empowerment we give patients to get better on their own.

If they aren't improving with a solid HEP, then we can talk about layering things in. But let's stop acting like they can't get better without us "fixing" them every Tuesday at 10 AM.

Prioritize the exercise. Delay the surgery. Empower the patient.

Check out the full breakdown in the latest blog post. Infographic and research citation in the post!

TeMPO Trial: Home exercise vs. in-clinic PT for meniscal tears. Discover why HEP is a powerful first-line treatment for knee pain & osteoarthritis.

01/19/2026

Ever try networking with another clinician only to realize... they aren't listening? 🤦‍♂️

My good friend Sean Wells recently shared a "networking fail" story that perfectly highlights the problem with rigid dogmatism in our profession.

He was chatting with a PT who is heavily invested in a specific "posture system."

The conversation went something like this:

❌ The Guru: Didn't even realize Sean was a fellow PT and practice owner (apparently active listening isn't part of his system? 😂).

❌ The Claim: If you find the "perfect posture," you prevent all disease states. (Yes, really. All of them.)

❌ The Kicker: When Sean explained that his new VR platform is an open framework—meaning you can plug any clinical model into it, whether it's biomechanical, psychosocial, or manual therapy—the Guru shut him down.

He told Sean: "You're going to fail."

This is the "Guru Trap" in a nutshell.

When you are so married to YOUR hammer, you can't see the value in anyone else's toolbox. The full episode has other such face palm moments that Dr. E shares - full episode is here https://open.spotify.com/episode/3af81qe8D4tJFQrRuJ2fVG?si=r1hZAMsJQnaLMQ599rP8Vg

01/16/2026

🛠️ Grip strength: The missing link in your clinic? - https://mailchi.mp/modernmanualtherapy.com/questions-7244023

01/16/2026

How many of your patients have "strong" grips but can’t control their wrist extensors to save their life? 🙋‍♂️

We all know grip strength is a massive predictor of overall health and longevity, but most traditional tools only hit the flexors. If you’ve been looking for a way to level up your clinic’s rehab game (or your own), you need to see the Sidewinder Revolution.

I recently got my hands on this beast, designed by my friend and colleague Dr. Nick Rolnik, and it’s a game-changer for a few reasons:

Quality You Can Feel: This isn't a cheap plastic toy. It has the mass and build quality that screams "professional grade."

Dual-Action Loading: You can work wrist flexion and extension simultaneously. No more switching tools or awkward setups.

Infinite Adjustability: The resistance k**b lets you go from "rehab mode" to "social media challenge" level difficulty with a few turns.

Versatility: Easy to use in multiple positions to target different mechanical advantages.

Bonus: It makes you feel like a Jedi. Unfortunately, it doesn’t actually emit a lightsaber beam (Dr. Rolnik, maybe in version 2.0? 😉).

If you’re ready to stop "just squeezing" and start training the entire forearm complex effectively, check it out at the link below.

👉 Get yours here: https://modmt.com/sidewinder

01/16/2026

New PT Episodes Dropped: Directional Preference, Patellofemoral Pain, Building a Movement and More - https://mailchi.mp/modernmanualtherapy.com/the-latest-podcasts-from-the-pt-podcast-network-7244013

01/12/2026

New PT Episodes Dropped: Pregnancy Exercises, Pain and Imaging, Managing Patellofemoral Pain - https://mailchi.mp/modernmanualtherapy.com/the-latest-podcasts-from-the-pt-podcast-network-7243943

01/09/2026

Walking isn't just simple cardio - it needs to be dosed like any other exercise program/treatment.

A classic systematic review by Roddy et al. showed that when walking is prescribed with the same rigor as a strengthening program—specific frequency, intensity, and progression—it can actually outperform traditional quad strengthening for pain relief in knee OA.

In this breakdown, I walk through how “programmed walking” was structured:

3x/week, 30–60 minutes per session
Brisk intensity, around 50–70% heart rate reserve
Systematic progression of pace and load over time

Effect sizes for pain tell the story:

Structured walking (with formal program adherence): 0.52
Home-based quad strengthening: 0.39

The takeaway: modality is secondary to dosage. When walking is treated as a true clinical intervention—not a casual suggestion—it becomes a powerful tool for knee OA outcome

Learn how to manage most MSK cases head to toe with my easy to learn but powerful system - https://modmt.com/levelup - get unlimited access and earn CEUs

Learn the Eval, Reset, Stabilize System, easy to implement Clinical Practice Patterns, completely pain free manual therapy treatments, and simple movement screens. The emphasis is on patient education and empowerment

01/07/2026

Your Best Posture is Your NEXT Posture

How many of your patients are coming in stiff as a board because they’ve been told to sit "perfectly upright" with a lumbar roll glued to their spine?

In the world of Modern Manual Therapy, we know the truth: Your best posture is your NEXT posture. 🏃‍♂️

The "Posture Paradox" is real. When we force a rigid position—even a "good" one—we’re just trading one type of mechanical stress for another. Our spines aren't statues; they thrive on variability and movement.

If you want better outcomes for your patients (and less stiffness for yourself), it’s time to ditch the rigidity and focus on Emptying the Cup. ☕️

The MMT Game Plan for a Healthy Spine:

Movement Variability > Static Symmetry: Don’t fear the slouch! A little flexion isn't the enemy—staying in any one position for too long is.

The 20-20 Rule: It’s simple, actionable, and patient-friendly. Every 20 minutes, move for 20 seconds. It breaks the creep of static loading and resets the neural system.

Repeated Resets: Think of these as "micro-dosing" movement. Whether it’s repeated extensions, chin tucks, or just a quick walk, these resets empty the cumulative "stress cup" before it overflows into pain.

Ditch the Crutches: Lumbar rolls have their place for acute symptomatic relief, but they shouldn't be a permanent cage. Use them to calm things down, then move toward independent variability.

Movement is Medicine. Let’s stop teaching our patients to be still and start teaching them to be resilient.

Level up your patient outcomes with a simple and powerful approach, get unlimited access and earn CEUs - https://modmt.com/levelup

Physical Therapists: How do you explain the "Next Posture" concept to your patients who are obsessed with sitting up straight? Let’s discuss in the comments! 👇