Manual Medicine / Manual Therapy Workshop in Manila on March 07, 2010

What matters is what you do with what you're given.
This is not about how good the stuff we share with you is.
This is about your ride, your experience, your application.
We humbly suggest that you make it count.

WORKSHOP DETAILS

Manual Medicine Workshop Session 3: Shoulder: Techniques and Protocols

FOR IMMEDIATE RELEASE PR Log (Press Release) – Feb 26, 2010 –

After an extremely well-received 2-session offering on Manual Therapy Treatments for the Head and Neck, the Manual Medicine Group has now opened An Invitational-only Sharing Session / Workshop on the Hands-on Treatment of Shoulder Dysfunctions, including the so-called "Frozen Shoulders." A continuation into the Intermediate Techniques for the Cervical Area will be pursued if interest and time permit. This will be a welcome bonus for avid adherents of Hands-on Pain Relief.
If you've been with them before, know that you'll get the same no-holds-barred answer-everything kind of environment among appreciative and cheering peers when you see the MMG for:

Manual Medicine Workshop Session 3: Shoulder: Techniques and Protocols /
March 07, 2010 / Pasig City, Philippines

For details and booking, practitioners are directed to
Dionne at (+63)905-4269-496
------------------------------------------------------------------------------------
"Any sufficiently advanced technology
is indistinguishable from magic."
(Arthur C. Clarke)

Manual Medicine Group Philippines Launches New Workshop For Hands-on Pain Relief
The Manual Medicine Group and the Physical Rehabilitation Unit of Truecare Medical Clinics have set a date for their 3rd Manual Therapy Workshop for 2010. The next workshop, due on March 07, 2010, will feature the latest Manual Medicine protocols.

---------------------------------------------------------------------------
Experience A Mind-Body approach to Hands-on Pain Relief
via various Manual Medicine Techniques and Technologies.
Healing For the bones / joints, nerves, muscles, the spine, the cranium, the brain, ligaments, tendons, & inter-vertebral disk.
---------------------------------------------------------------------------

Manual Medicine Group presents a Hands-on Workshop for treating the Shoulder and the Cervical Spine

FOR IMMEDIATE RELEASE
PR Log (Press Release) – Feb 26, 2010 – After an extremely well-received 2-session offering on Manual Therapy Treatments for the Head and Neck, the Manual Medicine Group has now opened An Invitational-only Sharing Session / Workshop on the Hands-on Treatment of Shoulder Dysfunctions, including the so-called "Frozen Shoulders." A continuation into the Intermediate Techniques for the Cervical Area will be pursued if interest and time permit. This will be a welcome bonus for avid adherents of Hands-on Pain Relief.
If you've been with them before, know that you'll get the same no-holds-barred answer-everything kind of environment among appreciative and cheering peers when you see the MMG for:

Manual Medicine Workshop Session 3: Shoulder: Techniques and Protocols /
March 07, 2010 / Pasig City, Philippines

For details and booking, practitioners are directed to
Dionne at (+63)905-4269-496
------------------------------------------------------------------------------------
"Any sufficiently advanced technology
is indistinguishable from magic."
(Arthur C. Clarke)

Manual Medicine Group Philippines Launches New Workshop For Hands-on Pain Relief
The Manual Medicine Group and the Physical Rehabilitation Unit of Truecare Medical Clinics have set a date for their 3rd Manual Therapy Workshop for 2010. The next workshop, due on March 07, 2010, will feature the latest Manual Medicine protocols.

---------------------------------------------------------------------------
Experience A Mind-Body approach to Hands-on Pain Relief
via various Manual Medicine Techniques and Technologies.
Healing For the bones / joints, nerves, muscles, the spine, the cranium, the brain, ligaments, tendons, & inter-vertebral disk.
---------------------------------------------------------------------------

An Invitational-only Sharing Session / Workshop on the Hands-on Treatment of Shoulder Dysfunctions, including the so-called "Frozen Shoulders"

An Invitational-only Sharing Session / Workshop on the Hands-on Treatment of Shoulder Dysfunctions, including the so-called "Frozen Shoulders"

Part Two, Time and Increased ICP permittting, we'll do
Cervical Intermediate on the same day.

March 07, 2010.
Pasig City AICA.

Contact Dionne to RSVP.

If you've been with us before, know that you'll get the same no-holds-barred answer-everything kind of environment among appreciative and cheering peers when we see you for:

Manual Medicine Workshop Session 3: Shoulder: Techniques and Protocols / March 07, 2010 / Pasig City, Philippines

Cost-sharing for This Clinical Upgrade Session:
paydate: cost
March 1: P555
March 2: p777
March 3: p888
March 4: p999
March 5: p1,200
March 6: p1,350
March 7: p1,500
March 15: p1,888 (delayed payment scheme)
March 30: p2,888 (delayed payment scheme)
Yes, we're encouraging early registration.
Yes, we'll accept Cards (Paypal).

Please bring a towel and an open mind.

"Any sufficiently advanced technology
is indistinguishable from magic."
(Arthur C. Clarke)

We'll welcome anyone. Still, Only the brave and the bold need come.

Yours in the continued Evolution of Manual Medicine,

Manual Medicine Workshop on March 07, 2010

Welcome to the Cervical 3 / Shoulder 1 MMG Session.

First off, let's review what we've learned.

1) Spaceman / Floatation Unwind, Supine. Can you imagine what it would be like to let your patient's body guide you into its own healing mode? Technique: Supine, head supported. Induction technique on Neuromyofascial Focal Progressive Unwind.
2) Mandible Disconnection from Cervical Back-bending. Biomechanics meets Proprioception. Technique: Mandible actively engaged in opening. Cervical firing isolated proprioceptively. Active attempt to open jaw without engaging cervical segment movement. Post-treatment: Isolated segment treatment via the other techniques.

March 07, 2010:
Individual Techniques:
(When was the last time you saw a workshop manual online, open for everyone’s prying eyes?)

1) Review of Basic Model: Multistacker Unwind (ever seen Eight Degrees of Freedom?), focal, vector-locking openers. Note localizing versus blocking handholds / techniques. Question to ask: “How do you…”
We reviewed this in Session 2. Now we fine-tune.

2) Cervical FB-BB in rotation, supine.
a) Cervical Rotation taken into flexion-extension cycles; active nodding; side-bending.
b) Compare with pre-harmonic patterns.
c) Technique:
i) Endrange rotation, taken into flexion and extension
ii) Supine.
d) Compare Facet opener variations and LVLA openers.

3) Epicranial Aponeurosis Release (Special Precaution: Avoid Lateral Sphenoid Wing Compression)

4) Cranial Vector Releases:
a) AP
b) Left, Right
c) Fronto-Occipital
d) Diagonals
i) Left>Right
ii) Right>Left
iii) Occipital L-R

5) Cranial-sacral dural release posterior hookup (Compare to Xiphoid-Halux Hold)

6) Posterior cervical wedging, advanced, RRDT modifications. Consider cervical stairstepping.

7) Cervical side-bending in rotation, supine
8) Masseter release, local, direct, external-internal
9) Palatal arch-basing
10) Maxillary anterior lift

--------------------------------------------------------------------------
Session I-C: Overflow (If you can still handle more Great Stuff)
March 21, 2010

Cervical Spine:
Cervical Somatic Dysfunction Findings, Diagnoses, and Documentation
Spinal Mechanics, Dynamics, and Fryette's Laws
Principles and Practice of Functional Ease Techniques and Multiplanar Ease Stacking
Localization of Eases and Restrictions at the OA and AA Joints

METs and MET variations, including
multi-planar METS
Oculocephalogyric Activation METs
Brake-response METs
QuickMETs

Myofascial Release Secrets, including:
the 'seventh plane of movement'
the 'hidden plane': torsion

Escaping the trap of the Traps: nociceptive regions with trapezius distribution reflection
Local and Nonlocal, Direct and Indirect Myofascial Releases
Articulatory Myofascial releases for the occipital / cranial base, sub-occipital area, and neck

Ignored Anatomy and Nociceptive Checkpoints for the Hypersympathetic Response

RDT basics of formulation and Parasympathetic Ablation Method I
(sub-ischemic focal antagonist compression)

The simplest thing – exercise I: a powerful neck and mind reset (the secret head rotation)

Basic NLP semantics / language and Engendering Rapport

Manual Therapy Billing for US Medicare / Tricare Coverage

Principles of Setting up at resistive endrange for Non-thrust Cavitation

Dorn Method Techniques for the Neck

Bowen Relaxation Moves for the Neck

Strain-counterstrain techniques as a mode of ease

Optional Techniques:
a) The Non-surgical Facelift
b) Upper Masseter Intra-oral
c) Maxillary Lift
d) Laryngeal anterior release
---------------------------------------------------------------------------

Wow!

