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Nontraditional Manual Therapy
730 Plays2 years ago
Josh and Miranda talk about nontraditional manual therapies including cupping, needling, and IASTM.
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Transcript
Introduction to Alternative Manual Therapy
00:00:05
Speaker
Hi, I'm Josh McDonald. And I'm Brandon Materi, and we are Hand Therapy Academy.
00:00:09
Speaker
Today we're gonna talk a little bit about some other forms of manual-ish kind of therapy options. We do stretching, we do soft tissue mobilization with our hands, and we do like edema reuptake and lymphatic drainage stuff, but we're gonna talk about some of the other versions of manual therapy that you may put under that billing code and what we do in the clinic.
Practical Experiences vs. Research Focus
00:00:29
Speaker
Less about like what research says, because we can all go find that, and you can find some pro and con for almost anything, but kind of what we use in the clinic and what we find more effective.
00:00:37
Speaker
Okay, so this will be like needling, cupping, instrument assisted soft tissue mobilization, that stuff. So what is
00:00:44
Speaker
one of your favorite alternative manual therapies? Is it cupping? Is it the tools? What is it?
Benefits of Tools in Manual Therapy
00:00:51
Speaker
It's the tools. It's the tools. We have several kind of spread all around our clinic and we find good value in scar management. We find good value in releasing adhesions and getting blood flow to the area, but we're not doing super aggressive. We're just doing like a, I'll call it a two out of five kind of grade on it. It's very informal.
00:01:11
Speaker
Yeah, what I really like about the tools is it can really save your hands, right? So you can hold them in positions that don't put stress on your CMC joint and those things. So I think that's really been a key to our clinic in using them. The other thing that I like is that you can get a little bit of feedback from the tool. You can kind of feel when there's like those special adhesions when you're running that tool along the muscle belly, you can feel those. So I really like that aspect of the tools.
00:01:39
Speaker
Yeah. Um, have you been to one of the iced in courses, one of the different branded versions of the course?
Costs and Learning in Manual Therapy
00:01:45
Speaker
No, I have not. Have you? I have not either.
00:01:49
Speaker
When I was at one of my clinic practices at Mayo Clinic, excuse me, they were taught, I asked them and say, do I need to go to a grassing course? Do I need to go to an A-STEM course? Or now there's a ton of them. There's hot grip has one and I think rock tape has one. And this therapist, several therapists said, no, we'll teach you the concepts and principles. It's basically what you would do with your hands with a tool. You can go to the course and spend
00:02:13
Speaker
2,000 to 3,000 and then the tools are super expensive or you can learn like so much of what we do from the therapists around us and this handed down kind of the information we pass on from one to the next and still have great access to tools on Amazon and all these other places. Yeah, I think when it first came out the tools I think were alone were like $3,000 and as a younger therapist, you know,
00:02:39
Speaker
not making talk dollar in a clinic, it seemed like it was too expensive and not affordable.
00:02:45
Speaker
Yeah. Yeah. It is a much more approachable thing. Now we've kind of standardized a little bit. It's much more available to purchase these tools and go to some other clinics and see like, Hey, what tools do you like? And you can find very similar tools on Amazon. It's hard without some scale of how big is the tool and what does the profile look like? But yeah, you can find lots of options that spending thousands and thousands at a conference. And usually each tool has a few different edges on
Brandon's Cupping Techniques
00:03:09
Speaker
it, right? So how
00:03:10
Speaker
how rounded it is, how square, if it's more beveled, and then you can use the different edges to reach different tissue depths. Yeah, yeah. How about cupping? Do you use cupping very often? Yes, I love cupping. What's your go-to time for using it? I would say I like it a lot for like lateral epicondylalgia.
00:03:29
Speaker
any like tendinopathy type thing. I like to use it for increasing blood flow and not just the, you know, the cups with the pump. We've been just doing more of the silicone cups, the smaller ones for scar adhesions. They're usually a little bit less aggressive. If I'm doing, you know, more of the upper arm, I'll use the other cups with the pump, but I like the little small cups and they're affordable so patients can buy them. One patient population I don't typically do them on is any, the EDS patients because sometimes there's, you know, skin is so,
00:04:00
Speaker
that it's contraindicated, but for everyone else, I do really enjoy cupping and patients seem to like it. How about you? What are your thoughts on cupping? I'm a big fan of it. I agree with you on some of the tendinopathy stuff. I also use it on nerve compression things. So like a carpal tunnel, even working up proximal, because you can get a lot of double crush stuff going on. I've got a gunshot wound. We're using it up on radial nerve so I can feel it's super effective.
00:04:24
Speaker
Like you, I've got to watch for skin integrity stuff. So our older population, I've got some patients with carpal tunnel that I won't use it on because I'm worried that I'm going to like, compromise skin integrity. Like it's a fantastic option. I don't do a lot of the dragging the cupping along the skin. More so I'll do where the cup is static. Like if I'm trying to release some scar adhesions over like an EDC or EIP, I'll put it over that scar adhesion.
