2022 R2P Symposium Thoughts
Such a great weekend at this year’s symposium teaching with Jeff Beran, PT, and Cody Dimak, DC. The theme for this year was ‘Loading the Painful Patient’, and we really tried to give the lay of the land in terms of a conceptual framework from which a practitioner can work to head down the path to mastery. We took a swing at working all the way from movement patterns, coaching communication, high-level diagnostics, to performance programming.
This was a behemoth undertaking as we were trying to give a glimpse of the entire ‘Rehab to Performance’ continuum in just 2 short days. While I’m biased, I think we did a pretty damn good job. Out of this weekend, a few common themes and questions arose, along with a few of my own takeaways.
Students (and docs) are still very much seeking order/progression within an active care model. The question of ‘what would you do first’ or ‘why did you decide to do that came up numerous times throughout the talk. While, my initial answer to these questions was that we were trying to relay a principally based framework to work from which in the end creates better autonomy, independent clinical reasoning, and eventually creativity. I do appreciate the lack of direction when first beginning. So here is my general hierarchy of treatment if I had to put it in a list (which makes me cringe just a bit)…
Adjustments/mobilization/end range loading: the effect from biomechanics, neurophysiologic, and pain-relieving basis put this at the top of the list.
Stabilization strategy work: whether it is central stability, vestibular work, cerebellar integration, or purely grooving a new pathway. Movement strategy precedes general strength work by a country mile.
Tissue work: dry needling, manual therapy, neurodynamics, and I would even include some loading strategies (think isometrics or eccentrics at end-range AKA DNS for decreased tone and reduction of TrPs)
Load: it’s like hitting the save button on a document. You don’t want to hit save on a document with a bunch of typos, but at the same time, we are not ‘movement editors’ every person and each scenario will require different degrees of nuance when it comes down to just how concerned we are with movement quality over pure load management strategies.
That’s about all you get when it comes to treatment choices, and it varies widely on a case-by-case basis as to which tools and which order you would use them in, but at least this gives a clinician a working order, to begin with.
Remember all portions of the diagnostic process are therapeutic (or nocebic) depending on how you utilize them, and vice versa for treatment strategies. So go out there and start throwing some paint on a canvas, because nobody really appreciates art more than the artist.