Contact Dionne.

See you there!

Manual Therapy for The Cervical Region / Head-Neck-Jaw / Shoulders

Fine Tuning.

We hope to do a bit more of the following on March 07, 2010:

Evolving Outline:

Notions / Theories:
1. Conversations in Manual Medicine: Tracing vectors as a way of noticing Neuromyofascial Focal Progressive versus Full-Body Unwinding.
2. Conversations in Manual Medicine: Descriptions of the Cranial Mechanism (With opportunity for Interactive, Participant-based Sub-session)
3. The Still Point and Beyond
4. Introduction to "Brain and Beyond" Techniques.
5. Neurologic Integration:
a. How to fit in Neural “Sliders”
b. How to use Reflexes as a treatment tool (Introduction to the Reflexive De-afferentation Technique Paradigm)
6. Protocols and how to dissect and modify them: (the "Inglorious Basterds" Paradigm)
7. R.D.T. checkpoints
8. Parasympathetic Reboots
9. Identifying the Primary biomechanical pathology

How much can you handle?

How much faster do you want your patients to get the results they demand?

See you on March 07, 2010.

It'll primarily be Shoulder Session.
But let's see how much more we can fit in, shall we?

March 07, 2010. Call Dionne today.

Manual Medicine Group's "Cervical Session 2" Review

Review:

Stuff we learned on February 21, 2010 included:

1. How to use Bayliss Collapse / Engagement to determine local versus distal / compounded bony locks. Bayliss Mechanics essentially demonstrates how much of what we’ve been taught all along about spinal and bony biomechanics has been false. All of the old biomechanics has been developed on cadavers and bones. That means that all of the old material was based on false or already subluxated models. The Bayliss approach is not only novel – it is the only one that has properly demonstrated to me how subluxations in live people actually happen and can be reduced properly. How is this useful? Here’s a question: You know how a bone slips out of place without a sound? You do? Good. Now, why is it that we insist on “forcing” bones bones back into place with a sound? It’s force that produces the cavitation. Cavitation sounds are not the determinant of having reduced a subluxation properly.

2. How cervical locks differ from other subluxations.

3. The Therapeutic pulse and how to use it. The Therapeutic Pulse (Davidson, 2008) is not a pulse per se, but the combination of responses from the body which indicate that a certain approach is the proper one for the therapist to take (on the perspective that the body itself most favors this approach). The Therapeutic Pulse is determined by taking note of the Circulatory response, the Breathing response, and the Cranial Mechanism response. Other indicators, such as a Still Point (Andrew Taylor Still) or the Neuromyofascial Focal Progressive Unwind (Toledo, 2007), also contribute to the assessment of the Therapeutic Pulse.

4) Digastric release

5) Disconnecting jaw drop from cervical backward-bending

There's a lot more, yes -- but these are the ones we got the most questions on. Hope this helps.

--------------------------------------------------------------------------
See you all on March 07, 2010 at the AICA at Pasig!
We'll be doing Shoulder Stuff!

And, yes - a whole lot more.

How much good stuff can you handle?
--------------------------------------------------------------------------
Perhaps the two hardest things for humans to do, we can name:
(1.) Asking for help
(2.) Making a change

We understand. The fact that you are here tells us that:
(1.) You understand that help would be good
(2.) You understand the need to change, to adapt, to grow.

SO, if you want better results than you have been getting
and are willing to make the scary powerful changes needed
to get where you'd prefer to be,
we're here for you.

It's time to come over and see what you can do better.

Because you deserve better.

Because your patients deserve better.

And you know it.

March Seven, 2010.

See ya.

Manual Medicine Workshop Session 3: Shoulder: Techniques and Protocols / March 07, 2010 / Pasig City, Philippines

An Invitational-only Sharing Session / Workshop on the Hands-on Treatment of Shoulder Dysfunctions, including the so-called "Frozen Shoulders"

Contact Dionne to RSVP.

If you've been with us before, know that you'll get the same no-holds-barred answer-everything kind of environment among appreciative and cheering peers when we see you for:

Manual Medicine Workshop Session 3: Shoulder: Techniques and Protocols / March 07, 2010 / Pasig City, Philippines

Cost-sharing for This Clinical Upgrade Session:
paydate: cost
March 1: P555
March 2: p777
March 3: p888
March 4: p999
March 5: p1,200
March 6: p1,350
March 7: p1,500
March 15: p1,888 (delayed payment scheme)
March 30: p2,888 (delayed payment scheme)
Yes, we're encouraging early registration.
Yes, we'll accept Cards (Paypal).

Please bring a towel and an open mind.

"Any sufficiently advanced technology
is indistinguishable from magic."
(Arthur C. Clarke)

A Hands-on Approach to Eliminating Neuro-Musculo-Skeletal Pain: Updates in Manipulation Manual Medicine Workshop on February 21, 2010

Perhaps the two hardest things for humans to do, we can name:
(1.) Asking for help
(2.) Making a change

We understand. The fact that you are here tells us that:
(1.) You understand that help would be good
(2.) You understand the need to change, to adapt, to grow.

SO, if you want better results than you have been getting
and are willing to make the scary powerful changes needed
to get where you'd prefer to be,
we're here for you.

It's time to come over and see what you can do better.

Because you deserve better.

Because your patients deserve better.

And you know it.


February 21, 2010:
9:15 am to 10 am: "Updates in Manual Medicine"
Cost: FREE. Option to bring us coffee if you'd like to.
Partial Pre-session Reading Online: http://en.wikipedia.org/wiki/Muscle_energy_technique

Ideal Audience:
Practicing Manual Therapists, Doctors progressing into Soft Tissue and Neural Work.

Screening Questions:
Why do you want this?
How is this useful to you?
What would you feel if you had mastery of this?


YES! This is an invitation!

What: Manual Medicine Workshop
What’s that?: How to turn of pain (& fix body glitches) with your hands.
When: Feb 21, 2010; 10 am to 3 pm (with some leeway for the string of questions that kick in after we know enough to ask better and better questions.)
Where: AICA; at Captain Henry Javier Avenue, Skyway Twin Tower 2; Next to Valle Verde Country Club; Near Bagaberde; Pasig City, Philippines. Very near ULTRA.
We are at: http://www.aicaculinary.com
Why: Evolution is Calling. We like people. Sharing is good.
Also: We'd rather demo than debate.
Remember to RSVP!: Dionne is at (+63) 905 426 9496.

Session I-b (February 21, 2010)
Rapid-Reflexive De-afferentation Techniques
(R.D.T.) Foundation Techniques Dissected
http://en.wikipedia.org/wiki/Reflexive_antagonism
The Head, Neck, and Jaw in Focus


Evolving Outline:

Notions / Theories:
1. Conversations in Manual Medicine: Tracing vectors as a way of noticing Neuromyofascial Focal Progressive versus Full-Body Unwinding.
2. Conversations in Manual Medicine: Descriptions of the Cranial Mechanism (With opportunity for Interactive, Participant-based Sub-session)
3. How to use Bayliss Collapse / Engagement to determine local versus distal / compounded bony locks. Bayliss Mechanics essentially demonstrates how much of what we’ve been taught all along about spinal and bony biomechanics has been false. All of the old biomechanics has been developed on cadavers and bones. That means that all of the old material was based on false or already subluxated models. The Bayliss approach is not only novel – it is the only one that has properly demonstrated to me how subluxations in live people actually happen and can be reduced properly. How is this useful? Here’s a question: You know how a bone slips out of place without a sound? You do? Good. Now, why is it that we insist on “forcing” bones bones back into place with a sound? It’s force that produces the cavitation. Cavitation sounds are not the determinant of having reduced a subluxation properly.
4. How cervical locks differ from other subluxations.
5. The Therapeutic pulse and how to use it. The Therapeutic Pulse (Davidson, 2008) is not a pulse per se, but the combination of responses from the body which indicate that a certain approach is the proper one for the therapist to take (on the perspective that the body itself most favors this approach). The Therapeutic Pulse is determined by taking note of the Circulatory response, the Breathing response, and the Cranial Mechanism response. Other indicators, such as a Still Point (Andrew Taylor Still) or the Neuromyofascial Focal Progressive Unwind (Toledo, 2007), also contribute to the assessment of the Therapeutic Pulse.
6. The Still Point and Beyond
7. Introduction to "Brain and Beyond" Techniques.
8. Neurologic Integration:
a. How to fit in Neural “Sliders”
b. How to use Reflexes as a treatment tool (Introduction to the Reflexive De-afferentation Technique Paradigm)
9. Protocols and how to dissect and modify them: (the "Inglorious Basterds" Paradigm)
10. R.D.T. checkpoints
11. Parasympathetic Reboots
12. Identifying the Primary biomechanical pathology

