Panel Discussion: Practice it or pitch it?
Is it your lack of proficiency, or the technique/exercise itself that is ineffective? The decision to continue practicing a particular technique/exercise or remove it from your repertoire is something you do after every workshop, book, article, etc… and it shapes how you practice/train. How do you make those decisions? How long do you practice a technique before you decide the issue is not your proficiency? Does the learning curve related to a particular technique influence whether or not you will use that technique in the future?
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This discussion started on my Facebook page: https://www.facebook.com/brent.brookbush on May 2nd, 2015
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Scotty Butcher Depends on the importance of the skill to what you want to achieve - May 2 at 10:53am
Brent Brookbush Can you give us an example Scotty Butcher … How do you decide the skill is important?
From a strength training stand-point this conversation may be better served by considering ancillary lifts (hip thrusters, gluteus medius work, push-ups on a ball) and not your major lifts (squat, deadlifts, bench, pull-ups) - May 2 at 10:57am
Scotty Butcher Also depends… importance can be dictated by many things (ie. individual goals, anatomy, task requirements, philosophy of training, etc). Even your assumption of more importance of major lifts vs accessory/assistance/ancillary lifts will vary (although philosophically, I tend to agree with you here as you know, but I also know many therapists/trainers who would disagree in some ways). - May 2 at 11:36am
Scotty Butcher Assuming a philosophy similar to what you've proposed, what about the individual who can't adequately train conventional lifts (mobility, anatomy, etc), and needs to rely on progressive loading of the ancillary lifts? What about when the specific goal dictates emphasis on a particular movement/exercise? I'd be willing to spend years on a specific skill if it was important enough. Others, I wouldn't spend any time doing (other than experiential). - May 2 at 11:39am
Brent Brookbush I see where you are coming from, I was certainly not thinking from a developing skills perspective when I wrote the question. Obviously skill takes time.
I was thinking more about a trainer/therapist who comes home from a conference with 15 techniques that he/she just learned. Let's say one of those techniques is Kinesioloy Tape. How long would you continue to try using Kinesiology Tape before you made a decision regarding its effectiveness? Obviously it is a technique that takes some practice…
I am not really proposing a philosophy as trying to discover how each of us develops our personal repertoire or practice pattern. Obviously, you have your favorite techniques Scotty Butcher (we all do), why are they your favorite? - May 2 at 11:45am
Kathy Benson Zetterberg I think it comes down to education and understanding what you are trying to accomplish. I know for myself following NASM's OPT Model give me an integrated approach with specific variables of each exercise. Not all exercises are for everybody. There needs to be a systematic approach for each individual depending on what their goals are. - May 2 at 9:26pm
Leon Chaitow Brent Brookbush - if a method. technique etc has validity - based on clinical experience or research evidence - we need to remember that the technique/modality/method (whether passive manual or active movement) is a catalyst, and that any 'success' it may have in terms of clinical benefit depends on the ability of the patient to respond to the biomechanical, biochemical, psychosocial, neurological etc etc stimuli.
The variables relating to any given intervention are enormous, ranging from the unique attributes of the individual, to the variables inherent in application of 'treatment' in term of dosage (type/ degree/intensity of load application, repetitions, duration, etc)
---- in other words there may be nothing wrong with a method, or the clinical reasoning behind its use in management of a particular condition, but if the resilience of the patient is diminished….it won't work.
Matching treatment to the ability of the individual to respond positively, is therefore the art of manual treatment - May 2 at 12:01pm
Adam Wolf Leon you're the man. Damn I love reading your books, posts and thoughts.
Thank you sir. You're an inspiration. - May 2 at 11:54am
Brent Brookbush So Kathy Benson Zetterberg ,
Using the NASM model you decide to activate someones Gluteus Maximus and Gluteus Medius using exercise "X"… how long would you continue to use that exercise before you assume that you have become proficient enough to judge against other Glute Activation exercises in your repertoire? - May 2 at 11:57am
Kathy Benson Zetterberg By the results I'm getting .. And by following the latest science based techniques. - May 2 at 4:16pm
Maurice D. Williams Client feedback, reassessment, progress. I really like what Leon said! - May 2 at 12:00pm · Edited
Brent Brookbush Nicely said Leon Chaitow ,
As I mentioned to Scotty Butcher , the real intent of this conversation it to try to shed light on how we create our repertoire. As we grow as professionals we add new things and discard others. Would you say that you do a fair amount of comparing techniques? Or is it another influence that refines your technique selection (assuming all the methods you have considered are valid)?
Note: Validity and patient perception are noted as two factors contributing to technique selection. - May 2 at 12:04pm
Brent Brookbush Hey Adam Wolf ,
Leon Chaitow is undoubtedly an incredible resource, and I am always humbled by his participation in these panel discussions, but you are no slouch
How do you decide when it is time continue practicing a technique, or time to trash it? For example, I just saw your shoulder mobilization video where you used an end range IR, ADD & EXT holding a bar and moving the body… Why that and not the traditionally used towel technique? - May 2 at 12:08pm
Mark Jamantoc Words of so much wisdom yet again Leon Chaitow! - May 2 at 12:17pm
Adam Wolf Brent thanks for the kind words…….
