Laura Mannering Physical Therapy

10/26/2023

Please join me! Free tickets on Eventbrite.

Please join me for a lecture and interactive discussion surrounding low back pain! We'll touch on diagnoses, prevention, and treatment.

03/21/2023

None of this 12 different things mumbo jumbo.

02/28/2023

The body does not often magically regain normal status after a major trauma like surgery.

02/17/2023

02/04/2023

Such important information! Keep the S in your spine.

NOTE FROM TED: While some viewers may find this helpful as a complementary approach, please do not look to this talk as a substitute for medical advice. Ther...

01/25/2023

Unfortunately, you must question research. It’s rife with poor methodology, assumptions, and bias, and often carried out by researchers & institutions corrupted by financial & power incentives.

01/25/2023

Once you learn how to diagnose them, you realize they really do make up the bulk of orthopedic disorders.

Once you learn how to treat them, you realize how much sense it all makes.

Yes, tendinopathies, tears, fractures, and other diagnoses exist. But I find that 70-80% of orthopedic disorders are tweaked joints that resolve with mostly simple movements that patients can do themselves.

01/22/2023

Like tendons, ligaments, capsules, menisci, labrums, & muscles. I find 70-80% of patients’ orthopedic problems are joint tweaks that need repeated movement in the correct direction to resolve.

Robin McKenzie proposed this concept in the 1950s, but few clinicians accept it.

01/19/2023

Now I know how to keep my back healthy, with monitoring my range of motion, being aware of prolonged postures and activity loads, and daily or near-daily quick range of motion exercises.

01/17/2023

I have an idea! When you understand that joints can easily get tweaked, you start listening for patterns of joint positions that are aggravating & relieving. You ask specific questions about what flexion activities do, what extension activities do, what rotation activities do to the pain, and so on.

And, more important than even asking the right questions, you repeatedly move patients in different directions as part of your orthopedic evaluation & use cause-and-effect to assess what happens to the subjective symptoms & objective baselines.

To be clear, most clinicians do NOT believe that joint derangements exist. Instead, they diagnose problems with muscles and structures - and they come up with convoluted stories like IT band syndrome & patellofemoral pain syndrome.

I find 70-80% of orthopedic disorders are tweaked joints that need movement in a specific direction to get back on track.

Robin McKenzie discovered this in the 1950s and called them joint derangements. He developed a system of repeated movement testing to add to orthopedic exams that determines if the disorder is a joint derangement or not and he devised a system of directional preference movements to fix them.

01/14/2023

Symptoms in the upper trap area are from a spinal problem until proven otherwise. It’s uncommon that a problem in the shoulder joint would refer pain there.

Additionally, it is very, very rare that someone would injure their upper trap muscle itself.

Clinicians need to get a very clear picture of where ALL symptoms are, because if a patient says my shoulder hurts and points to the lateral shoulder that’s very different than a person who says my shoulder hurts and points to their lateral shoulder AND upper trap area.

There doesn’t have to be neck or mid back pain itself for that to be the source of the problem. Referred pain is very common from the spine.

Effective care starts with the right diagnosis.

01/12/2023

Costs are out of hand. A big reason is, with so many parties & payers involved, people have no idea how to value different medical tests & interventions.

If people had to pay exclusively out-of-pocket, for example, I bet you’d see a lot fewer people spending their money on MRIs, x-rays, and injections. Ideally, people would be better at finding clinicians that can diagnose & treat effectively - not just bill.

I don’t advocate that we make healthcare a privatized system. But what we’re doing is not working, as evidenced by the slew of people with unresolved musculoskeletal symptoms (especially low back pain) and the slew of medical institutions, doctors, and insurance companies getting rich. This is partly due to the system itself.

01/09/2023

Feeling better & moving better will go hand in hand. This has an important implication: if we can do a repeated movement & your mobility improves, there’s a strong chance the symptoms will likewise improve. (That is, keep doing that specific movement!)

Additionally, it’s helpful to teach patients this concept so that they don’t have to wait until pain comes on to know there’s an issue. If they can quickly assess their range of motion & find motion loss or pain with motion, they can correct it with their directional preference exercise, ideally before symptoms emerge.

If you don’t know that your mobility & your symptoms are connected, you think your pain just appears out of the blue, for no reason. Understanding how a mechanical joint derangement behaves gives you much more control & reduces fear.

01/08/2023

Making someone feel better & reversing someone’s disorder are not necessarily the same. Orthopedic studies should delineate changes in pain & function, yes. However, they should identify changes in musculoskeletal system markers.

01/06/2023

I know that you think doing just one exercise is unusual - especially when it’s an exercise you’ve never seen before or a spine movement for your extremity complaint. I know.

01/04/2023

Repeated movement testing is cause & effect analysis. So, if there’s something that reproduces YOUR SPECIFIC complaint, it’s great to be able to use it before & after a repeated movement to understand the behavior of the problem.

If a patient has mentioned in the verbal history that every time she jumps it hurts her ankle or when she reaches into her bag, it hurts her neck, I’ll ask her to do that.

If nothing has already been mentioned, after I take the standard orthopedic baselines I’m sure to ask if there’s anything we can do right then that would bring about the patient’s complaint that could help us with testing.

Most times there is.

Think squats, walking or jogging down the hallway, jumping, stepping up/down, reaching, lifting, a certain yoga pose or stretch, rolling over, getting up off the floor, buttoning a shirt, and so on.

If there isn’t, then we’ll simply use the standard orthopedic baselines & gauge the effect over time on the problematic things outside the office.

Here’s an example: shoulder pain that’s produced with a push-up. Say we do 30 neck retractions with overpressure & the push-up is the same. Then we do 30 neck retraction-extensions & the shoulder pain with the push-up decreases 50%. I take that piece of information in conjunction with the others to decide if neck retraction-extension is worth investigating more at home.