Individual Techniques:
(When was the last time you saw a workshop manual online, open for everyone’s prying eyes?)
1) Review of Basic Model: Multistacker Unwind (ever seen Eight Degrees of Freedom?), focal, vector-locking openers. Note localizing versus blocking handholds / techniques. Question to ask: “How do you…”
2) Cervical FB-BB in rotation, supine.
a) Cervical Rotation taken into flexion-extension cycles; active nodding; side-bending.
b) Compare with pre-harmonic patterns.
c) Technique:
i) Endrange rotation, taken into flexion and extension
ii) Supine.
d) Compare Facet opener variations and LVLA openers.
3) Spaceman / Floatation Unwind, Supine. Can you imagine what it would be like to let your patient's body guide you into its own healing mode? Technique: Supine, head supported. Induction technique on Neuromyofascial Focal Progressive Unwind.
4) Mandible Disconnection from Cervical Back-bending. Biomechanics meets Proprioception. Technique: Mandible actively engaged in opening. Cervical firing isolated proprioceptively. Active attempt to open jaw without engaging cervical segment movement. Post-treatment: Isolated segment treatment via the other techniques.
5) Epicranial Aponeurosis Release (Special Precaution: Avoid Lateral Sphenoid Wing Compression)
6) Cranial Vector Releases:
a) AP
b) Left, Right
c) Fronto-Occipital
d) Diagonals
i) Left>Right
ii) Right>Left
iii) Occipital L-R
7) Cranial-sacral dural release posterior hookup (Compare to Xiphoid-Halux Hold)
8) Posterior cervical wedging, advanced, RRDT modifications. Consider cervical stairstepping.
9) Cervical side-bending in rotation, supine
10) Digastric release
11) Masseter release, local, direct, external-internal
12) Palatal arch-basing
13) Maxillary anterior lift
14) Galea aponeurosis & aponeurotic releases
15) Disconnecting jaw drop from cervical backward-bending
--------------------------------------------------------------------------
Session I-C:
March 21, 2010

Cervical Spine:
Cervical Somatic Dysfunction Findings, Diagnoses, and Documentation
Spinal Mechanics, Dynamics, and Fryette's Laws
Principles and Practice of Functional Ease Techniques and Multiplanar Ease Stacking
Localization of Eases and Restrictions at the OA and AA Joints

METs and MET variations, including
multi-planar METS
Oculocephalogyric Activation METs
Brake-response METs
QuickMETs

Myofascial Release Secrets, including:
the 'seventh plane of movement'
the 'hidden plane': torsion

Escaping the trap of the Traps: nociceptive regions with trapezius distribution reflection
Local and Nonlocal, Direct and Indirect Myofascial Releases
Articulatory Myofascial releases for the occipital / cranial base, sub-occipital area, and neck

Ignored Anatomy and Nociceptive Checkpoints for the Hypersympathetic Response

RDT basics of formulation and Parasympathetic Ablation Method I
(sub-ischemic focal antagonist compression)

The simplest thing – exercise I: a powerful neck and mind reset (the secret head rotation)

Basic NLP semantics / language and Engendering Rapport

Manual Therapy Billing for US Medicare / Tricare Coverage

Principles of Setting up at resistive endrange for Non-thrust Cavitation

Dorn Method Techniques for the Neck

Bowen Relaxation Moves for the Neck

Strain-counterstrain techniques as a mode of ease

Optional Techniques:
a) The Non-surgical Facelift
b) Upper Masseter Intra-oral
c) Maxillary Lift
d) Laryngeal anterior release

--------------------------------------------------------------------------

Cost-sharing for this Practice Upgrade Investment:
For those who register / commit to participate during the
February 21, 2010 Seminar-Workshop
Manual Medicine: Going Beyond Cervical Treatments
An Introduction to Scope, Synthesis
And Clinical Bases of Reflexive De-afferentation Techniques
(An Overview of Manual Medicine Techniques)

The following cutoff dates and corresponding fees apply:
Date of registration: cost share:
Up to December 29, 2009: P500
Up to January 31, 2009: P555
Up to February 07, 2010: P777
Up to February 14, 2010: P888
February 15 onward: P1,200
On-site: P1,555

If you think we should really charge what we think this material is worth, please bring a few hundred dollars so we can get really good food for the workshop!

Regret that free slots are already taken.

Here’s the deal, though:
If you bring in 4 new registrants, we’ll count you in for the incredibly low price of ABSOLUTELY FREE!

Yes, we are essentially rewarding (1) early commitment and (2) a sharing of this evolving technology.

Ideal Audience:
Practicing Manual Therapists,
Doctors progressing into Soft Tissue and Neural Work.


WHERE IS EVERYONE'S REGISTRATION DATA?
To confirm registration, please leave a note with your nearest coordinator, to be forwarded to Dionne with your coordinator's endorsement, with the following data:
1. Your name, designation, institution, position occupied or maintained
2. A brief statement declaring why you're attending
3. The names of your two study-buddies
4. A brief list of what you already know, what you're certified to practice, and what you have mastery of.

WE RESERVE THE RIGHT TO TURN AWAY ANYONE WHO DOES NOT COMPLY WITH THIS REQUEST. This also lets us free us your seat to others who are raring to join us. Did we mention we overbooked early?

P.S., we truly are sorry. While certificates will be issued, if you are merely looking for a piece of paper to stuff your portfolio or crowd your wall with, please offer your slot to any colleague you believe will more benefit from this. Your understanding with regard this matter is much appreciated.

ATTIRE:
Please come in either loose, comfortable clothing (anything easily removable is preferred) or in thin, body hugging clothing (no neoprene dive suits or Gortex body armor).


EQUIPMENT:
Please bring a large towel. One neuro hammer per group would be useful. One goniometer per group would be great. Those who prefer to bring along an anatomy atlas will be most welcome to do so. One skin marker or eyeliner pen per group may prove useful. One small, thin, long towel (Barbero towel) would be useful as well. A skin marker or eyeliner per group would be very useful for newbies.


SUGGESTED WORKSHOP FORMAT:

Preferably, three people will be assigned per group / table / plinth. They will alternate roles: patient, practitioner, and preceptor. This enables each participant to see each technique twice in their own time. Corrections and adaptations may be incorporated during each second demo.

Group numbers will be assigned. Each group will rotate a member at the main demo table at the front of the class at the start of each new technique demo. That group's two other members come closest to the main table to observe and ask questions re each new technique. This enables each group of three to become the resource persons for at least one technique. They can then proceed to master that technique and pass it on. They are thus encouraged to learn each technique they are decked to a degree worthy of peer review and learning. One or more groups may thus, over time, pass their mastered technique onto others. This will also engender a collaboration between colleagues (and perhaps between institutions), who may choose to meet to master each other's sets in between workshops. They are encouraged to pass on well-mastered techniques to uninitiated colleagues.

As in life, these are mere suggestions. (They do, however, make the ride much more worthwhile.)


The Point:
We would suggest as a personal Goal for everyone (on top of their own goals) after proper completion of this session:
Be able to Treat headaches in minutes (sometimes in seconds!)

This is a call to our Colleagues, almost a plea.

I heard a German Quote last year which translates roughly to:
"How you shout into the forest
Determines the echo you get."

So we shout: Help us evolve this healing field.

"There are no problems we cannot solve together,
And very few that we can solve ourselves."
(Lyndon Johnson, Former US President)

I think it was the hockey sensation Wayne Gretzky that said:
"Invariably, The Goals I never make are those I never take."

Why not Do in minutes what others do in sessions or follow-up days?!