00:04:49
Speaker
and have them just do light finger extension. I just find that dragging the cupping is a very aggressive way to do that. And it ends up causing maybe more trauma than it, than it solves. Yeah. And I think that's where the silicone cups are nice is because they're not as aggressive, but yeah, kind of braiding it. And I think you and I took a needling and cupping course together, you know, a few years back. And I remember there was one study that the lady presented to us saying the difference between a good cuppa and a bad cuppa is two cups.
00:05:17
Speaker
I don't know if you remember that, but it's basically like, it doesn't, I think our instruction on it was like three or four hours, but it doesn't require a lot of skills, right? So once you've done a couple, you kind of get the hang of it. Yeah, yeah.
Discussion on Dry Needling
00:05:33
Speaker
Okay, so let's talk about dry needling. Let's assume that it's allowable in your state, in your area. Are you a fan of cupping, or excuse me, dry needling?
00:05:43
Speaker
I do like dry needling for larger muscles, so I love it in the upper traps. That's probably one of my favorite uses of it, but in the hand, I think it really hurts, and most of the time the patients are like, that really hurts. So I don't do it a lot in the hand. I like it for lateral elbow stuff, but not a lot in the more distal structures. How about you? Are you using it in those areas?
00:06:07
Speaker
I'll definitely use it for tennis elbow, lateral cup and epicondylalgia. I'll use it some on shoulder stuff for sure. Like you said, as you get more distal, it gets much more sensitive. I've had a couple of patients who saw me do it like on someone's tennis elbow and they said, hey, can you do that on my PIP joint? I'd love to have that done. Or they've had it before on their back. Can we try it on the PIP joint?
00:06:27
Speaker
And so I can find that joint capsule space with it. And some patients love it, some don't. It's not as in general, dry needling is not one of my like go-tos because it uses a fair amount of expendable resources. And so it's me buying more stuff. And it's not something that a lot of people are comfortable with having done on them or even watching someone across the room having it done. So I've got to make sure it's the right patient in the right situation and they're comfortable with it before I go pulling out needles
00:06:57
Speaker
And it's also not a billable service. So it's not something I'm comfortable like taking up five or 10 or maybe 15 minutes of time when I may have a limited amount of time before that patient leaves and it's not a billable service. So yeah. Right. But I mean, every once in a while you get that patient that you do it and they're like, I feel so much better now. Yeah. That's a win.
00:07:17
Speaker
Yes, absolutely. And I feel like I'm kind of finding diagnoses for which, whether it's my technique is limited, where I feel like that's a diagnosis I want to use it for. That's one that works well on. And sometimes it's the third or fourth option I'll pull out if my low-hanging fruit stuff isn't working. Then I'll say, well, let's try Neelink, because that can be an effective approach for this. Yeah, that's very true. Yeah.
00:07:37
Speaker
How about laser? Are you a fan or have you used laser before?
Interest in Laser Therapy
00:07:41
Speaker
You know, this is definitely an area I'm interested in. I've been seeing more and more with like red light and type of stuff like that. And I think that there is some okay research supporting it. So it's definitely something I'm interested in. I think it's finding the right unit and with cost. So it's not something that I am using currently, but something I am interested in using. And I think if it's something that you like and it works well, then
00:08:06
Speaker
By all means, use it, right? Yeah, yeah. I used it with another therapist I worked with for a while, and it was her little laser unit, and it was like a pen-shaped size thing. It was not the red light version. This was before that kind of grew in popularity. And I didn't find that my patients responded all that significantly to it. And I'd ask them like a session or two of doing it for a while, because I learned it from her. And they'd say, I don't really feel a difference on it. So I kind of reduced my session to things that they felt they got value out of.
00:08:36
Speaker
Yeah, with that, I think it depends on the laser, right? I think there's so much variability and so many things on the market that you really have to find one that has the same parameters and
00:08:47
Speaker
in what you know has been shown to work. Yeah, yeah. So it's not a go-to for me. I don't have it in the clinic. I don't use it, but I know some people have fantastic outcomes
Effective Methods for Patient Care
00:08:56
Speaker
with it. And that's really what MOLSTIS comes down to. If you're comfortable with iStim, but not with cupping, if you don't feel like cupping is valuable or supported by research, then by all means don't use it. But if your patients are getting better because of a method that you're using, then by all means use it as long as it's not contraindicated for some other reason.
00:09:14
Speaker
Right, definitely.
Conclusion and Listener Engagement
00:09:16
Speaker
All right, so that's good for some of our different options for manual therapy things. If you guys have any questions, feel free to reach out to us at info at handtherapyacademy.com or Instagram at handtherapyacademy.