Patient history includes back pain and left sided leg symptoms (S1 sensory changes).   No signs of ominous pathology.
Prior treatment: weekly instrument assisted manipulative therapy with mild improvement each week.  Patient was also stretching at home.

So at this point the question is what to do.  First, I’ll say that  when I take over care for a patient who believes their current treatment regimen is working, I rarely change it initially unless I have significant concerns.  I instead work with it and make gradual changes in most cases.  I believe that what the patient thinks will make them better often does.  Their confidence in their treatment is an important part of the puzzle. (Is this approach right or wrong?  Feel free to weigh in.) 
Next issue is what to change in the treatment to make it more effective… the frequent debate is with whether to mobilize or stabilize first.  From Boyle’s Joint by Joint approach we have some general guidance as to what tends to need to be mobilized and what areas tend to need stability.  From FMS/SFMA (& others) we have the general concept that mobility is necessary before stability.  While I agree that mobility is often needed first, this is not a rule as much as it is a guideline.  Frequently, I’ve seen that providing stability where needed allows the nervous system to reduce the ‘tightness’ of other areas.  As stability is restored, the nervous system stops drawing upon ‘prime movers’ to act as stabilizers and mobility is restored.  To determine what type of treatment is most likely to benefit an individual patient, I follow this model, as outlined by Dr. Craig Liebenson.  Its brilliant simplicity is applying a McKenzie (MDT) concept to active care, including mobility & stability exercise.  While the mobility vs. stability debate will continue on, there is a more important first step that is at times overlooked. So let’s go back to this patient I saw and the case at hand.  I did provide instrument assisted manipulative therapy, similar to what the patient had previously received.  The patient was satisfied with this portion of care.  I also reviewed the patient’s current stretches.

After realizing that the patient was performing positions that involve common back injury mechanism (repeated or prolonged end-range loading, in this case lumbar flexion), I simply asked that she stop doing 2 of the 4 stretches the patient was doing on her own each day to try and remedy her condition.  (Picture on right was #1, a seated version with legs spread was #2.)

The outcome:  Patient returned 2 days later and was 50+% improved.  After 3 months of symptoms, I consider that a positive outcome.  Please realize, this is not a post about me, how good a job I did, or the quality of care I strive to provide.  It is also not a post to say, look at what someone  else was doing wrong.  (I hate these types of blog posts and FB posts.  We’re all on the same team.)  In fact, if you reread this you’ll see that I actually did very little.  I simply duplicated someone’s treatment.  The only thing that was changed is I followed the advice of one of the Prague school pioneers.

“The first treatment is to teach the patient to avoid what harms him.”  Karel Lewit, MD

Patients who are not well informed as to what harms them are unlikely to respond favorably. Removing offending movements, positions, and activities is essential.  Sparing advice trumps mobility, stability, balance, etc.  (In reality it often includes bits and pieces of all of them.)  At times patients have a hard time understanding how important and powerful this part of treatment is.  I’ve heard and use the following story, “If you came here with thumb pain, I could treat your thumb any way imaginable, but if it hurt because you were hitting it over and over again with a hammer, wouldn’t you agree that teaching you to swing the hammer differently is most important?”  Change hammer & thumb to anything that resonates with the person in front of you and I think you’ll have a productive first interaction.

Don’t skip step 1:  ”Teach the patient to avoid what harms.”  (Added note: Don’t let step 1, become ‘avoid activity’, be specific.)

Sparing strategies:

A) For repeated movements: ergonomic advice, teach/train better quality movement, and improve joint centration. 

B) For prolonged loads: microbreaks.  If you stand, sit. If you sit, stand.  Examples:  Brugger’s postural relief position.  McGill’s overhead reach.  

This course is offered with support from the International Society of Clinical Rehab Specialists and Theraband® Academy.

Date: June 16-17, 2012

Time:
Saturday: 8:30-5:00
Sunday: 8:30 –1:00

Location:
Northwestern campus (room TBA)

Register below or view course flyer.

Functional Foundations course includes: Movement Screening & Assessment, Corrective Exercise, Clinical Decision Making, and the Transition to Peak Performance.

“It is not just another protocol driven seminar, but rather a thought process that is forever evolving. you will learn: (1) how to think and (2) how to find that one specific exercise that will make an immediate change in your patient.” – Justin -NYCC

Movement quality and correction are an essential addition to the chiropractic evaluation and practice.  Come learn the skills so you have a strong foundation in these essential skills.

The future is near and you must choose your path. The shift in paradigm has begun, is your foundation strong enough for you to thrive?

