This blog is from 

 

In my courses we address a # of common questions that we all face –

  • When would I know to prescribe a specific exercise or should we follow a one size fits all philosophy?
  • Every exercise is a test – why?
  • When should I do manual therapy or utilize modalities?
  • When should we “go hard or go home”?
  • How do I tell when a dysfunctional patient has a primary respiration, postural, flexibility, or motor control problem – in other words how can I find their “key weak link”?

My course series is designed to both teach the basic skills of a Rehab-based practice & to focus on Clinical Problem Solving.  Often a Stab, manual therapy, Butler or McKenzie practitioner fails to see the full value in other’s approaches.  Often a trainer becomes a “corrective exercise specialist” & forgets how vital strength &  power are. These principles are similar for a movement specialist who is a trainer as one who is a clinician. Quality not quantity is our goal. Competency before capacity.

“Doctors have always recognized that every patient is unique, and doctors have always tried to tailor their treatments as best they can to individuals.”
– President Obama, January 30, 2015

The functional approach is not a cookbook. Instead the focus is on Clinical Reasoning Skills. Today this is being re-branded as Precision Medicine“Until now, most medical treatments have been designed for the “average patient.” As a result of this “one-size-fits-all” approach, treatments can be very successful for some patients but not for others. Precision Medicine, on the other hand, is an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles.” 

 

I learned this from  Karel Lewit who referred to Pr. Janda as the original & himself as a thief!

I first met Lewit in June 1986 and Janda the following year. When I visited Prague in 1990  I was amazed at how Karel consistently was able to find the source of his patient’s pain and remove it by restoring function to a “key” tissue –  joint, muscle, fascia, or skin.

It was a systematic process, but not a cookbook. He examined his patients for trigger points (the twitch response or objective sign of their pain disturbance),  then formed a clinical hypothesis about a key dysfunction that he felt was pathogenically correlated w/ their trigger point & symptoms. To test his hypothesis he treated the key functional pathology of the motor system. And, as many of you know his success was over 90%!

The approach  taught in my courses as well as those of Dr.’s Jason Brown & Justin Dean are derived from Lewit’s. It is called the Clinical Audit Process – The Role of Reassessment_ The Clinical Audit Process. With the Prague School approach you will learn to go beyond the palpatory signs of a trigger point or passive ROM impairment, to identify in all your patients the key functional pathology of the motor system. The key outcome or goal of care is to improve their unique mechanical sensitivity (the movement which reproduces their characteristic symptoms – FMS 0/3). The means to this end is to find the  key kinetic chain dysfunction (e.g. motor control error). This is always a painless dysfunction (FMS 1/3) . You will learn how to  form a clinical-treatment plan that will transform their painless dysfunctions (1/3 tests) into acceptable movement patterns with minor compensation (2/3) ready for bodyweight training or near perfect movement patterns (3/3) ready for load & higher intensity training.

TRANSFORMING  A 1 INTO A 2 IS THE THE HIGHWAY TO THE CNS. IT IS THE BEST WAY TO MYELINATE THE SYNAPTIC CONNECTIONS FOR RE-GROOVING HEALTHY MOTOR & MOVEMENT PATTERNS. This puts the focus on the “low lying fruit” as Gray Cook says. Since you are only as strong as your “weakest link” focusing on the 1’s is more powerful than focusing on the 2’s.

The beauty of this paradigm is that the “key link” & therapy can be soft tissue, lower quarter kinetic chain, core dysfunction, feet, or even orofacial. The PATIENT CENTERED treatment is always customized to the patient’s goals and is never a cookbook-generic solution. Our goal is to give patients confidence they can succeed – Self-Efficacy. To do this we avoid trying to “police perfection”.

Our job as neuromusculoskeletal experts is to find what Pr. McGill calls the Functional Diagnosis, or the GAP between the pts FUNCTIONAL CAPACITY & their FUNCTIONAL GOALS. As Lewit says “the methods should serve the goals”. In the R2P programs   a wide variety of invaluable methods –  T4-8 extension mobs, Kolar’s deep abdominal wall facilitation, Butler’s neuromobs, etc.. But, we don’t teach technique seminars  since instead of relying on a cookbook you want to learn a systematic, ongoing assessment process. (see Lewit’s recent paper Lewit_Lessons_for_the_future).

I will never forget the gift that Karel Lewit & Vladimir Janda gave us of clinical reasoning. Their conviction in the Functional Pathology of the Motor System as a North Star to guide us is what seperates what we do from those who focus on structural pathology or just the site of symptoms (e.g. pain generator). Our gift to our patients is that we can find and remediate the cause of their symptoms. You will learn to  search for the key functional pathology – or the “software problem” which is always a reversible lesion leading to seemingly remarkable results.

The modern stability paradigm of McGill, Lewit, & Janda follows a systematic method, that does not make us a prisoner of protocols. As we learn more about the MAGIC of Regional Interdependence we can see how & why Lewit & Janda emphasized the Stratification Syndrome of alternating areas of hypo & hypertonus – or what is now called the Joint by Joint approach of Boyle & Cook. Clearly, as Dr Lewit taught “he who treats the site of pain is lost.”

Now, add to this the ability to quickly RE-SET the CNS with the great codebreaker – Developmental Kinesiology –  there is no excuse to treat the structural pathologies (e.g. hardware) or symptoms without and even greater emphasis on the functional pathology or software.

See also this blog link on the CAP which takes you step by step through the process taught in our R2P programs.

This is an exciting time to learn how to become a benchmark, “cutting edge” provider in NMS care. Each of you are black belts in the many different arts of caring for the locomotor system – strength & conditioning; chiropractic; soft tissue therapy, acupuncture, PT modalities, etc.. We each  can learn from one another. I am extremely happy to bring my Problem-Solving courses around the globe and I hope that you can beat the drum so PT, ATC, S & C, & DC colleagues can develop mastery in the functional approach to the locomotor system.

There are so many experts in the field of musculsokeletal pain, rehab & performance. Please check out 2 of my favorites –

See you soon!

Craig

Comments:

Geez Craig, after such an eloquent explanation, it’s all I can do to not repeat both modules of the course! I’d love to read the linked Lewit papers but they’re password protected. I’ll see you in Seattle.

For those readers who haven’t checked out these MSC modules let me give 2 thumbs up after my experience with MSC 1 and 2. Dr. Liebenson has synthesized his 25 years of personal study with the heads of the Prague school and McGill’s evidence into a clear, coherent, cogent, clinical practice model. You’ll walk away with practical tools that can be used on Monday morning in your clinics. If the Prague school info is new to you, prepare to be totally rocked. If you’ve been exposed through classes in school, prepare to have your tools honed so that you can cut through the pain-chasing paradigm and get to truly fixing things. Be a better clinician, get better outcomes, set yourself apart in your community as an innovator. Cheers!