Modern Manual Therapy

06/09/2026

Manual Therapy vs. Exercise for Neck Pain 📊

Here’s a great infographic summarizing the TAMERE RCT study (2026) on chronic nonspecific neck pain.

The Takeaway: There was no significant difference in pain reduction between the therapist-led and exercise groups, but both showed significant improvements in function and quality of life.

Clinical Implications: It highlights a complementary "eclectic approach"—using manual therapy early on to modulate pain ("opening the functional window"), followed by active exercise to reinforce movement and build long-term resilience ("building the house"). Check out the full breakdown below! 👇

06/08/2026

Weekend Wrap-Up: Live Flagship Seminar in NWA! 🚀

Just finished up an incredible weekend teaching my flagship quarter seminar down in Northwest Arkansas. We had a phenomenal group of rehab professionals, and the live patient demos were a perfect showcase of why I love teaching this framework.

We saw rapid responses across the board, but one live case really stole the show and perfectly highlighted the power of mechanical assessment.

We treated a fellow PT who presented with a complex mix of both severe acute and chronic issues:

The Acute Injury: He came in highly acute after literally lifting a massive 60-inch CRT TV out to the curb. (If you remember how heavy those old-school TVs are, you know the exact mechanism of injury here! 📺😅)

The Chronic Issue: At the same time, he was dealing with pain and severe stiffness across three levels in his cervical spine, having had a spinal fusion just a year ago.

The Intervention & Results:

We utilized end-range loading for both areas, and the response was phenomenal.

For the cervical spine, we demonstrated to the class that end-range loading was not only appropriate but highly effective and safe, even one-year post-fusion. We saw dramatic, rapid improvements in his cervical range of motion and stiffness. 📈

For the acute lifting injury, we utilized repeated loading and gave him targeted self-treatment strategies. The functional outcome was huge. Not only was he walking and standing comfortably, but he was actually able to attend mass with me later! There is absolutely no way he would have been able to kneel down for that long without those repeated loading and self-treatment strategies.

The Clinical Takeaway:

Don't let structural dogma, acuity, or a history of surgery dictate your treatment plan. When you apply solid clinical reasoning, respect the tissue, and empower the patient with self-treatment strategies, end-range loading is an absolute game-changer.

Thanks to everyone in NWA who came out, asked great questions, and made it a fantastic weekend!

Keep it Eclectic! ✌🏽🧠

06/04/2026

I posted before about how we should be moving away from terms like impingement and release. I had a patient this week who's been working with me throughout my entire transition from an old-school manual PT to the Modern Manual Therapy: Eclectic Approach version.

She was talking and joking, about how she's not allowed to use my "banned words." She knew all of them. She said, "Oh, this feels like a release," and "I know I'm getting an impingement in my shoulder," and "I know you don't like those terms."

I thought about it, and I realized that patients don't really care about the terms or what the research shows—that impingement isn't really happening, or that manual therapy is not specific. They really only care about how you can fix their problem.

So, I told her, "I know in the past I've said those things aren't happening, but I think that in general, they're great descriptors of what it feels like." If a patient asks why this works, then you can get into it, but you shouldn't just shoehorn your current updated "beliefs" —modern mechanisms of manual therapy—into the standard Rehab process. Granted, this patient is a very intelligent, PhD-level educated biochemist and a pilates instructor, so she's always been interested in the mechanisms. She finds it fascinating how I've changed my language over the past 15 years she's been working with me on and off. But it really had me thinking: instead of banning words or telling patients that's not what's happening, we should be better about validating their complaints, acknowledging that's what they're feeling, and focusing on solutions rather than verbal corrections. Let me know what you think.

06/02/2026

One of the things that gets the most pushback in my live seminars, in my videos, and posts online is the concept of manual therapy and rapid results from passive care being non-specific/neurophylogic.

I think there are many reasons why we should have always known that the rapid results we get in range pain and restoration of motor control have been non-specific/ contextual. The example would be

* Taking five to seven courses
* Getting a certification
* Practicing your butt off

You're told you have to....

* practice these techniques and assessments 10,000 hours, to become proficient.
* Yet, as soon as you actually get back to your clinic and even in the course, you probably get success that maybe you didn't have before and you are not doing it anything remotely close to what the instructor actually is the "only correct way to do it."

More evidence would be that various schools of thought from dry needling, soft tissue work, joint manipulation, neurodynamics, core strengthening, general strength training, and pain science education all seem to have rapid effects; even things like that are off the wall crazy concepts like craniosacral therapy and traditional Barnes type MFR that have somato-emotional releases, patients still "get better" from those approaches as well. All these various approaches supposedly all have different mechanisms, yet people still respond.