Registration Type

Student$200.00 USD Faculty$200.00 USD Field Practitioner$300.00 USD Last Minute Student/Faculty$250.00 USD Last Minute Field Doc$350.00 USD

Registrant Name:

Registrant email:

• Catch up on my subscription to Research Review Service.  If you want a taste, here’s some free samples.  RRS 
• Logged into my Back Letter Subscription (thanks to my ISCRS membership) and skimmed April’s edition.  Back for a more detailed review soon.
• Checked out the great Cubos blog. Always impressive.  Going to miss having Jeff in Marietta with me this weekend for the R2P course.  Really looking forward to working with him next month in Daytona Beach, FL.  Not just for the weather, but an opportunity to share ideas with someone as well versed as Jeff.
• Shared some informal conversation with some great professionals (Perry & Mat).
• Remembered to clear my schedule to attend Dr. John Taylor’s seminar.

I love finding a few extra minutes in the day.  In hindsight, I probably should have gotten away from this chair and my computer.  I hear movement is good.  Maybe I’ll do that next time.

Is your chair killing you?

1. Why sitting sucks??   http://archinte.ama-assn.org/cgi/content/short/172/6/494

Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults

Conclusions  Prolonged sitting is a risk factor for all-cause mortality, independent of physical activity. Public health programs should focus on reducing sitting time in addition to increasing physical activity levels.

Video on this same subject:

2. How much do we know?  How much do we need to admit we do not understand?  A glimpse at why we must all be ‘comfortable with uncertainty’ as we prescribe, instruct, and educate our patients.

3. What are some people thinking about when the work out? Thanks to Phil Snell, DC for bringing this to my attention (it looks nothing like his videos @ www.myrehabexercise.com.  At some point people will begin to get the concept that training should focus on long term athletic development in kids and long term athletic participation in adults.  Thinking of specific adaptation to imposed demand…. I have no idea what this guy is training for.

4. Maybe yoga isn’t for everyone.  Another example of why exercise must be thoughtfully prescribed and caution should be used by non-clinical folks working with those who have clinical conditions.  http://onlinelibrary.wiley.com/doi/10.1111/j.1533-2500.2012.00545.x/abstract;jsessionid=567DC952E4D1FE4F92B86AF3928875A6.d02t01

Presented by Richard Cohen, DC

Certified Child and Adult Vojta Therapist

Continuing Education Credits for Chiropractors from NYCC

This course is designed for those practitioners who have and have not been exposed to reflex locomotion.  If you desire a basic or advanced understanding of the assessment, application and use of reflex locomotion this course is for you.

View Detailed Course Description

Course date:
June 23-24.   Saturday 12-6, Sunday 8-2.

Course fee:
$300 Early registration (pre-May 31)
add $50 for those who wish to receive CE credits (available to chiropractors from NYCC)
add $50 registration after June 1.

Course Location: A block of rooms is reserved for Saturday, June 23 for $119/night.  Online or by phone use group code: VSRC

Hilton Garden Inn Troy
235 Hoosick Street
Troy, NY  12180
877-STAY-HGI
troy.HGI.com

Vojta Seminar Registration – Albany, NY June 23-24, 2012

Course Registration (before June 1) $275.00 USD Early Registration + CEs $325.00 USD Registration (after June 1) $325.00 USD Registration + CEs $375.00 USD Student (full time) $250.00 USD

Name:

email:

To register by mail, send the following to the address below:

Name:____________________________________________________________

State for requested CEs________________________________

Check enclosed @$300/pp (add $50n for CE credits)=______(checks payable to Cohen and Haydu Chiropractic, P.C.)

Registration Info and Payment may be sent to: 

Dr. Richard Cohen
Attn:  Dr. Richard Cohen/Vojta
417 Market St.
Kingston, PA  18704

 About the Instructor:
Dr. Richard Cohen, the first native English speaking practitioner certified by
the International Vojta Society and the only one on the East Coast, has
developed a program to help chiropractors and other manual therapists
appreciate how the principles of movement development can be used in the
analysis of the pain patient or the patient with movement disorders. This
program will help attendees understand the principles of movement
development and how these principles change our view of the musculoskeletal
system and its role in movement. Your appreciation of movement and muscle
function will be enhanced and changed by your attendance at this program.

Read what past participants have said:

 “Thank you for a great seminar.  The information was excellent and at a very high level.  I feel much more confident about my Vojta abilities now and also have a greater understanding of how to use different positions to treat certain problems.”    Jeff Remsburg

“I think that the weekend I spent with you was a huge turning point in my ability to apply the principles to all my treatments.  It was as if a light was turned on in my brain and I can see things better.”  Gary Bowman, Illinois Spinal and Sports Rehabilitation

“I think the layout and content of the seminar is the missing link in the fundamental understanding of developmental kinesiology.”  Vice Lujan

“The course and attention to the hands on applications helped not only to reinforce what I learned in other courses but it took my understanding to another level.”  Leon Aibinder, D.C., New York, NY

“Before this seminar I was intimidated by how difficult to understand the Vojta/Reflex Locomotion technique seemed to be.  Dr. Cohen’s clear explanation and demonstration along with his clinical applications made the technique not only straight forward but a welcome and immediately useful addition to my tool box.”  Steve Henderson, D.C., Kansas City, MO.

