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Why "slack" works better than "stretch" (and how to explain it to patients)Clinicians hear it all the time: "I’m stretch...
07/30/2026

Why "slack" works better than "stretch" (and how to explain it to patients)

Clinicians hear it all the time: "I’m stretching every day, but my back/hip/shoulder still feels tight."

Our default reflex is often to prescribe more stretching. But if a patient is already stretching consistently without lasting results, doing more of the same isn't the answer.

Fighting the Guardian

Here’s the catch: when tightness or stiffness is accompanied by pain, it’s usually an issue of increased tone and protective guarding—not short tissues.

Yanking into that end-range can trigger an alarm in the Central Nervous System (CNS). The nervous system perceives the stretch as unsafe, driving tone right back up the moment they stand up. You might get a temporary window of mobility, but you haven't changed the system's threat perception.

Instead of fighting the tension, try going the other direction: a novel, shortening, or slack-based strategy.

The Finger Trap Analogy

Here’s how I explain this to patients when they wonder why "slack" works better than stretching:

Think of a finger trap.

What happens when you put your index fingers (the 2nd digits) in and pull both ends apart as hard as you can? The harder you pull, the tighter the mesh constricts.

The only way to release the tension and get your fingers out isn't to pull harder—it’s to push the ends together first to create slack.

When you find the right directional preference—one that unloads or shortens the area—you take the tension off the system. The nervous system relaxes its guard, pain drops, and mobility returns naturally.

Mobility is a Habit (and Movement is the Dosage)

Finding the right movement strategy is only half the battle. To keep the new range, you have to load it.

Mobility behaves like a habit. Once you identify the directional preference that improves pain and range, prescribe it like a medication:

Repetition is the dosage.

Frequency matters. Micro-dosing movement throughout the day keeps the CNS feeling safe in that new range.

Without the right dosage, the desired neuromuscular effect simply won't stick.

Stop forcing stretches into guarded tissue. Find the slack, load the pattern, and dose it repeatedly throughout the day.

What’s your go-to entry point when stretching fails to clear protective guarding? Let’s discuss below.

Words have power. The language we use in healthcare can either empower a patient to move or trap them in decades of fear...
07/27/2026

Words have power. The language we use in healthcare can either empower a patient to move or trap them in decades of fear.

When we frame structural variations or normal healing processes as dangerous "fragility," we don’t just misinform—we directly induce fear-avoidance behaviors.

Here are two real-world examples of how irresponsible phrasing broke movement confidence:

Case 1: The Fear of Paralysis

A young patient with acute low back pain visited a chiropractor for the first time. She has moderate, structural, idiopathic scoliosis—something that isn't going to change with an adjustment and isn't inherently dangerous.

The message she received:

"This is so bad. If you don't get regular adjustments, by the time you're 25, you're going to be paralyzed."

The impact:

A single statement set her up for over 20 years of fear-avoidance, hyper-vigilance, and a belief that her spine is more fragile than it really is.

Case 2: The Sitting Phobia

A patient presented with chronic low back pain. Four years prior, following a discectomy and eight weeks of severe discomfort, his radicular neural complaints resolved—leaving only local low back pain.

The message he received:

"Sitting is bad for you. Avoid it as much as possible. You should only sit when you eat—no more than 10 to 15 minutes a day."

The impact:

For four years, this individual restructured his entire life to avoid sitting for more than 15 minutes at a time, crippling his social life, career, and basic daily comfort.

Moving Forward: Reframing Pain & Movement

Phrasing matters. Catastrophizing structural findings or declaring normal human postures "dangerous" creates persistent disability out of manageable conditions.

Focus on resilience, not fragility.

Educate on adaptative capacity, not structural doom.

Promote movement confidence rather than imposing arbitrary physical restrictions.

Let's keep our clinical language grounded, empowering, and positive. Movement is safe, the human body is resilient, and our words should reflect that.

07/22/2026

One-sided headaches, upper trap tightness, and TMJ pain rarely exist in isolation.

When patients present with unilateral facial or cervical pain, the underlying driver is frequently a sensitized upper cervical spine—specifically the C0–C1 (OA) joint—combined with hypertonic masticatory muscles like the masseter and temporalis.

Standard jaw stretches often miss the mark because moving through the range prematurely activates the very anterior musculature you're attempting to relax.

Here are 3 targeted directional preference and isometric resets to break the tone-pain cycle:

1. Maxillary Retraction with Terminal Overpressure

Warm up with a clean chin tuck before adding overpressure.

Key Cue: Achieve full active retraction first, then apply web-space pressure over the maxilla at end-range.

Why: Pressing throughout the full excursion fires the anterior cervical flexors, counteracting the intended relaxation effect.

2. Same-Side Upper Cervical De-sensitization (OA Joint)

Target cervicogenic headaches and upper trap pain referring from the upper cervical complex.

Option A (OA Nod): Rotate the head slightly toward the affected side, maintain a tall chest position, and perform small, gentle nods.