NOTE that Content of proposed Session I-b above may change at any time, without prior notice, and may be modified by how many participants are present, and how much good coffee we've had.

Yes, that's a hint! Bring coffee. Bring food. (We’re at the A.I.C.A. this time)
Bring more coffee.

Many already understand that this is valuable information we're sharing. The techniques themselves are, in practice, invaluable.

Still, some people do not value what comes free. Yes, we know you're not like that. You know what we mean. So they are also most welcome to register late. And anyone who registered early is still most welcome to bring enough pizza for a baranggay. Or coffee. Or both. My cat likes Whiskas Ocean Fish Flavor. Yes, she asked me to tell you that. The rest of this post is very serious.

You now know how to use the Therapeutic Pulse.
Next up: How do you maximize that gift?

GUARANTEED RESULTS!
Simple, straight, no-B.S. 100% Refund Money-back Guarantee:
Take the techniques you get from this into the clinics, into your patient's homes.
If you don't make up your money in professional fees from using at least one of the techniques here, we'll refund your money.
Experiment. Try it for eighty days. Use it! Prove us wrong! If, in that time, you have not recovered your costs because the techniques have not worked (one possible reason: whatever you DO NOT TRY does NOT WORK. Laziness voids offer.)
Next, if you have ANY technology that works better, faster for any of the indications we overlap technologies with, we'll refund your money, and pay you to show us what you have!

P.S.:
If this Challenge feels rude,
Who is it that's reacting?
If you have any resistance to this,
Why is that?

Ever notice how peak moments and life-changing events can be scary right before you get a grip on them?


(Per request, this is now starting to look like a manual! That's a hint, colleagues! Anyone want to volunteer to have their name printed as a co-author on a manual?)

One of the best ways we know of
to get out of a rut
is amazingly simple:
ASK GOOD QUESTIONS.
So,
here's a little attempt at that.

Have you ever walked away from a workshop remembering nothing?
Have you ever walked away from a workshop with a bunch of techniques and no idea how they all fit?
Are you regularly using techniques from the last few workshops you've been to?
Have you ever wanted to design your own workshop?
If you could do things better, what would you do?

It's happened to us, so we're asking.
And now we're asking you.
Help us do this better.
Help us so this works for you.

Paraphrased from the Late Pope John Paul II:
"This is one way,
not necessarily
THE way."

WHAT IS YOUR WAY, and where does it lead?

May you be blessed abundantly in every way.


One of the best lessons We've ever gotten from Neurolinguistic Programming sums up as:
"Emulate someone who is getting the results that you want to have."

Perhaps that's why we keep seeking out the best of the best in the field of Hands-on Pain control.

Also, while perched on the shoulders of the giants in our field,
The perspective is amazing.


See you at the Sessions!

Yours in the Evolution of Manual Medicine,

Strix

Definition of Terms related to Osteopathic Manual Medicine Techniques

The intent here is to increase the open-sourcing of OMT terminology so that newbies are better able to concentrate on technique learning.

Glossary of Osteopathic Terminology
Prepared by the Educational Council on Osteopathic Principles (ECOP) of the American Association of Colleges of Osteopathic Medicine
(AACOM).
July 2006 Revision, ©2006 The Educational Council on Osteopathic Principles and the American Association of Colleges of Osteopathic Medicine

A
abbreviations: types of osteopathic
manipulative treatment.

ART: articulatory treatment
BLT: balanced ligamentous tension treatment
CR: osteopathy in the cranial field
CS: counterstrain treatment
D: direct treatment
DIR: direct treatment
FPR: facilitated positional release treatment
HVLA: high velocity/low amplitude treatment
I: indirect treatment
IND: indirect treatment
INR: integrated neuromusculoskeletal release treatment
LAS: ligamentous articular strain treatment
ME: muscle energy treatment
MFR: myofascial release treatment
NMM-OMM: neuromusculoskeletal medicine
OCF: osteopathy in the cranial field/cranial treatment
OMTh: osteopathic manipulative therapy (non-US terminology)
OMT: osteopathic manipulative treatment
PINS: progressive inhibition of neuromuscular structures
ST: soft tissue treatment
VIS: visceral manipulative treatment
accessory joint motions: See reference to "secondary joint motion."
accessory movements: Movements used to potentiate, accentuate, or
compensate for an impairment in a physiologic motion (e.g., the movements needed to move a paralyzed limb).

To start off the general terminology Glossary:
accommodation: A self-reversing and nonpersistent adaptation.
active motion: See motion, active.
acute somatic dysfunction: See somatic dysfunction, acute.
allopathy: 1. A therapeutic system in which a disease is treated by producing a second condition that is incompatible with or antagonistic to the first.(Stedman’s)
allopath: A term used to refer those holding a Doctor of Medicine (MD) degree, a non-osteopathic medical degree.
anatomical barrier: See barrier, (motion barrier)

Manual Medicine Workshop / Sharing Session: February 21, 2010 CERVICAL AND BEYOND

February 21, 2010:
9:15 am to 10 am: "Updates in Manual Medicine"
Cost: FREE. Option to bring us coffee if you'd like to.
Partial Pre-session Reading Online: http://en.wikipedia.org/wiki/Muscle_energy_technique

Ideal Audience:
Practicing Manual Therapists, Doctors progressing into Soft Tissue and Neural Work.

YES! This is an invitation!

What: Manual Medicine Workshop
What’s that?: How to turn of pain (& fix body glitches) with your hands.
When: Feb 21, 2010; 10 am to 3 pm (with some leeway for the string of questions that kick in after we know enough to ask better and better questions.)
Where: AICA; at Captain Henry Javier Avenue, Skyway Twin Tower 2; Next to Valle Verde Country Club; Near Bagaberde; Pasig City, Philippines. Very near ULTRA.
We are at: http://www.aicaculinary.com
Why: Evolution is Calling. We like people. Sharing is good.
Also: We'd rather demo than debate.
Remember to RSVP!: Dionne is at (+63) 905 426 9496.

Session I-b (February 21, 2010)
Rapid-Reflexive De-afferentation Techniques
(R.D.T.) Foundation Techniques Dissected
http://en.wikipedia.org/wiki/Reflexive_antagonism
The Head, Neck, and Jaw in Focus


Evolving Outline:

Notions / Theories:
1. Conversations in Manual Medicine: Tracing vectors as a way of noticing Neuromyofascial Focal Progressive versus Full-Body Unwinding.
2. Conversations in Manual Medicine: Descriptions of the Cranial Mechanism (With opportunity for Interactive, Participant-based Sub-session)
3. How to use Bayliss Collapse / Engagement to determine local versus distal / compounded bony locks. Bayliss Mechanics essentially demonstrates how much of what we’ve been taught all along about spinal and bony biomechanics has been false. All of the old biomechanics has been developed on cadavers and bones. That means that all of the old material was based on false or already subluxated models. The Bayliss approach is not only novel – it is the only one that has properly demonstrated to me how subluxations in live people actually happen and can be reduced properly. How is this useful? Here’s a question: You know how a bone slips out of place without a sound? You do? Good. Now, why is it that we insist on “forcing” bones bones back into place with a sound? It’s force that produces the cavitation. Cavitation sounds are not the determinant of having reduced a subluxation properly.
4. How cervical locks differ from other subluxations.
5. The Therapeutic pulse and how to use it. The Therapeutic Pulse (Davidson, 2008) is not a pulse per se, but the combination of responses from the body which indicate that a certain approach is the proper one for the therapist to take (on the perspective that the body itself most favors this approach). The Therapeutic Pulse is determined by taking note of the Circulatory response, the Breathing response, and the Cranial Mechanism response. Other indicators, such as a Still Point (Andrew Taylor Still) or the Neuromyofascial Focal Progressive Unwind (Toledo, 2007), also contribute to the assessment of the Therapeutic Pulse.
6. The Still Point and Beyond
7. Introduction to "Brain and Beyond" Techniques.
8. Neurologic Integration:
a. How to fit in Neural “Sliders”
b. How to use Reflexes as a treatment tool (Introduction to the Reflexive De-afferentation Technique Paradigm)
9. Protocols and how to dissect and modify them: (the "Inglorious Basterds" Paradigm)
10. R.D.T. checkpoints
11. Parasympathetic Reboots
12. Identifying the Primary biomechanical pathology