“This class is a must for any practitioner wishing to restore normal movement patterns and functionality in their patients.  It has opened my eyes to a whole different level of treatment- a subconscious, involuntary level.”   Kerri Nelson, D.C., Atco, NJ

“Dr. Cohen presents Vojta/Reflex Locomotion in a simplified and easy to learn set of steps and procedures.  It is easy for someone new to Vojta to pick up the basics and implement them into practice.  The hands on time and one-on-one attention we received allowed us to feel and see the effects of the therapy first hand which made a big impression on me.  I would definitely take another seminar by Dr. Cohen and would recommend this seminar to other doctors of chiropractic.”  Richard Strunk, D.C., Kansas City, MO.

with Charlie Weingroff, DPT, CAT, CSCS

Date: Sat/Sun 06/09-10/2012

Time: Sat 9-6, Sun 8-3:00

Location: Troy, NY @ RPI Campus in the East Campus Athletic Village; lecture will be held in the Harkness Room.

Course fees:

• $499 Early (before 05/21/2012)

• $599 (after 05/21/2012, while available)

• Student rate: $299 early; $399 after 05/21

DRESS COMFORTABLY & BE PREPARED TO PARTICIPATE

 This course is open to:

• Those who aspire to TRAIN clients/athletes at a high level.
• Those who strive to REHAB patients at a high level.
• Those who appreciate the continuum of REHAB & TRAINING.
• Anyone looking to develop stronger network and better understand the team approach.

This includes: PT, DC, MD/DO, ATC, fitness trainers, strength coaches, sports coaches, movement specialists, & students currently enrolled in these programs.

DON’T MISS ON THIS OPPORTUNITY!!!

Watch Charlie in action: Core & Diaphragm with Charlie Weingroff

Register below.  Bonus offer: Rehab=Training Training=Rehab DVD (regular $199) available for $160 with course registration.

Rehab=Training Training=Rehab seminar June 9-10

Early Registration (before 05/21) $499.00 USD Registration (after 05/21) $599.00 USD Student Early (before 05/21) $299.00 USD Student (after 05/21) $399.00 USD ISCRS Member Registration $549.00 USD Early Reg. + DVD $659.00 USD Registration + DVD $759.00 USD Student Early + DVD $459.00 USD Student + DVD $559.00 USD

Specialty

ATC DC Fitness professional MD/DO PT Strength coach Student Other

Name:

email:

If you don’t know Charlie, you’re missing something.

Charlie is a Doctor of Physical Therapy, a Certified Athletic Trainer, and a Certified Strength and Conditioning Specialist. He was most recently the Director of Physical Performance and Resiliency and Lead Physical Therapist for the United States Marines Corps Special Operations Command in Camp Lejeune, NC. He is also Director of Clinical Education for the Vibraflex Whole-Body Vibration and Andante Medical, the makers of the SmartStep, mobile force plate. He graduated from Ursinus College with a degree in Exercise and Sports Science in 1996, and went on to earn an MSPT in 1999 and DPT in 2010 from the University of Medicine and Dentistry of New Jersey.

Prior to returning to his home state of New Jersey in the Fall of 2006 after 12 seasons of professional basketball, he was the Head Strength & Conditioning Coach and Assistant Athletic Trainer for the Philadelphia 76ers in the NBA. Among the highlights of his tenure in Philadelphia was being part of the medical staff that ranked 1st in the NBA in Player Missed Games in the 2005-06 season.

Through rehabbing patients, he subscribes to a movement-based approach popularized by the works of Dr. Vladimir Janda, Dr. Shirley Sahrmann, Dr. Stuart McGill, Pavel Kolar, Mike Boyle, and Gray Cook. In training athletes and clients, he champions the principles of the Functional Movement Screen and sound, evidence-based training principles. Some of the methodologies Charlie is formally trained in include DNS, ART, Dry Needling, Graston, FMS/SFMA, and the RKC.

Aside from working with patients, athletes and clients, he is also under the bar himself. In 2007, he achieved AAPF Elite status in the 220 weight class with a total of 1915 pounds. His best power-lifting competition total is 800 squat, 510 bench press and 605 deadlift.

For more visit his blog @ www.charlieweingroff.com

For more info:

email: jbrowndc @ gmail.com
call: (518) 477-4405
Registration by check is accepted.  (email or call for mailing address)

DVD Special: Training=Rehab Rehab=Training $160 for seminar attendees. Will be delivered at seminar, in person, by Charlie.

Note: Seating is first come first served and space is limited.

Rooms:
special rate of $129 /night
on-line at troy.HGI.com
By phone: 877-STAY-HGI
group code:  RTCC
For group rate: book by 5/18/2012

Bringing a friend or significant other?

Need more of a reason to come???  You shouldn’t, but here you go.

- Americade in Lake George

- Dave Matthews in Saratoga Fri & Sat night @ Saratoga Performing Arts Center.