Option B (Retraction with Rotation): Perform a full chin tuck, return halfway to neutral, and rotate back into the symptomatic side with repeated end-range overpressure.

3. Isometric Mandibular Resets for Hypertonic Clenching

To inhibit overactive temporalis and masseter muscles, leverage reciprocal inhibition with a stable cervical base.

Mandibular Protraction: Hold a chin tuck while performing an isometric mandibular protraction.

Mandibular Depression: Place the tip of the tongue on the roof of the mouth (keeping the teeth apart) while holding a chin tuck and performing an isometric mandibular depression.

The Clinical Takeaway: Retraction serves as the baseline directional preference. Adding targeted upper cervical loading or isometric mandibular contractions helps down-regulate hypertonic clenching muscles and unload the OA joint.

The combo that gives the most relief should be done repeatedly throughout the day, think 10 reps 6-8 times/day minimum.

It never ceases to amaze me how many patients think being beat up after manual therapy is normal.Had a consultation toda...
07/21/2026

It never ceases to amaze me how many patients think being beat up after manual therapy is normal.

Had a consultation today with a patient I see intermittently at her workplace. Her low back pain was flaring up, and she was debating going back to her chiropractor.

Her main hesitation?

Every time he adjusts her upper back, she gets super tense, and she’s sore for several days afterward.

I had to set the record straight: Manual therapy should not make you worse.

Here is what I tell patients:

- Exercise? Yes, Delayed Onset Muscle Soreness (DOMS) happens.
- New Movement / Range? Sure, a little transient achiness or novelty effect is fine.
- Manual Therapy? It should NOT leave you sore, bruised, or flared up for days or a week post-treatment.

We like to joke about terms like "Physical Terrorist" or "Pain and Torture," but in reality, manual therapy should be modulating pain, not creating it. If your patient is guarding and bracing every time you touch them, you aren't resetting the nervous system—you're threatening it.

Modulate pain first. Then load.

How many of your patients come in thinking that severe soreness after rehab or bodywork is just "part of the process"? Let me know your thoughts in the comments! 👇

Manual Therapy for Hypermobility?Yesterday, I worked with a client presenting with chronic TMJ, facial, cervical, and ra...
07/16/2026

Manual Therapy for Hypermobility?

Yesterday, I worked with a client presenting with chronic TMJ, facial, cervical, and radiating arm pain.

She suspected she was "a little" hypermobile. After a quick assessment, she scored a 9/9 on the Beighton score—confirming systemic hypermobility. She was actually please to learn she was so mobile, as no one had ever confirmed it for her.

She had already cycled through massage therapy, chiropractic care, and acupuncture. Each offered minimal relief lasting only 1 to 2 days.

Here is the clinical truth I shared with her:

If a patient is a rapid responder who gets even vhours of relief, the issue isn't the treatment itself. It's the program.

For these patients, the program should focus on two things:

Temporarily avoiding things that sensitize the system.
High dosages of things that desensitize the system.

During our movement screen, we checked her cervical range of motion. I began with cervical retraction and overpressure.

💡 Clinical Tip: Mind the Mandible

When performing cervical overpressure, she was pressing on her mandible, not her maxilla. This is a common error, especially with TMJ patients.

I use the maxilla for cervical overpressure on everyone—not just TMJ patients. Why? Because you want to avoid turning a cervical patient into a TMJ patient by repeatedly overpressuring the mandible.

With just light, sustained overpressure on the maxilla for one minute, she experienced significant relief.

The Hypermobility Misconception

There is a common belief in the rehab world that hypermobile patients shouldn't get manual therapy or end-range loading.

This is a mistake.

The magic happens at end range. Because hypermobile patients are more mobile than the average person, they need to push quite a bit farther to actually reach that end range. Not necessarily harder, but farther.

After combining joint mobilization and soft tissue work to actually reach and load those end ranges, she left with significant relief.

The Takeaway:

Hypermobile patients absolutely benefit from manual therapy and loading. But you have to actually reach their true end range to make the change stick.

End range is where the magic happens.

How do you approach end-range loading with your hypermobile patients? Let's discuss in the comments.

07/15/2026

Struggling with patient overhead mobility limitations or persistent shoulder impingement signs? Traditional doorknob stretches might be missing the mark.

Try this quick Reset and Load sequence instead to get immediate, lasting changes.

1. The Reset: The "Reverse High Five"

Instead of constantly aggressively stretching the lat, we can slack the tissue to open up immediate elevation.
Put the shoulder into internal rotation.
Move back into extension (like a reverse high five).

The Result: This simple reset frequently clears up impingement signs and yields instant improvements in overhead range of motion upon retest.

2. The Load: Crystallize the New Motion

Mobility without stability doesn't stick. You need to lock in that newly gained range. If you don't have weights on hand for an overhead carry, a simple wall isometric works perfectly:

Place hands on the wall and bend forward.
Push up into the wall actively.
Hold for 30 to 60 seconds to crystallize the new motion and strengthen the nervous system in that new pattern.