Why would all these disperate approaches all work well? Are they taught by a bunch of gurus, or is it that everything works for similar reasons, meaning- novel input that changes output? Let me know what you think!

05/29/2026

💡 Stop Chasing the Hip: It Might Be the Spine

We’ve all seen it: a patient walks in with a "hip issue." They have limited flexion, internal rotation is limited, and split squats feel like they’re trying to move through wet cement.

The trap? Spending 20 minutes on hip distractions and soft tissue work.

The reality? 80% of hips—just like 80% of shoulders—can be successfully treated with repeated lumbar loading.

In this video, I’m looking at a classic unilateral pattern. We checked her side-bending and noticed a clear asymmetry. Instead of grinding away at the hip joint, we used a lumbar sideglide in standing to reset the system.

The result?

Improved hip ROM (Internal Rotation & Flexion)
A much easier split squat
A very happy patient!

If the hip doesn’t clear with local movement, look upstream. The lumbar spine is a frequent flyer for referred hip pain and mechanical restriction.

🚀 Recovery Plan Action Steps:

For a patient presenting with this pattern, here is how I’d build the HEP:

Desensitize: Lumbar Sideglides in Standing, loading the left side (pushing hips to the right).

Dose: 10 reps every hour (or as needed for symptom relief).

Verify: After a week of consistent loading and desensitization, we re-test the "asterisk" sign (the split squat).

Load: Once the movement is quiet and ROM is restored, we stop "fixing" and start building. Transition to progressive hip loading and strengthening—yes, including those split squats! 🏋️‍♂️

Are you checking the spine on every hip patient? Why not?

05/26/2026

If you’re seeing cervical radicular pain in the clinic, you’re likely already reaching for manual therapy. But the real question is: Are you targeting the joint, the nerve, or both? 🧐

The latest 2025 systematic review in JOSPT (Garcia-Juez et al.) gives us a clearer picture of how these inputs stack up.

Here is the breakdown of Articular vs. Neural Mobilization:

🔵 Articular Mobilization (The Joint Focus) Targeting the cervical and thoracic segments with upglides, downglides, and manipulation. The goal here is simple: improve regional mobility and downregulate localized nociception by stimulating those mechanoreceptors.

🔵 Neural Mobilization (The Neurodynamic Focus) Think sliders and tensioners. We aren't "stretching" the nerve; we’re restoring sliding dynamics and reducing mechanical sensitivity along the entire pathway.

The Clinical Takeaway? The data suggests an Integrated Approach wins. Combining articular and neural techniques shows a greater potential for short-term pain relief and disability improvement than picking just one.

My Roadmap for CRP:

Decompress & Downregulate: Start with joint inputs to quiet the system.

Introduce Nerve Sliders: Get the neurodynamics moving without increasing irritability. Add Cervical Retractions and SB to the same side of arm Sx to replicate the cervical mobilization.

Transition to Active Loading: Lock in those gains with repeated motions like cervical retractions and sidebending.

Manual therapy is a powerful bridge to movement, but remember—the evidence certainty is still moderate to low. Use these tools to create a window of opportunity for your patients to get back to loading.

Keep it simple. It’s all about the right input at the right time.

My flagship course is on sale this week, along with everything else at the shop, check it out here. https://edgemobilitysystem.com/pages/mmtuq

05/20/2026

Ever heard of SAM? No, not the guy from HR—we’re talking about Sustained Acoustic Medicine. 🔊

In this asynchronous deep dive, Dr. Sean Wells joins me to unpack this "new" wearable, low-intensity continuous ultrasound device that’s making waves (literally) in the rehab world. It’s being touted for everything from knee OA to chronic low back pain, with some literature even suggesting it hits those elusive MCID targets for pain relief.

But here’s the rub:

The Price Tag: We’re talking roughly $8,000 for a retail unit. For a clinic owner? Even at a professional discount, you’re looking at a massive ROI hurdle.
The Mechanism: Is it truly mechanotransduction, or is it just the neurophysiological effect of wearing a "prescription-only" device for 4 hours straight?
The Competition: Can isometric loading or even a simple roll of kinesiology tape provide the same neuro-modulation for a fraction of the cost?