Individual Techniques:
(When was the last time you saw a workshop manual online, open for everyone’s prying eyes?)
1) Review of Basic Model: Multistacker Unwind (ever seen Eight Degrees of Freedom?), focal, vector-locking openers. Note localizing versus blocking handholds / techniques. Question to ask: “How do you…”
2) Cervical FB-BB in rotation, supine.
a) Cervical Rotation taken into flexion-extension cycles; active nodding; side-bending.
b) Compare with pre-harmonic patterns.
c) Technique:
i) Endrange rotation, taken into flexion and extension
ii) Supine.
d) Compare Facet opener variations and LVLA openers.
3) Spaceman / Floatation Unwind, Supine. Can you imagine what it would be like to let your patient's body guide you into its own healing mode? Technique: Supine, head supported. Induction technique on Neuromyofascial Focal Progressive Unwind.
4) Mandible Disconnection from Cervical Back-bending. Biomechanics meets Proprioception. Technique: Mandible actively engaged in opening. Cervical firing isolated proprioceptively. Active attempt to open jaw without engaging cervical segment movement. Post-treatment: Isolated segment treatment via the other techniques.
5) Epicranial Aponeurosis Release (Special Precaution: Avoid Lateral Sphenoid Wing Compression)
6) Cranial Vector Releases:
a) AP
b) Left, Right
c) Fronto-Occipital
d) Diagonals
i) Left>Right
ii) Right>Left
iii) Occipital L-R
7) Cranial-sacral dural release posterior hookup (Compare to Xiphoid-Halux Hold)
8) Posterior cervical wedging, advanced, RRDT modifications. Consider cervical stairstepping.
9) Cervical side-bending in rotation, supine
10) Digastric release
11) Masseter release, local, direct, external-internal
12) Palatal arch-basing
13) Maxillary anterior lift
14) Galea aponeurosis & aponeurotic releases
15) Disconnecting jaw drop from cervical backward-bending

Session I-C: Optional Techniques:
a) The Non-surgical Facelift
b) Upper Masseter Intra-oral
c) Maxillary Lift
d) Laryngeal anterior release

Cost-sharing for this Practice Upgrade Investment:
For those who register / commit to participate during the
February 21, 2010 Seminar-Workshop
Manual Medicine: Going Beyond Cervical Treatments
An Introduction to Scope, Synthesis
And Clinical Bases of Reflexive De-afferentation Techniques
(An Overview of Manual Medicine Techniques)

The following cutoff dates and corresponding fees apply:
Date of registration: cost share:
Up to December 29, 2009: P500
Up to January 31, 2009: P555
Up to February 07, 2010: P777
Up to February 14, 2010: P888
February 15 onward: P1,200
On-site: P1,555

If you think we should really charge what we think this material is worth, please bring a few hundred dollars so we can get really good food for the workshop!

Regret that free slots are already taken.

Here’s the deal, though:
If you bring in 4 new registrants, we’ll count you in for the incredibly low price of ABSOLUTELY FREE!

Yes, we are essentially rewarding (1) early commitment and (2) a sharing of this evolving technology.

Ideal Audience:
Practicing Manual Therapists,
Doctors progressing into Soft Tissue and Neural Work.


WHERE IS EVERYONE'S REGISTRATION DATA?
To confirm registration, please leave a note with your nearest coordinator, to be forwarded to Dionne with your coordinator's endorsement, with the following data:
1. Your name, designation, institution, position occupied or maintained
2. A brief statement declaring why you're attending
3. The names of your two study-buddies
4. A brief list of what you already know, what you're certified to practice, and what you have mastery of.

WE RESERVE THE RIGHT TO TURN AWAY ANYONE WHO DOES NOT COMPLY WITH THIS REQUEST. This also lets us free us your seat to others who are raring to join us. Did we mention we overbooked early?

P.S., we truly are sorry. While certificates will be issued, if you are merely looking for a piece of paper to stuff your portfolio or crowd your wall with, please offer your slot to any colleague you believe will more benefit from this. Your understanding with regard this matter is much appreciated.

ATTIRE:
Please come in either loose, comfortable clothing (anything easily removable is preferred) or in thin, body hugging clothing (no neoprene dive suits or Gortex body armor).


EQUIPMENT:
Please bring a large towel. One neuro hammer per group would be useful. One goniometer per group would be great. Those who prefer to bring along an anatomy atlas will be most welcome to do so. One skin marker or eyeliner pen per group may prove useful. One small, thin, long towel (Barbero towel) would be useful as well. A skin marker or eyeliner per group would be very useful for newbies.


SUGGESTED WORKSHOP FORMAT:

Preferably, three people will be assigned per group / table / plinth. They will alternate roles: patient, practitioner, and preceptor. This enables each participant to see each technique twice in their own time. Corrections and adaptations may be incorporated during each second demo.

Group numbers will be assigned. Each group will rotate a member at the main demo table at the front of the class at the start of each new technique demo. That group's two other members come closest to the main table to observe and ask questions re each new technique. This enables each group of three to become the resource persons for at least one technique. They can then proceed to master that technique and pass it on. They are thus encouraged to learn each technique they are decked to a degree worthy of peer review and learning. One or more groups may thus, over time, pass their mastered technique onto others. This will also engender a collaboration between colleagues (and perhaps between institutions), who may choose to meet to master each other's sets in between workshops. They are encouraged to pass on well-mastered techniques to uninitiated colleagues.

As in life, these are mere suggestions. (They do, however, make the ride much more worthwhile.)


The Point:
We would suggest as a personal Goal for everyone (on top of their own goals) after proper completion of this session:
Be able to Treat headaches in minutes (sometimes in seconds!)

This is a call to our Colleagues, almost a plea.

I heard a German Quote last year which translates roughly to:
"How you shout into the forest
Determines the echo you get."

So we shout: Help us evolve this healing field.

"There are no problems we cannot solve together,
And very few that we can solve ourselves."
(Lyndon Johnson, Former US President)

I think it was the hockey sensation Wayne Gretzky that said:
"Invariably, The Goals I never make are those I never take."

Why not Do in minutes what others do in sessions or follow-up days?!


NOTE that Content of proposed Session I-b above may change at any time, without prior notice, and may be modified by how many participants are present, and how much good coffee we've had.

Yes, that's a hint! Bring coffee. Bring food. (We’re at the A.I.C.A. this time)
Bring more coffee.

Many already understand that this is valuable information we're sharing. The techniques themselves are, in practice, invaluable.

Still, some people do not value what comes free. Yes, we know you're not like that. You know what we mean. So they are also most welcome to register late. And anyone who registered early is still most welcome to bring enough pizza for a baranggay. Or coffee. Or both. My cat likes Whiskas Ocean Fish Flavor. Yes, she asked me to tell you that. The rest of this post is very serious.

You now know how to use the Therapeutic Pulse.
Next up: How do you maximize that gift?

GUARANTEED RESULTS!
Simple, straight, no-B.S. 100% Refund Money-back Guarantee:
Take the techniques you get from this into the clinics, into your patient's homes.
If you don't make up your money in professional fees from using at least one of the techniques here, we'll refund your money.
Experiment. Try it for eighty days. Use it! Prove us wrong! If, in that time, you have not recovered your costs because the techniques have not worked (one possible reason: whatever you DO NOT TRY does NOT WORK. Laziness voids offer.)
Next, if you have ANY technology that works better, faster for any of the indications we overlap technologies with, we'll refund your money, and pay you to show us what you have!

P.S.:
If this Challenge feels rude,
Who is it that's reacting?
If you have any resistance to this,
Why is that?

Ever notice how peak moments and life-changing events can be scary right before you get a grip on them?


(Per request, this is now starting to look like a manual! That's a hint, colleagues! Anyone want to volunteer to have their name printed as a co-author on a manual?)


One of the best ways we know of
to get out of a rut
is amazingly simple:
ASK GOOD QUESTIONS.
So,
here's a little attempt at that.

Have you ever walked away from a workshop remembering nothing?
Have you ever walked away from a workshop with a bunch of techniques and no idea how they all fit?
Are you regularly using techniques from the last few workshops you've been to?
Have you ever wanted to design your own workshop?
If you could do things better, what would you do?

It's happened to us, so we're asking.
And now we're asking you.
Help us do this better.
Help us so this works for you.


Paraphrased from the Late Pope John Paul II:
"This is one way,
not necessarily
THE way."