I base my exercise & manual modalities on what works for the people I'm in front of….some things for some people some of the time…..
That being said, my choices are based on the thresholds of who I'm working with, and if at all possible I'm going to choose to work the selected tissue as close to its "function" as possible…… or integrated integration, recognizing that it’s a spectrum and often we need to step back from integrated integration and go to integrated isolation or isolated integration, or if they are very low threshold, then isolated isolation…….it’s all based on who i'm working with and creating success
regarding the video you mentioned, I used this as opposed to a towel technique because I can place the shoulder girdle into a position and drive motion into it, as opposed to moving the towel to move the arm. - May 2 at 12:47pm
Mark Jamantoc When I first graduated from PT, the background we had for manual therapy techniques was little to non-existent. If anything, we learned the very basic stuff you read in books. Internship was really no different besides learning the basic skills and grading of mobilizations. Other than that, I had to seek out and learn on my own. So I started taking 2-3 manual therapy courses per year from a variety of authors, and sources. It allowed me to compare, experiment on what works, and be able to apply these daily in the clinic using a test - retest principle - which to me is probably the most effective approach if you're in our field. I give an average of 4 visits using a variety of techniques from my toolbox (very eclectic approach as I believe there are many ways to improve a condition). If I feel the patient would benefit from a specific technique that I feel I am either inadequate or that I have not trained on it, I send them somewhere else. I almost never stick to protocol and tailor my treatment on a case to case basis which possibly would change daily. - May 2 at 1:05pm
Brent Brookbush I like the test - intervention - retest approach… simple, effective and not preached enough - Mark Jamantoc - May 2 at 1:30pm
Mark Jamantoc Brent most clients today are well informed online and offline through word of mouth that you have to get results in one visit. Especially with my private pay patients, it's imperative we up our game to be out of the traditional PT model i.e. Modalities: TENS, U.S. - May 2 at 1:58pm
Nick Manzoni Now, I'm just your small time personal trainer. I'm not as book taught as other commenters or Brent , I do however, feel that in order to decide when to use an exercise I need to understand the client’s goal. We all realize that there are a multitude of exercises that, for example, activate Gluteus Maximus. My choice in exercise is almost always to duplicate proper movement patterns. With properly activated muscles with a diminished chance of compensation issues I can say with certainty that there is no goal the client could give to me that I couldn't achieve. If the client is given an exercise and they cannot perform it, a simple series of regression will weed out a "lack of body understanding". If regression still produces a lack of desired movement, I would then change the exercise. Timetables change based on client history and ability. This is unfortunately not a "one size fits all" approach and as a professional, we would need to also use our best judgement and risk assessment. - May 2 at 2:25pm
Kennet Waale I will chime in on this from a coaching background and a lot of post-rehabilitation work in conjunction with various therapists. Even in the simplest forms in a gym with a client who is in need of post-rehabilitation work or not, aiming to improve baseline function, I have found the test-intervention-retest approach extremely useful. As an initial assessment we often use postural and gait analysis as our tests and retest with the intervention/exercise based on the individual needs and wants. Therefore, if the client responds to the variables related to the prescription of the exercise (repetitions, time, duration, tension, breathing etc etc) and if the individual attributes allow for an improved understanding of why we are doing what we are doing, why should we then "remove" anything from our repertoire?
The more techniques/exercises/sources of quality information we have, the better we will be able to cater for our clients. - May 2 at 7:15pm
Tim Henriques When it comes to exercise you follow the results. You are your first client so first experiment and learn to see what works and what doesn't on yourself. Second learn from those who have achieved results themselves and their athletes/clients in the domain you are working on. Third apply your techniques to a reasonably decent sized group of people and validate your approach with results. Once you have done all of the above then share it with others so they can learn from you. The joy of working on the components of fitness is they are all easily testable and so as long as the focus is results you won't spend too much time chasing ineffective methods. My thoughts anyway, thanks for posting. - May 2 at 7:35pm
Leon Chaitow a further thought….compliance/adherence is clearly a vital aspect of any training/rehabilitation program - and what's known about this fragile area is that individuals will only 'comply' and do their homework if :
a/ they understand why they are doing whatever it is they've been asked to do (in my patient population this usually relates to breathing retraining)
b/ it is not unpleasant (unless the individual enjoys discomfort)
c/ it doesn't interfere too much with their normal routines
d/ they can be persuaded to give it time ---in breathing work this can mean months to reeducate deeply established habit-patterns
If any of these elements are missing then even the best protocols are likely to fail. - May 2 at 9:40pm
Brent Brookbush Nice point about "Regression" Nick Manzoni - May 3rd at 7:44am
Brent Brookbush Hey Kennet Waale , to you point "…why should we then "remove" anything from our repertoire?"
