Manipalooza is a three day event held by Evidence in Motion every April in Denver. This is a high-energy affair which brings together researchers, fellows, residents and clinicians from around the world (but mainly the United States). The weekend is full of lab-intensive courses, lectures and roundtable discussions. The number of participants is limited, which creates an intimate setting where no one goes unnoticed, un-photographed or un-helped. Here are some of the highlights:
The CT Junction and Thoracic Spine Manipulation was taught by no other than Dr. Tim Flynn and Dr. Jeff Moore from Colorado in Motion. The dynamics between the instructors, fellows and participants created a fun environment full of energy and excitement. These two instructors have a gift for breaking down the process of spinal manipulation into simple steps, making it is accessible by all.
Another prolific clinician/researcher, Dr. Julie Whitman, taught a class with Fellow, Mary Derrick, called “Practical Manipulation Strategies for Women and/or Undersized Clinicians“. Dr. Whitman has a knack for teaching and modifying spinal manipulations in a way that allows a smaller framed person or someone who is not able to generate as much force in traditional positions. Some modifications being on the opposite side of the patient than usual (supine lumbo-pelvic manip), using props or foam rolls (mid thoracic manipulation) and changes in the patient position (posterior and inferior glides of the glenohumeral joint). These ladies blew everyone away with their “out of the box” techniques.
A Manipalooza wouldn’t be complete without Adriaan Louw. He brought his team from ISPI, including Louie Puentedura, Jessie Podolack and Brett Neilson who provided a top-notch presentation on Testing and Treating a Sensitive Nervous System via Neuroplasticty. The team at ISPI has been doing an excellent job standardizing care and giving the clinician legitimate tools to help those with signs of centralization and/or homunculus changes. Clinical Pearls from their presentation include:
- Importance of differentiating central sensitization from neuroplasticity changes. People with chronic pain may have symptoms of one or both. Each require different treatment strategies.
- There is a neat rat study that looked at damage to the periphery nervous system and its affect on the central nervous system, which was an increase in the blood-brain barrier permeability. The secret link between the two systems is found in the immune system. Check out the article here:
- Pain Acceptability Scale: this is a new scale that Dr. Jessie Podolack introduced to us. It is used to help patients understand how much pain is acceptable with activity. If you can picture a stop light, the Green Light will be levels 0-2 on their NPRS, Yellow is 3-5 and Red is 6-10. From my understanding, research is soon to be published to validate this scale.
The research in pain science is still growing. I believe that this new way of approaching pain is going to change the way we practice. We should incorporate principles of pain education and “words that heal” into our every day interactions with patients.
Other Clinical Pearls
Every class was jammed pack with a ton of excellent information. As much as I’d like to share everything I learned…. I thought I would just share a few of my favorite clinical pearls.
Improving outcomes with effective HEP Dr. John Seivert has a database of videos that he has been recording over the past year to use as patient education and instruction on HEP. Check out his database of HEP and pt eduction at movementmedicine.solutions, it is free to use. He also developed an amazing spine and muscle mobilization, called the myotool. Aside from these amazing tools he introduced to us, he also gave us some solid advice on increasing patient compliance with HEP.
- At the end of the initial evaluation, come up with an HEP that will help treat their symptoms, before you do manual therapy, using the test/retest method to help solidify their buy-in.
- Use a patients cell phone to record the 2-5 exercises you are prescribing. Also take a picture of the written descriptions and provide a physical copy.
Stories We Tell My favorite part of Dr. Larry Benz‘s presentation was his explanation of counterfactuals. Theses are stories we make up to justify something that is almost true. These are “alternative facts” that we make up, and everyone does it (not just our President & his team). Everyone does this, including our patients and ourselves.
- Upward Counterfactuals: (“Glass is half empty”). These stories are when something happens and you think to yourself, if I would have. These cause feelings of regret, frustration and blame but these near misses also guide future behaviors.
- Downward Counterfactuals: (“Glass is have full”). These stories are ones we tell ourselves when something happens and we think, well it could have been worse. This optimistic view point brings purpose and meaning to our lives.
Although upward and downward counterfactuals are both necessary to be a balanced human, we need to help the patient rewrite their story in a positive way. Enable your patient to imagine themselves as their “best possible self” and develop a plan to help them accomplish that. Rewrite their story.
Cervical Manipulation Risks Dr. Jeff Moore has made it a mission in his life to educate physical therapists around the world about the real risks of cervical manipulation and how to mitigate them. Highlights include:
- We have a higher risk of dying after running a marathon than causing a stroke with a cervical manipulation.
- During the exam you have to prove that your patient with neck pain does not have a vascular issue. You can do this by:
- Red Flag Screening: Know your red flags & risk factors for vascular dysfunctions.
- Thorough History: looking for any minor mechanical trauma (ie. neck extension for a long period of time).
- Individuals with CAD were 60 times more likely to have been exposed to recent mechanical trauma (Thomas 2015)
- Discipline Technique: use multiple levers with your technique to keep their neck in midrange
- cervical lateral flexion + rotation
Why I left Medicine in America (Dr. Tim Flynn): The medical system has failed us in the sense that over the past 10-20 years there has been a decrease in referrals for PT and increase in opioid prescription for chronic pain. He laid out a compelling argument that “the modern U.S. Medical Industrial Complex has created, promoted, and sustained an epidemic in pain.” Dr. Tim Flynn delivered a personal story of his experience with western medicine and suggests that it may be time to find a new tribe to help counter this opioid epidemic. This new tribe must be multi-/interdisciplinary and include people outside the traditional medical model. Think yoga teachers, personal trainers, acupuncturists… the possibilities are endless and we are in a position to be leaders in this change.
There are many great things about going to an event like this. You have the opportunity to sharpen your manual skills, brush shoulder with some of the leading clinicians in our field, and have a blast drinking beer and eating food with the EIM crew. Why I love this event and crew so much is because of their contagious passion to change our profession and to be the best physical therapist possible for our patients.
Written by: Melissa Buehler, SPT