Modern Manual Therapy

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! 👇

01/06/2026

Living in Buffalo, I do a ton of shoveling in the winter (and gardening in the summer). Even though I take breaks every 15-20 minutes to do extensions, sometimes I still come inside feeling "stuck."

If you treat lumbar pain, you know the feeling. The patient is stiff, blocked, and sitting at a functional "Yellow Light." 🟡

Sure, traditional MDT is great. You could hammer your way through 30, 50, or 100 reps of press-ups until it clears.

OR... you could use a little PNF and Isometrics to get there in a fraction of the time. ⏱️

In this video, I’m demonstrating Standing Isometric Resisted Extension.

Why this works: I’ve noticed in the research (and clinically) that the longer a patient has back pain, the less force they can actually produce in extension. It’s often an inhibition problem, not just a mechanical block.

The Technique:

Patient stands facing away. (Stagger stance for stability).
Extend comfortably. Go to end range.
Isometric Hold: I apply P to A force. They resist me using their back extensors, not just their front leg.
Concentric Activation: "Push me back." I let them win, overcoming my resistance into further extension.

End Range Hold: "Don't let me push you forward."

💡 The Cue that helps: Tell them it’s a "Limbo Contest." Drive the hips forward, extend the spine, don't just retract the scapulae.

This is often the difference between doing endless reps and rapidly turning that Yellow Light into a Green Light. 🟢

Give this a shot next time you have a patient (or yourself) stiff after a heavy squat session, kettlebell swings, or just shoveling snow.

Have you used standing isometrics for lumbar resets before? Let me know in the comments! 👇

01/02/2026

Most CLBP programming is still guesswork. A 2024 JOSPT network meta-analysis suggests there is a clear “sweet spot” for weekly exercise volume: ~920 MET-min/week for big changes in pain and function.

This post breaks down what 920 MET-min actually looks like in real life, with four plug-and-play weekly templates you can adapt for very different CLBP presentations.

Curious if your current programming is underdosed, overdosed, or dead-on?

👉 Find out here: Precision Dosing for CLBP – Are You Hitting the 920 MET-Min Sweet Spot?

https://edgemobilitysystem.com/pages/mmtuqlq

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