WHAT IS YOUR WAY, and where does it lead?


May you be blessed abundantly in every way.

See you at the Sessions.

Yours in the Evolution of Manual Medicine,

Strix

application of manual therapy and supervised exercise adds greater symptomatic relief for osteoarthritis of the knee

Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program
Submitted September 30, 2004; Accepted May 18, 2005

from: PHYS THER Vol. 85, No. 12, December 2005, pp. 1301-1317

Abstract:
Background and Purpose. Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteo-arthritis (OA) of the knee. The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinically based physical therapy program. Subjects. One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinic treatment group (n=66; 61% female, 39% male; mean age [±SD]=64±10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [±SD]=62±9 years). Methods. Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. Discussion and Conclusion. Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.


Key Words: Exercise • Knee Osteoarthritis • Manual therapy • Physical therapy

Gail D Deyle, Stephen C Allison, Robert L Matekel, Michael G Ryder, John M Stang, David D Gohdes, Jeremy P Hutton, Nancy E Henderson and Matthew B Garber
GD Deyle, PT, DPT, is Assistant Professor and Graduate Program Director, Rocky Mountain University of Health Professions, Provo, Utah; Assistant Professor, Baylor University, Waco, Tex; and Senior Faculty, US Army–Baylor University Post Professional Doctoral Program in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, San Antonio, Tex
SC Allison, PT, PhD, is Professor, Rocky Mountain University of Health Professions, and Adjunct Professor of Physical Therapy Education, Elon University, Elon, NC
RL Matekel, PT, DScPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Madigan Army Medical Center, Ft Lewis, Wash
MG Ryder, PT, DScPT, is Major, Army Medical Specialist Corps, and Officer-in-Charge, Primary Care Physical Therapy, Brooke Army Medical Center, Ft Sam Houston, Tex
JM Stang, PT, DScPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Ireland Army Community Hospital, Ft Knox, Ky
DD Gohdes, PT, MPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Assistant Chief, Physical Therapy, Tripler Army Medical Center, Tripler AMC, Hawaii
JP Hutton, PT, MPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Eisenhower Army Medical Center, Ft Gordon, Ga
NE Henderson, PT, PhD, is Physical Therapist, Steilacoom, Wash
MB Garber, PT, DScPT, is Major, Army Medical Specialist Corps, and Assistant Chief, Physical Therapy, Brooke Army Medical Center

Address all correspondence to Dr Deyle at 3 Sherborne Wood, San Antonio, TX 78218-1771 (USA) (gdeyle@satx.rr.com)

Effect of Manual Medicine on Movement Disorders

It's really funny that, after years of seeing significant on-the-spot improvments for Parkinson's ambulatory difficulties, I only now found a journal article demonstrating that someone else figured out how to do the same thing long before I ever did. This is both humbling and reassuring.

Standard osteopathic manipulative treatment acutely improves gait performance in patients with Parkinson's disease
MR Wells, S Giantinoto, D D'Agate, RD Areman, EA Fazzini, D Dowling, and A Bosak


Patients with Parkinson's disease exhibit a variety of motor deficits which can ultimately result in complete disability. The primary objective of this study was to quantitatively evaluate the effect of osteopathic manipulative treatment (OMT) on the gait of patients with Parkinson's disease. Ten patients with idiopathic Parkinson's disease and a group of eight age-matched normal control subjects were subjected to an analysis of gait before and after a single session of an OMT protocol. A separate group of 10 patients with Parkinson's disease was given a sham-control procedure and tested in the same manner. In the treated group of patients with Parkinson's disease, statistically significant increases were observed in stride length, cadence, and the maximum velocities of upper and lower extremities after treatment. There were no significant differences observed in the control groups. The data demonstrate that a single session of an OMT protocol has an immediate impact on Parkinsonian gait. Osteopathic manipulation may be an effective physical treatment method in the management of movement deficits in patients with Parkinson's disease.

from the Journal of the American Osteopathic Association, Vol 99, Issue 2, 92-92; Copyright © 1999 by American Osteopathic Association

A Protocol for Research into the Effects of Manual Medicine on Chronic Tension Headaches

Study protocol
Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial
René F Castien1 , Daniëlle AWM van der Windt2,3 , Joost Dekker2,5 , Bert Mutsaers4 and Anneke Grooten1

1 Healthcare Center Haarlemmermeer, Hoofddorp, the Netherlands

2 EMGO Institute, VU-University Medical Center, Amsterdam, the Netherlands

3 Primary Care Musculoskeletal Research Centre, Keele University, Keele, Newcastle-under-Lyme, Staffordshire, UK

4 Avans Hogeschool, Breda, the Netherlands

5 Department of Rehabilitation Medicine, VU-University Medical Center, Amsterdam, the Netherlands

author email corresponding author email

BMC Musculoskeletal Disorders 2009, 10:21doi:10.1186/1471-2474-10-21

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2474/10/21

Received: 14 May 2008
Accepted: 12 February 2009
Published: 12 February 2009

© 2009 Castien et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background
Patients with Chronic Tension Type Headache (CTTH) report functional and emotional impairments (loss of workdays, sleep disturbances, emotional well-being) and are at risk for overuse of medication. Manual therapy may improve symptoms through mobilisation of the spine, correction of posture, and training of cervical muscles.

We present the design of a randomised clinical trial (RCT) evaluating the effectiveness of manual therapy (MT) compared to usual care by the general practitioner (GP) in patients with CTTH.

Methods and design
Patients are eligible for participation if they present in general practice with CTTH according to the classification of the International Headache Society (IHS).

Participants are randomised to either usual GP care according to the national Dutch general practice guidelines for headache, or manual therapy, consisting of mobilisations (high- and low velocity techniques), exercise therapy for the cervical and thoracic spine and postural correction. The primary outcome measures are the number of headache days and use of medication. Secondary outcome measures are severity of headache, functional status, sickness absence, use of other healthcare resources, active cervical range of motion, algometry, endurance of the neckflexor muscles and head posture. Follow-up assessments are conducted after 8 and 26 weeks.

Discussion
This is a pragmatic trial in which interventions are offered as they are carried out in everyday practice. This increases generalisability of results, but blinding of patients, GPs and therapists is not possible.

The results of this trial will contribute to clinical decision making of the GP regarding referral to manual therapy in patients with chronic tension headache.

Background
The 1-year prevalence of Chronic Tension-Type Headache (CTTH) is about 2–5% in the general population. In half of the CTTH cases, headache-related impairment in work performance is reported. [1,2] In addition to considerable impact on daily functioning and work participation, CTTH is a risk factor for overuse of analgesic medication [3]. Only about 20% of the CTTH patients seek medical care for their headache. This low consultation rate may be explained by insufficient information on the effectiveness of treatments or by previous negative health care experiences.[1,4]

In primary care treatment for patients with CTTH is often provided by the general practitioner (GP). The Dutch national general practice guideline for the management of headache describes diagnostic and therapeutic algorithms, consisting mainly of reassurance, lifestyle advice and medication.[5] The effectiveness of this guideline for patients with CTTH has not been investigated.

The pathogenesis of CTTH remains unclear. Pathophysiological theories considering central and peripheral pain mechanisms are described and have been discussed in the literature. [6] In recent research a correlation between CTTH and impairment of the cranio-cervical musculoskeletal function (forward head position, trigger points trapezius muscle, neck mobility) has been demonstrated [7-10] In combination with results obtained in previous studies the present data support the hypothesis that improvement of the cranio-cervical musculoskeletal function by a manual therapy intervention (postural correction, mobilisation cervical spine, and training of cervical muscles) may be an important factor to modify central or peripheral pain mechanism in CTTH. [11-15]

Three randomized clinical trials have investigated the effectiveness of manual therapy in patients with CTTH and reported benificial effects.[16-18]. However, because of variation in inclusion criteria, treatment techniques (high-, low velocity mobilization, exercises, traction), and small sample sizes there is insufficient evidence to support the use of manual therapy in the treatment of CTTH. Well-designed clinical trials are recommended to provide more substantial evidence for the effectiveness of manual therapy. [19,20]

Design
We aim to conduct a pragmatic, multicentre, randomised clinical trial, assessing the effectiveness of manual therapy (MT) compared to usual GP care in patients with CTTH. We have used the guidelines of the International Headache Society (IHS) for the design of randomised clinical trials for headache to develop the randomisation procedure, outcome measurements and statistical analysis.[21] The procedures and design of this study are approved by the Medical Ethics Committee of the VU University Medical Center in Amsterdam, The Netherlands. (Trial registration number TR 1074)

Study population
Participating primary healthcare centers and GPs in an urban area in the Netherlands, will invite patients with headache to participate in the trial.