Because some techniques are inherently better than others. If we are an outcome driven industry, should we not use the best tool for the job? - May 3rd at 7:46am
Brent Brookbush Great point about "trying it on yourself, first", and then applying to a larger group. Simple, yet effective Tim Henriques – May 3rd at 7:47am
Brent Brookbush Great point about "trying it on yourself, first", and then applying to a larger group. Simple, yet effective Tim Henriques - May 3rd at 7:47am
Brent Brookbush In both of your posts Leon Chaitow , you bring up home exercise program (HEP) compliance and the need for the HEP to not be painful or unpleasant. I hope everyone reads your posts, very insightful. – May 3rd at 7:51am
Brent Brookbush One point I wanted to discuss with this panel,
I have noticed many individuals will stop using a technique before they have had a chance to become proficient. They claim that they stopped using the technique, assessment or exercise because it did not work, but the truth is they never applied it well… Whether it is the SFMA, the Maitland-Australian Physiotherapy Seminars Approach, IASTM (Steve Middleton ), Brookbush Institute content, one of Leon Chaitow 's texts, or the program design in Tim Henriques book… rather than dig-in and really become proficient an individual will simply ditch said technique (usually bad mouthing it in the process) and take on something similar.
What do you think Leon Chaitow , Tim Henriques , Kennet Waale , Nick Manzoni ,Mark Jamantoc , Adam Wolf , Kathy Benson Zetterberg , and Scotty Butcher – May 3rd at 7:59am
Nick Manzoni I believe it almost akin to be an "insult" if someone isn't proficient in an endeavor. Their ego needs to be addressed and they need to understand they hired you, me, the panel, etc. to do a job. And to allow the work to be done. If it's an issue of just flat out not enjoying the movement: I would pair it with a complimentary movement the patient/client feels better doing and try to get them to draw the parallels. Lo, and behold they may actually be adherent! – May 3rd at 8:03am
Brent Brookbush So if we do not have instant success, we don't want to keep going because we can't believe that we are bad at something? - Nick Manzoni
Awwww… the ego, such a terrible and fragile thing. How many people use joint manipulations on this panel? How long did it take you to become comfortable and effective with these techniques. – May 3rd at 8:17am
Erik Korzen DC Just joined the discussion…but I do use joint manips. This might sound crazy by some of the manip techniques I learned felt natural and I became comfortable using them rather quickly. However, there are still some of the techniques I am not comfortable with, either due to my own lack of success or because I constantly try to match manips to the obvious factors (patient condition, patient size, gender, my size relative to patients, environment) – May 3rd at 8:23am
Nick Manzoni Unfortunately joint manipulation is outside my scope of practice. – May 3rd at 8:24am
Nick Manzoni Therefore it is terrible and doesn't work. - May 3rd at 8:25am
Brent Brookbush But you do not give up on these techniques "that are not comfortable"… why not Erik Korzen DC ? - May 3rd at 8:50am
Erik Korzen DC This is specific to manipulation techniques, but it ultimately comes down to what is most beneficial for the patient.
Example: CT junction extension restrictions, certain patients respond to seated better than prone and vice versa. Seated CT adjustments ( which I have progressively improved my skills on) is more difficult but that doesn't mean I simply give up. There are patients out there that may benefit from the technique. - May 3rd at 1:09pm
Brent Brookbush Great example, funny you mentioned that technique… I usually use the prone technique and just tried the seated for the first time since a workshop last month on a colleague. I definitely need more practice - May 3rd at 1:12pm
Scotty Butcher Our professions and industries are rife with critics who have not truly applied a technique. They will criticize it without fully understanding it. Choosing to not apply it, on the other hand, is a personal choice and everyone's right. Just don't speak badly about it until you understand it. - May 3rd at 11:09am
Tim Henriques That is ultimately on them. If they don't feel comfortable with it or don't know how to apply it, such is life, they can try to use what they have. Hopefully they realize it is their limitation and they don't bad mouth the process itself. I would also try to look around at what else is happening. Is everybody using that process or something similar and getting results but you are not? Then it is definitely you. Do most people feel that the process doesn't work but there are one or two people claiming it does? Then it is probably the process. – May 3rd at 11:56am
Mark Jamantoc Brent , in your experience, can you tell me your take on this? Are you comfortable with any one technique and why do you think it has worked for you? – May 3rd at 12:02pm
Brent Brookbush Great thought process Tim Henriques … I like your "take a look around" approach.
Mark Jamantoc - I use a ton of different techniques, but I have also trashed a lot. All of you know I am big on "Exercise/Technique Selection" and personally, I do my best to test/retest/compare/contrast various techniques. I continually bash techniques against each other until I find the most successful application.
I also try to give anything with good evidence and a sound rationale a fair chance. That means I may keep something in my repertoire for months, despite unsuccessful outcomes, before I finally get rid of it. – May 3rd at 1:09pm
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