By: Veronica Wong
On Oct 27-28, Dr. Liebenson held a seminar in Toronto (Continuum of Care – From Head to Toe) hosted by MSK+. His bio can be found here. -DW
I attended Dr. Craig Liebenson’s seminar weekends ago with David Wu and Kenneth Lo, as representatives of the Waterloo branch of Rehab 2 Performance. The seminar emphasized the importance of bridging the gap between rehabilitation, athletic development, and ultimately, performance. It was inspirational to meet other highly motivated students and clinicians.
The three big principles stood out:
1) The power of providing active care first
In his practice, Dr. Liebenson shared that active care is always provided first, followed by passive care (manual therapy) as a catalyst for rehab. Providing active care (self-performed exercises) first shows the patient that they have the power to fix themselves.
This empowerment means greater adherence to the prescribed between-session exercises since they have already been proven effective (through the Clinical Audit Process, see below). Rather than seeing their chiropractor or PT as “Mr. Fix-It”, patients are more likely to see them as a coach or teacher to guide them towards living an active and pain-free lifestyle.
But I am not convinced that active care should always be provided first. From observation of other clinicians, I’ve seen that starting with passive care may be able to get you to your goals faster and more effectively.
David Wu frequently mentions during R2P meetings, we start out as completely mobile babies. Putting our feet into our mouths is no problem. We later earn the right to crawl, walk, and run as we gain stability.
Passive care may be a faster method, when done properly, to gain some passive mobility back; active care could then be used to get active mobility so that we learn to use our new-found range of motion.
Though I’m no a clinician yet, I’m glad to be exposed to this new the idea of doing active care first!
Dr. Liebenson coaching active-care exercise
2) Guarding after injury is normal
After an acute injury, like as a sprained ankle, the brain will tell the muscles to go into a stiff, guarded position to limit the use of the injured ankle. The problem happens when the tissues heal but this “muscle memory” persists so that they are constantly stiff.
In these cases, stretching/mobilizing will not be the solution. The guarding should be reduced by letting the brain know that the tissues are no longer in danger and release its hold on the muscle.
That’s another reason to use active care first: by giving the patient a challenging movement that they can do successfully without pain, the threat levels in their brain is lowered.
However, I’m unsure how to determine whether someone is immobile due to post-injury guarding and not due to other reasons. This is important to know in order to determine the appropriate treatment.
3) Clinical audit process
There are three steps to the CAP that should be done for any new assessments:
Dr. Jason W. Brown (R2P co-ordinator) put it brilliantly simple as this
1. Find out what hurts (i.e. the painful dysfunction)
2. Find out what you suck at (i.e. non-painful dysfunction)
– The seminar emphasized poor movement patterns but can be applied generally to tissue quality as well
3. Find a tool that will improve 2 and then re-check if 1 has improved
– Tools include corrective exercises, manual therapy, acupuncture, etc
Lastly, here are a few quotes during the presentation that I found myself nodding along with and should be applied to any field of work:
“As to methods, there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble.”
– Ralph Waldo Emerson
“I am always aware of how many things which I taught in my long past have since been proved wrong. The most important attitude is therefore to be constantly aware that what you are doing and teaching now you will have to modify and correct in view of new facts. Thus you must keep an open mind for new knowledge, even if it sometimes shows that what you believed and taught before was wrong.”
– Karel Lewit
Be sure to check out other great seminars hosted by MSK+. To learn more about Dr. Craig Liebenson, visit his site: http://www.craigliebenson.com/
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Veronica Wong is a chemical engineering student at the University of Waterloo who’s planning on going to physical therapy school. First exposed to strength and conditioning through the Waterloo Parkour club, she has been an active member of the Warriors Strength and Conditioning Club since Spring 2011.
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