The Manual Man

The Manual Man The Official page of The Manual Man Physical Therapy, Nick Torres

07/15/2025

The upper thoracic spine ends up being the primary driver of a great amount of the NECK PAIN cases we see.
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Think about the neck as the “building” and the upper thoracic spine as the “foundation” for that building. If the foundation is stiff, not moving well, and lacking neuromuscular control, that spells bad news for the building living above it.
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We see this specifically with the extension and rotation of the upper thoracic spine. If extension is limited, it will drive the neck into a forward-head posture (no where else to go but forward). A lack of extension usually falls suit with a lack of rotation. Only thing is with the rotation limited in the upper thoracic, the cervical spine has to take up the slack and you end up with hyper-tonic cervical muscles that are just working way too hard through the day.
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So if you have neck pain, check out your upper thoracic spine mobility and stability. That may help tremendously.

05/14/2025

Anterior shoulder Pain‼️
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Many times, people will have pain in front of the shoulder secondary to lack of internal rotation and extension of the humerus and/or scapula. This lack of range, now drives the humerus forward, as a compensatory strategy to complete the motion you are attempting to achieve (ex. Bench press).
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How do we fix this?
First mobilize the anterior shoulder in a position of extension and internal rotation. We use a contract-relax technique to slowly take up more and more range of motion. You want to get as deep into the range as possible during your mobilizations, because the patient will likely be driving into that same deep range in their workouts.
Second, we must train that new range and cue patient to not allow shoulder to dump forward in space. We must facilitate and cue the rear shoulder muscles to fire, to prevent the anterior shear from occurring.
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Video 1: prone end-range internal rotation mobilization, shown in FMUT course
Video 2: continued
Video 3: neuromuscular education, shown in FMUT course

I think I’ve lived most of my life always moving forward and always thinking about the next thing. I think becoming a da...
05/13/2025

I think I’ve lived most of my life always moving forward and always thinking about the next thing. I think becoming a dad allowed me to STOP and just appreciate life. Appreciate my amazing beautiful wife. Appreciate my little baby girl (that just turned 4 months old). And appreciate also what I’ve done so far in my life. Being a dad is not easy, but it’s also not hard. It’s exactly what I needed in my life.

04/17/2025

Knee Joint Manual Mobilization‼️
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Many times I see lateral displacement of the foot contact to the ground. This coincides with a tibia that is laterally sheared, compared to position of femur. This usually also coincides with over-activity of the lateral musculature of the lower extremity and under-activity of the medial, specifically the hip adductor and medial hamstring muscles.
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Here, we mobilize the tibia into a medial shear, placing the knee joint on its axis, relative to femur. We then educate the adductor, internal oblique and glute medius muscles to maintain this position.
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ENJOY‼️
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Video 1: medial tibial shear , shown in FMLE course
Video 2: modified medial tibial shear
Video 3: hruska adduction lift test , shown in Pelvis Restoration course

04/06/2025

ACHILLES PAIN‼️
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For anything you put your body through, let’s say running for example, you gotta be sure it has the necessary mobility, stability, strength and resilience to do it, and do it GOOD!
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In others words: don’t write checks your body can’t cash. You will end up injured, in pain, or sore in ways that will make you not want to perform that “thing” in the future.
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For Mobility: the end-feel is KING 👑. It can look like you have good plantar-flexion of your ankle, but until you spring that end-range, you never really know.
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Video 1: posterior glide of distal tibia, shown in FMLE course
Video 2: anterior glide of talus, shown in FMLE course
Video 3: anterior glide of distal fibula, shown in FMLE course
Video 4: neuromuscular education

04/02/2025

Low Back Pain, Pelvic Up-Slip❗️
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Do you always catch yourself standing on one leg way more than the other. How about sitting towards one direction way more than the opposite. Now what if worse, you have pain in these positions.
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A common thing I see with those having low back pain chronically for years is one side of the pelvis that is elevated/higher than the other side. Think of the pelvis as the structural foundation of your building (body). If the foundation is canted to one side, it will drastically change how you sit, how you stand, how you walk, how you move.
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Here, we address these asymmetries with some great manual techniques. However I want to remind you guys that after this is done, you NEED to now reintroduce exercises that strengthening this position. Because I will guarantee you, that pelvis will go right back to what is was prior. A mobility program including weight bearing positions, like the fencer stretch I show here, are also necessary for maintaining this newfound pelvic neutrality.
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Video 1: inominate long-axis distraction mobilization, shown in FMLT course
Video 2: inominate inferior glide mobilization, shown in FMLT course
Video 3: soft tissue mobilization of QL, show in FM1 course
Video 4: hip inferior glide mobilization in fencer position, shown in FMLE course
Video 5: pre-assessment
Video 6: post-assessment