Patients between 18 and 65 years of age are invited if they have CTTH according to the classification of headaches of the IHS [22]: headache occuring on at least 15 days on average per month for a period of more than 3 months (≥ 180 days a year) and lasts for hours or may be continuous. The headache has at least one of the following characteristics: 1. bilateral location, 2. pressing/tightening (non pulsating) quality, 3. mild or moderate intensity, not aggravated by normal physical activities such as walking or climbing stairs; and both of the following: 1. no more than one of photofobia, phonophobia or mild nausea, and 2. neither moderate or severe nausea nor vomiting. Participants should be able to read and write Dutch.

Exclusion criteria include reumatoid arthritis, suspected malignancy, pregnancy, intake of either triptans, ergotamines or opioids on ≥ 10 days/month or simple analgesics on ≥ 15 days/month on a regular basis for ≥ 3 months, and having received manual therapy treatment in the 2 months before enrolment into the study.

After the GP has seen a patient with CTTH the patient receives an information letter about the trial. If the patient is willing to participate after reading the information he or she can contact the research centre. A researcher will screen interested patients by telephone and make an appointment to check inclusion and exclusion criteria, and complete the informed consent procedure. After written informed consent has been obtained, the baseline measurement is carried out. The design of the trial is explained in Figure 1.

Figure 1. Flow chart, representing the design of the trial on Chronic Tension Type Headache (CTTH).
.Baseline assessment
Table 1 shows the outcome measures and the time points at which they are assessed. At baseline we will collect additional information on demographic variables including age, gender, date of birth, education and occupation. The patient will also be asked to score expectations regarding the effectiveness of treatment on a 7-point rating scale (no result at all to very good result). In a standardised history taking procedure including the two-week headache-diary, the diagnosis of CTTH according to the diagnostic criteria of the IHS guideline will be confirmed.[22]

Table 1. Summary of data collection.
.Randomisation
Randomisation will take place after baseline measurement by the research assistant. Before the start of the trial a random sequence has been composed using computer-generated random numbers. Allocation is carried out by the research assistant who has not been informed about the random sequence, by giving the patient a numbered and sealed envelope.

The patient will open the envelope in the presence of another independent administrative assistant, who will subsequently make an appointment for the first treatment session either by the patient's own GP, or by one of the participating manual therapists.

Blinding
GPs and manual therapists cannot be blinded for treatment allocation, but will not be informed about the results of outcome measurements. The research assistant is kept blind for the patient's treatment allocation.

Data collection and administration will by carried out by an independent data assistent. The researcher is involved in the statistical analysis, but the analysis and interpretation of the findings will be audited and verified by an independent statistician.

GP intervention
Patients will be treated by the GP according to the national clinical guideline for the management of headache [5]. According to this guideline the GP will provide information, reassurance and advice and will discuss the benefits of lifestyle changes. If necessary, GPs may prescribe analgesics or non- steroid anti-inflammatory drugs (NSAID) or change current pain medication.

Manual Therapy intervention
MT treatment will include a combination of mobilisation of the cervical and thoracic spine, exercises and postural correction based on the management of cervicogenic headache. [23] Spinal mobilisations will consist of low and/or high-velocity cervical and thoracic joint mobilization and manipulation techniques. Therapeutic exercises consist of low-load craniocervical muscle endurance exercises and correction of sitting and standing posture. The participating MT's are registrated MT's and member of the national association of manual therapists. They have an average experience of 10 years as manual therapist and have completed the McKenzie B-course on the cervical spine. In two meetings the MTs have been trained in the treatment protocol, they have received a manual and patient-booklets with home exercises.

Depending on the patient's condition the MT can decide what type of techniques and exercises will be selected from the protocol. The MT will make a report of the treatment modalities used in each session.

The MT intervention is restricted to a maximum of 9 sessions (each 30 minutes) in 8 weeks after randomisation.

Primary outcome measures
The follow-up measurements will take place by a blinded research assistant immediately after the 8 weeks treatment period and after 26 weeks (long term follow-up). Two weeks before each measurement the patients receive and complete a two-week headache diary. The primary outcome measures are 1) the frequency of days with headache, and 2) use of pain medication (no. of doses NSAIDs or simple analgesics). Registration over a two week period is considered to be sufficient.[24]

Secondary outcome measures
The secondary outcome measures include:

* Headache pain intensity measured on a 10 point numerical rating scale (0 = no pain, 10 = most severe pain).

* The impact of headache on daily life will be scored by the patient using the Headache Disability Inventory (HDI) and the Headache Impact Test-6 (Hit-6). The HDI includes 25 questions on physical and emotional functioning with three possible response options: no = 0 points, sometimes = 2 points, yes = 4 points. A total score is computed by summating all scores, resulting in an individual HDI score ranging from 0 (no disability) to 100 (severe disability). A decrease in the total HDI of ≥ 16 points is considered to be a significant improvement. The test-retest reliability of the total score has been shown to be adequate (Pearson r 0.76 for 1 week; r = 0.83 for 6 weeks) [25]

* The Headache Impact Test (HIT-6) consists of 6 items (pain intensity, social functioning, role functioning, vitality, cognitive functioning and psychological distress) each with 5 response options; never: 6 points, rarely: 8 points, sometimes: 10 points, very often: 11 points, always: 13 points, with a total score ranging from 36 to 78 points. Internal consistency (Cronbach alpha: 0.89) and test-retest reliability (ICC ranging from 0.78 to 0.90) have been demonstrated to be good.[26] The HIT-6 is able to differentiate between mild, moderate and severe headache. A between-group difference in HIT 6 change score of 2.3 points over time among patients with chronic daily headache reflects improvement in headache that may be considered to be clinically significant. [27]

* The active range of movement in flexion, extension, right and left rotation and right and left lateroflexion of the cervical spine with the patient in a seated position will be measured by the research assistant with the CROM-device. The intra- and intertester reliability have been shown to be good (ICC. > 0.80). [28]

* Algometry on the trapezius descendens and the suboccipital muscle will be performed with a Wagner FDK algometer with a 3.0 kg/cm pressure at four points at the left and right side: two points on the upper trapezius muscle and two points on the suboccipital muscle. Patients will rate the severity of pain on a 0–10 point NRS scale (0 = no pain, 10 most severe pain). Scores for each pressure point will be summated into a total score ranging between 0 and 80 points. Mechanical pressure algometry has been described by several authors as a valid measurement for pain pressure treshold for the trapezius muscle and has a good to excellent intertester- (ICC 0.70–0.91), intratester reliability (ICC 0.84–0.88) and a intra-individual coefficient of variation of 18.5% at 1 week test-retest. [29-31]

* Endurance of the neck flexor muscles will be scored as the number of seconds the patient can raise his head from the table when lying on his/her back. In a study of the neckflexor endurance test among subjects without neck pain Harris et al. reported good to excellent intratester reliability (ICC 0.82–0.91) and moderate intertester reliability (ICC 0.67–0.78).[32]

* A lateral digital picture with a digital HP R707.5 camera will be taken in a seated and standing position to measure the craniocervical angle. Recently van Niekerk et al. evaluated the criterion validity of photographic measurement compared with a digital radiographic device (LODOX) for assessing the craniocervical angle in sitting position among high school students (Pearson r 0.89).[33] The reliability of photographic measurement of the craniocervical angle has been reported to be good in two studies(ICC >0.86). [33,34]

* Additional use of health care resources (including GP, psychologist, physiotherapist, acupuncture) will be reported by the patient at 26 week follow-up by completing a checklist. The patient will also be asked to report perceived improvement following treatment on a 7 point scale. (0 = much worse to 6 = much better).