Dr. Wells digs into the systematic reviews, while I play the skeptic, questioning if the "magic" is in the machine or the duration of the stimulus.
What do you think? Is SAM a valuable tool for those "failed-everything-else" patients, or is it just an over-engineered subscription model for ultrasound patches? 💸
Listen in to hear our take on:

Low-intensity vs. traditional high-intensity ultrasound.
The "Prescription-Only" placebo boost.
Why duration might trump intensity in pain modulation.

https://open.spotify.com/episode/2S6pNcEggxiSqIbCFFZlof?si=FZcrkdCkTMeZpO5O99yHFQ

Untold Physio Stories · Episode

05/18/2026

Rethinking Centralization: Peripheral Entrapment vs. Spinal Modulation 🧐

I’ve been reflecting on the centralization phenomenon, popularized by the McKenzie Method (MDT). We traditionally categorize centralization as the hallmark of a spinal source—if repeated sagittal or frontal plane motions move symptoms from the hand to the neck, we "know" it's the disc or the segment. The EXPOSS study (Rosedale et al., 2020) provides a strong foundation for this, showing that centralization is a primary prognostic indicator for non-surgical outcomes in radicular cases.

But lately, I’ve been experimenting on a "patient" I know very well: myself.

The Observation
I’ve had several instances of clear peripheral neurovascular compression:

The Airplane Test: Falling asleep with my ulnar nerve compressed against a hard armrest.

The Sleep Test: Waking up with a "dead arm" after sleeping with it overhead or directly on the limb.

In both of these specific instances (the plane and the sleep test), I was conscious of my head position, and it was in a neutral position—not the driver of the paresthesia. On the plane, for example, I use a specific pillow and head support that keeps my head mostly in a neutral position. The source was most likely peripheral.

The Paradox
Instead of waiting for the sensation to return naturally, I performed cervical retractions and ipsilateral side bending.

To my surprise, the symptoms centralized almost immediately.

If the cause was peripheral compression at the elbow or axilla, why did a proximal spinal maneuver modulate the distal symptoms so rapidly?

Centralization or Neuromodulation?
This raises a critical question for our clinical reasoning:

Is it truly centralization? Are we actually changing the mechanics of a secondary spinal contributor we didn't know was there?

Is it Systemic Modulation? Does the repeated spinal motion provide a potent enough neurophysiological input to "gate" or modulate peripheral ischemic signals?

Mechanical Tension? Does the proximal movement alter the neural tension along the entire tract enough to facilitate reperfusion or mobility at the peripheral site?

Let’s Discuss
The EXPOSS study tells us centralization predicts a good prognosis for spinal sources, but if peripheral nerve irritation responds to the same "loading" strategies, does it change how you triage your patients in the clinic?

Are we too quick to label any positive response to repeated motion as "spinal"? I'd love to hear from the MDT community and manual therapists. Centralization or pure modulation? Drop your thoughts below. 👇

05/13/2026

🚀 Improve Overhead Mobility & Trunk Rotation Fast

Are your patients struggling with restricted overhead reach or stiff trunk rotation? Instead of the usual doorframe stretches, try Lat Inhibition.

The "Slack" Strategy: Putting the lat on slack (instead of stretching it) helps reduce tone and eliminate compensatory rib flare. It's a game-changer for rapid responders.
Groove & Load:
Gaining the range is only step one! To make it stick:

Groove the new motion immediately.

Load it with overhead carries.

Strengthen the newly gained end-range for long-term stability.

Master your manual therapy and movement science! MovementScience LatStretch ShoulderMobility DPT

05/13/2026

Lat Inhibition for Rapid Gains in Trunk and Overhead Mobility

Still trying to gain overhead range by cranking on the lats with a PVC pipe? There’s a more efficient way to decrease tone and improve motor control.

In this demonstration, we use a Lat Inhibition technique. Instead of a traditional stretch, we put the tissue on "slack."

The Clinical Logic:
Inhibit, Don't Crank: Putting the lat on slack often yields a "rapid responder" effect, improving bilateral symmetry without the "threat" of an aggressive stretch.

Neutrality Matters: Reducing lat tension helps eliminate compensatory rib flare and anterior pelvic tilt, allowing for a cleaner overhead path.

The "Opposite" Approach: If the standard doorframe stretch isn't working, try the Costanza method—do the opposite and slack the tissue instead.

Lock in the Gains
Gaining the range is only half the battle. To make it stick, you have to groove the new motion. Once you’ve cleared the restriction, it’s time to load it. I like to transition immediately into overhead carries or end-range strengthening. This builds stability and "convinces" the nervous system that this newly gained range is safe and functional. - Earn CEUs and get unlimited access to my fully online flagship course. https://edgemobilitysystem.com/pages/mmtuqlq