03/25/2025

LOW BACK PAIN WITH FORWARD BENDING❗️
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If someone has pain with forward bending, I know the issue here is lack of spinal flexion, specifically at the lumbar region. With lack of spinal flexion, I’m thinking shortness of spinal extensors such as Lumbar paraspinals and QL.
I’m also thinking limitations in vertebral and SI joint gapping. So I know I need to incorporate some type of posterior depression of the pelvis during my treatment and with my neuro-education piece. Here are two of my favorite positions/techniques to get the job done. 1. Seated Forward bend and 2. Side-lying basking seal. Both are focused on creating space to allow spinal flexion to occur! ENJOY❗️
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Video 1: STM of lumbar paraspinal in seated forward bending, shown in FMLT course
Video 2: QL mobilization in side- lying basking seal, shown in FM1 course
Video 3: neuromuscular education with pelvic posterior depression in side-lying, shown in PNF1 course
Video 4: pre test using forward bend test, shown in foundations course
Video 5: post test using forward bend test

03/16/2025

OVERHEAD FLEXION MANUAL MOBILIZATION‼️
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When someone has a limitation in overhead flexion, you want to assess and treat the soft tissue around the lateral border of the scapula. If the scapula is too far laterally driven, it will limit the amount of upward rotation that is required for over-head arm reaching.
This mobilization doesn’t feel the best, but it’s a guaranteed way to improve flexion and then start training in true full range of motion.
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Video 1: subscapularis tendon mobilization with assisted over head flexion using dowel, shown in FMUE course
Video 2: lat muscle mobilization, shown in FM1 course
Video 3: continued

Who would like this done to them⁉️

02/23/2025

Painful Shoulder with Sleeping❗️
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🗣️“My shoulder hurts when I sleep on it”
🗣️“I wake up with this weird stiffness in my shoulder in the morning”
🗣️“It is painful to roll over on my side in bed”
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These are all complaints I hear on a regular basis as a physical therapist. Here is what you have to do for patients who have similar complaints.
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First assess and treat the mechanical requirements of the position. For sleeping on a shoulder, that requires a significant amount of horizontal adduction. Many times the humeral head presses into the coracoid process and/or the acromion, making it painful for the GHJ. You must make sure the humeral head has space to create efficient end-range horizontal adduction. You must then create neuromuscular connections with this end-range position, in its efficient state. Why? Because if you don’t, that humeral head will go back to where it was before! Lastly, you must bring them to their painful position and assess/treat there. This step right here sounds like common sense, but you would not believe how many PTs do not assess + treat in positions that the patients complain of pain. ENJOY🤘🏽
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Video 1: horizontal adduction mobilization with strap, taught in FMUE course
Video 2: humeral head mobilization in “roll on it” FM, taught in FMUE course
Video 3: neuromuscular education post

02/16/2025

Hamstring Neural Tension❗️
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For people out there that live in a chronic state of “hamstring tightness”.
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You know these people. They passively stretch everyday and before every workout, yet still complain of their hamstrings always being tight. This is for you.
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It’s not truly your hamstring muscle(s) length that is short or tight. It comes down to the position of your Lumbar spine and pelvis that are creating a deep pull of the neural and dural structures down the back of your leg. So how do you improve it? By getting dynamic with your neural system and by connecting stability to the points of tension you feel and lastly, by altering the position of your pelvis and lumbar spine, with lumbo-pelvic stability exercises, before you work out or are active.
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Here is a quick progression of the manual component of this treatment.
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Video 1: sacrotuberus ligament and piriformis mobilization with neural flossing, shown in FMLE course
Video 2: hamstring separation mobilization, shown in CBI course
Video 3: hamstring insertion mobilization using praying mantis and prone ballerina as NMR, shown in FMLE course

01/19/2025

LUMBAR SPINE SHEAR TECHNIQUE FOR HIP-PELVIS-TRUNK CONNECTION ‼️
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Something I’ve always noticed is the relationship between the structural alignment of the spine, specifically related to frontal plane position, and the ability of the core to fire. Why is that ? It’s because the core muscles are literally all of the deep tonic stabilizing muscles that connect directly to the spine. So if the spine is, say for example, significantly sheared to the right at the lumbar area, it will directly affect the contractile capabilities of the deep muscles that connect to it.
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So correction of the spinal position can actually positively affect your ability to connect to your core. Here, we show a spinal lateral shear mobilization. I then quickly get that core to fire using some PNF (proprioceptive neuromuscular facilitation) and VA-LAAA, like magic we have a patient that has a newfound connection to their core.
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I see this many times extremely helpful for moms that are postpartum. They tend to carry their baby on their right side hip, causing the lumbar spinal position to veer towards the right. Tie this to the fact that they have increased ligamentous laxity, now their pelvis + lumbar spine are sheared so far to the right, they have no chance to connect to their core. Something like this works perfectly for a patient such as this.
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Video 1: set up and performance of lumbar spine lateral shear mobilization, shown in FMLT course
Video 2: neuromuscular education using PNF pelvic anterior elevation pattern, shown in PNF1 course

A huge milestone is about to take place. •••And her name is Gabriella. •••
11/17/2024

A huge milestone is about to take place.
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And her name is Gabriella.
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