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In my courses we address a # of common questions that we all face –
- When would I know to prescribe a specific exercise or should we follow a one size fits all philosophy?
- Every exercise is a test – why?
- When should I do manual therapy or utilize modalities?
- When should we “go hard or go home”?
- How do I tell when a persistent pain client has a primarily functional issue vs yellow flag belief as their “key link”?
Our FPM Lab Immersion Experiences are designed to teach both the basic skills of a Training/Rehab-based practice & to focus on Clinical Problem Solving / Programming. Often a traditional PT/DC/DO uses Stab, manual therapy, Butler or McKenzie approaches & fails to see the full value in resistance training or self-management. Often a trainer becomes a “corrective exercise specialist” & forgets how vital strength & power are. These principles are similar for a movement specialist who is a trainer as one who is a clinician. Quality not quantity is our goal. Competency before capacity. Failure tolerance not policing perfection. And, load management not biomechanics alone since “it’s not the load that breaks you down, but the load you’re not prepared for.”
“Doctors have always recognized that every patient is unique, and doctors have always tried to tailor their treatments as best they can to individuals.”
– President Obama, January 30, 2015
The functional approach is not a cookbook. Instead the focus is on Clinical Reasoning Skills & problem solving. The profile precedes the program. Today this is being re-branded as Precision Medicine. “Until now, most medical treatments have been designed for the “average patient.” As a result of this “one-size-fits-all” approach, treatments can be very successful for some patients but not for others. Precision Medicine, on the other hand, is an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles.”
I learned this from Karel Lewit who referred to Pr. Janda as the original & himself as a thief!
I first met Lewit in June 1986 and Janda the following year. When I visited Prague in 1990 I was amazed at how Karel consistently was able to find the source of his patient’s pain and remove it by restoring function to a “key” tissue – joint, muscle, fascia, or skin.
It was a systematic process, but not a cookbook. He examined his patients then formed a clinical hypothesis about a key dysfunction that he felt was correlated w/ their symptoms. To test his hypothesis he made an intervention & checked baseline activity intolerances over time for progress.
Dr Lewit wrote, “…psychological factors play a great role, as motor patterns are to a certain degree expressions of the state of mind: anxiety, depression and an inability to relax…. no less important is the subject’s psychological attitude to pain…”
The approach taught in FPM courses is derived from Dr Lewit’s. It is called the Clinical Audit Process & now is updated as the Debrief . With the Prague School approach you will learn to go beyond the palpatory signs of a trigger point or passive ROM impairment, to identify in all your patients the key functional pathology of the motor system or Yellow Flag belief.
The key outcome or goal of care is to improve the client’s activity intolerances or lived experience. In session baseline mechanical sensitivities (the movement which reproduces their characteristic symptoms) should also improve over time.
The means to this end is to find the key yellow flag fragilista belief, load management issue, &/or baseline functional capacity deficit.
Our good is to connect the dots from our client’s story to a relatable plan. De-sensitizing then creating an environment for adaptation. Finally transferring that adaptation to successful participation in valued life activities.
The beauty of this paradigm is that the “key link”, training & therapy can be manual therapy, resistance training &/or self-management.
The CLIENT-CENTERED approach is always customized to the person’s goals and is never a cookbook-generic solution. Our goal is to give people confidence they can succeed – Self-Efficacy. To do this we avoid promising to “fix” things or trying to “police perfection”. We guide by the side & play the role of Alfred more than Batman.
Our job as neuromusculoskeletal experts is to find the Functional Diagnosis or the GAP between a client’s CURRENT CAPACITY & their REQUIRED CAPACITY or DEMANDS. As Lewit says “the methods should serve the goals”.
In the FPM programs we teach a wide variety of invaluable methods – cognitive-functional training, motivational interviewing, movement prep, GPP. But, we don’t teach technique seminars since instead of relying on a cookbook you want to learn a principle-based template process. (see Lewit’s recent paper Lessons for the Future).
I will never forget the gift that Karel Lewit & Vladimir Janda gave us of programming & clinical reasoning. Their conviction in the Functional Approach & your client’s lived experience as a North Star to guide us is what seperates what we do from those who focus on structural pathology or just the site of symptoms (e.g. pain generator). Our gift to our clients is that we can support their pursuit of getting back to activity & return to participation. We don’t say it’s “wear & tear” learn to live with it or we’ll fix it. We say you can adapt its “wear & repair”.
Instead of irreversible structural pathologies or hardware issues (broken parts) we focus on the bodies software which is always reversible. This validates your client’s lived experience and story while giving them hope through our behavioral experiments leading to a positive experience with movement.
The FPM paradigm follows a scientific framework, that does not make us a prisoner of protocols. As we learn more about the resilience process our clients become less reactive. As Dr Lewit taught the sustainable model focuses on function not symptoms because “he who treats the site of pain is lost.”
This is an exciting time to learn how to become a benchmark, “cutting edge” expert in the musculoskeletal space. Each of you are black belts in the many different arts of training & treating the locomotor system – strength & conditioning; chiropractic; soft tissue therapy, acupuncture, PT modalities, etc.. We each can learn from one another. I am extremely happy to bring my Problem-Solving courses around the globe and I hope that you can beat the drum so PT, DO, ATC, S & C, & DC colleagues can develop mastery in the client-centered, functional approach to the locomotor system.
See you soon!
Craig
Comments:
Geez Craig, after such an eloquent explanation, it’s all I can do to not repeat both modules of the course! I’d love to read the linked Lewit papers but they’re password protected. I’ll see you in Seattle.
For those readers who haven’t checked out these MSC modules let me give 2 thumbs up after my experience with MSC 1 and 2. Dr. Liebenson has synthesized his 25 years of personal study with the heads of the Prague school and McGill’s evidence into a clear, coherent, cogent, clinical practice model. You’ll walk away with practical tools that can be used on Monday morning in your clinics. If the Prague school info is new to you, prepare to be totally rocked. If you’ve been exposed through classes in school, prepare to have your tools honed so that you can cut through the pain-chasing paradigm and get to truly fixing things. Be a better clinician, get better outcomes, set yourself apart in your community as an innovator. Cheers!