Give this quick sequence a shot with your next shoulder patient and let me know how it works out in the comments below!

Looking for unlimited access to clinical gems and CEUs? Check out the link in the comments for my online flagship seminar.

I’ve been teaching, presenting, and mentoring for over 25 years.My lectures and weekend courses are generally well-recei...
07/13/2026

I’ve been teaching, presenting, and mentoring for over 25 years.

My lectures and weekend courses are generally well-received. But if I'm being completely honest?

It’s easy to get stagnant.

If you aren't actively getting coached, audited, or seeking feedback, your material and your delivery get stale. Period. That’s why I love working with an organization (Pro-Activity) that pushes for continuous, honest feedback. It keeps you sharp.

Two recent tweaks completely changed how I present to clinicians—and honestly, how I talk to patients on the table, too.

1. The 1-2 Point Summary

At the end of a presentation, lecture module, or at the end of an evaluation, don't just stop. Summarize the absolute main takeaways. But keep it to ONE or TWO points max. If everything is important, nothing is. Keep it hyper-focused so it actually sticks and they can execute it immediately.

2. Flip the Q&A Script

Instead of wrapping up a section and asking the standard:

"Do you have any questions?"

Switch it to:

"What questions do you have for me?"

Let that sink in for a second.

When you ask "Do you have any questions?", people automatically tune out. It feels like a formality. Or worse, patients and clinicians feel insecure and stay silent because they don't want to look like they didn't get it.

But saying "What questions do you have for me?" is an actionable statement. It assumes they have thoughts. It safely invites them to share.

But here is the real secret sauce: You have to pause.

Ask the question... and then just shut up and wait.

It might feel incredibly uncomfortable on both sides for a few seconds. Sit with that discomfort anyway. That silence is exactly what creates the space for the introverts, the hesitant students, or the overwhelmed patients to finally speak up.

Whether you're standing in front of a room full of physios or trying to get buy-in from a patient, the words—and the deliberate silences—you use matter.

Stop settling for a stagnant delivery. Keep evolving.

What questions do you have for me on this one? 👇 Let me know in the comments.

07/07/2026

Are you treating hip stiffness as a primary hip problem? 🧠

Often, when patients present with tight hips and low back pain, we immediately look at the hip joint itself. But frequently, that stiffness is a protective mechanism or a symptom rooted right in the lumbar spine.

If you want a quick sequence to reset the system and start building real, resilient trunk and hip strength, try this:

1️⃣ The Lumbar Spine Reset: Repeated backward bends. Think of it like a limbo contest. Have your patients use the 20/20 rule (every 20 minutes, do 20 seconds of extension) throughout the day. You’ll be surprised how often freeing up the back immediately loosens up those "tight" hips.
2️⃣ The Horse Stance: Once the hips feel looser post-extension, lock in that range with an isometric horse stance. Pro-tip: get an isometric chest workout in at the same time by squeezing the hands together. Hold for 30–60 seconds.
3️⃣ The Isometric Bear Crawl: Finish with an isometric bear crawl hold on hands and toes. It acts like a mini-plank but is often much friendlier on the core while strengthening both the anterior chain and the back.

Keep the strength work to 1–2 times a day, but push for frequent backward bends.

Give this sequence a shot with your patients this week and let me know in the comments how their hips and backs respond! 👇

Who is a candidate for repeated motion testing and end-range loading? Short answer: Anyone you would consider mobilizing...
07/02/2026

Who is a candidate for repeated motion testing and end-range loading? Short answer: Anyone you would consider mobilizing or manipulating.

In my courses, I get asked all the time:

"Would you do this on a post-op patient?"
"Would you try this on an acute injury?"
"What about chronic back pain?"

But the one that surprises me the most—and I hear it constantly—is: "What about an older patient? Especially one who is really stiff?"

Let’s look at the logic here.

Ask any manual therapist and they’ll tell you: it is always easier to manipulate someone who is stiff. It takes less wind-up, less slack to take out, and you hit the barrier faster.

So, by that exact same logic, it is also much easier to end-range load someone who is stiff. And yes, our older patients are often stiffer.

Just because someone walks into your clinic with a severely arthritic hip, a ton of crepitus, and advanced degenerative changes on an X-ray doesn't mean you count them out.

Don't assume they won't respond to repeated motion strategies—especially when looking at the lumbar spine.

Here is the key distinction we need to make as rehab professionals:

Mobility might not change rapidly in a highly osteoarthritic joint.
Pain modulation absolutely can.

They might still be a rapid responder for pain, even if their range of motion doesn't budge.

So, who is a candidate for end-range loading? The net is much wider than you think. If you’d put your hands on them to mobilize them, you should be testing them for a directional preference.

What's your experience with end-range loading your stiffer, older population? Let me know in the comments.

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