Sample size
In a pilot study the 2 weeks headache diary showed an average of 11 days with headache in both treatment groups at baseline. After 8 weeks the frequency of days with headache in the GP group was reduced to 7 days, in the MT group to 3 days. In the full trial we aim to detect a difference in reduction of at least 3 days (SD 5) between both groups. To detect this difference with a one-sided significance level of 0.05, and power of 0.80 we have to include at least 35 patients in each treatment group. The participants in the pilot study reported taking on average 2 doses of NSAID or analgesics per 2 weeks. With a sample size of 35 patients per group we can detect a difference of at least 0.5 (SD 0.8) doses per 2 weeks between the groups. With a calculated loss of participants in the full trial of 15%, this trial attempts to enroll forty-two patients with CTTH in each treatment groups (GP, MT).

Statistical analysis
Baseline comparability will be investigated by descriptive statistics to examine whether randomisation was successful. For each patient, the change between baseline and follow-up will be calculated for all primary and secondary outcome measures. The statistical analysis will be performed according to the intention-to-treat principle.

Between group differences and 95% confidence intervals will be calculated, and tested using the Student t-test in case of normal distributions. Non paramaratric testing will be used for non-normal distributions. In addition, a per-protocol analysis will be performed, analysing only those patients with no serious protocol deviations. Comparing the results of the intention-to-treat and the per-protocol analysis will indicate if and to what extent protocol deviations might have influenced the results. Multivariate regression analysis will be conducted to examine the potential influence of differences in baseline characteristics on outcome.

If results on primary outcomes show normal distributions we will compute effect sizes (standardised mean differences) as the mean difference between groups over the pooled standard deviation. Effect sizes will be rates as follows: small (0.2–0.5), medium (0.5–0.8) or large (>0.8).

Feasibility of the study design
A pilot study was conduced between June 2006 and December 2006 to evaluate the feasibility of the measurements, randomisation-procedure and treatment protocols (33). The recruitment of participants for this pilot-study took place in two primary health-care centers in The Netherlands. A total of 20 patients were randomised to either the GP or the MT intervention group. Thirty-one patients who had a strong preference for the manual therapy intervention and could not be randomised were asked to participate in a parallel cohort-study. In this study similar baseline and follow up measurements were conducted.

The results of the pilot study showed that the procedures were feasible. The research-assistants, general practitioners and manual therapists reported having no problems to adhere to the guidelines and protocols for measurements and treatment. In order to include a total of 80 patients over a period of one year, 32 GPs and 4 MTs have been recruited to participate in the full trial.

Discussion
We have described the design of a RCT to evaluate the effectiveness manual therapy compared to GP usual care for patients with CTTH. Both approaches are commonly used: most GPs will consult recommendations by the national clinical guideline when managing patients with headache. The manual therapy intervention is based on a treatment protocol developed in consensus with the participating MTs, and consists of commonly used mobilisation techniques and exercises. This pragmatic design will increase the external validity of the results of this trial. The MT treatment is assumed to improve cervical and thoracic spine movement and function, leading to a decrease in the frequency of headache-days. The education and exercise-training in this program is focused on self-mangement and postural correction, and aims for a sustained long-term effect. Although van Ettekoven et al [34] reported beneficial effects of a craniocervical training program for patients with CTTH, it still remains unclear what mechanisms may explain these effects. Measurement of the neckflexor muscle endurance, active range of motion of the cervical spine and the craniocervical angle in our study will provide more information on assumed processes during treatment.

This trial has a few limitations. The first limitation is the limited possibilities for blinding. Double blinding procedures in a pragmatic study cannot be obtained, and it is not possible to blind the participating GPs, MTs and patients for intervention. We do hope to reduce the risk of information bias by using standardised procedures and assessment by a blinded research assistant. The second limitation of this pragmatic trial concerns the difference in time spent on the patients' treatment by the GP and MT. It is unclear to what extent this time-factor will attribute to the overall effect of manual therapy.

Inclusion of a sufficient number of eligible patients for the RCT will be the most difficult element of this study. Rasmussen et al described a low consultation rate in patients with CTTH: only twenty percent will consult their GP [4]. The GPs will have to identify these patients during office hours and inform them about the trial. This method of recruitment has been reported to be associated with low recruitment rates.[35] In order to optimize the inclusion of patients the GPs and healthcare centers receive 'newsletters' and visits from the researcher on a regular basis to obtain the full participation in the trial.

The pilot study demonstrated a preference for manual therapy in the majority of patients. For patients who do not consent to randomisation we will conduct a parellel cohort-study alongside the trial to monitor outcome this group of patients. Expectations regarding the result of treatment will be asked for all participants in both trial and cohort, in order to estimate the potential influence of these expectations on outcome.

To publish an article of a study design has some advantages. Publication bias can be prevented whereby only studies producing positive results are more likely to be published.[36] It also offers an opportunity to reflect critically on the study design, independently of the results.

In this trial we will evaluate and compare two treatment protocols (GP, MT) that reflect 'usual care' for patients with CTTH. Therefore, the results of this pragmatic trial will contribute to clinical decision making by the GP in patients with CTTH, providing information on the potential benefits of a referral for manual therapy in primary care in the Netherlands.

Competing interests
The authors declare that they have no competing interests.

Authors' contributions
RC wrote the manuscript. Critical revision of the manuscript and contribution to the study design and statistical analyses by DvdW, JD and BM. RC, DvdW, JD and AG participate in the coordination of the study. All authors read and approved the final manuscript.

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Pre-publication history
The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2474/10/21/prepub

Shatter This False Belief and Be Free

Any form of measuring yourself
by the unkind action of another towards you
is like looking into a badly fractured mirror...
and then blaming yourself
for the shattered image you see therein.
(Guy Finley)

Trivia: Did you know that the blue whale has no natural predators?


There can sadly be too much back-bashing in the medical and paramedical professions, so i hope that the quote above just helps those who are still affected by that crap.

Our smallest suggestion at the moment? Walk on and let it slide.

If you grow large enough, even the toughest predators leave you alone.
Even the most magnificent predatory dinosaurs died out.

Why not just go, grow, evolve?

--------------------------------------------------------------------------
"Find it, fix it, and leave it alone.
But make sure you find it, make sure you fix it,
before you leave it alone!!"
-Dr. Andrew Taylor Still
--------------------------------------------------------------------------
Yours in the Evolution of Manual Medicine,

Manipulation Quotes

“Good health and good sense are two of life's greatest blessings. “
Maxim 827 – Publius Syrus (42 B.C.)

“Health is the vital principle of bliss,
And exercise, of health.”
The Castle of Indolence. Canto ii. Stanza 55. – James Thomson (1700-1748)

”For every chiropractor, there is an equal and opposite chiropractor.”—from an American DC who preferred to stay anonymous.

"The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease." --Thomas Edison

"As to disease, make a habit of two things - to help, or at least to do no harm."--Hippocrates

"If we cannot heal in one way, we must learn to heal in another." --Sherwin B. Nuland

"Men may doubt what you say, but they will believe what you do." --Lewis Cass

"Conventional wisdom can often be defined as the shared ignorance of the chattering class." --Unknown

"Great spirits have always encountered violent opposition from mediocre minds." --Albert Einstein

"When the minds of the people are closed and wisdom is locked out they remain tied to disease." -- Ch'i Po

"The enemy to any science is a closed mind." --Mohamed Hatta Abu Bakar, HMD

"The art of medicine consists in amusing the patient while nature cures the disease." --Voltaire

"More can be learned from what works than what fails." --Rene Dubos

"You cannot teach a man anything, you can only help him to find it within himself." --Galileo

These were lifted from the book "Dissecting Chiropractic" by Strix Toledo

Manual Medicine Workshop / Sharing Session: "CERVICAL & BEYOND" February 21, 2010

YES! This is an invitation!

First off, depending on whether Dionne approves of the idea, we hope to have a 40-minute freebie on February 21, 2010:
9:15 am to 10 am: "Updates in Manual Medicine"
Cost: FREE. Option to bring us coffee if you'd like to.
Partial Advanced Reading Online: http://en.wikipedia.org/wiki/Muscle_energy_technique

After that we continue with what we like best:
What: Manual Medicine Workshop (a Sharing Session)
What the f.... is that?:
How to turn of pain & fix body glitches with your hands.
When: Feb 21, 2010; 10 am to 3 pm, with some leeway for the string of questions that kick in after we know enough to ask better and better questions.
Where: Pasig City, Philippines. AICA at Captain Henry Javier Avenue, Skyway Twin Tower 2. Pasig City, Philippines. Next to Valle Verde Country Club. Near Bagaberde. We are at: http://www.aicaculinary.com
Why: Evolution is calling. We like people. Sharing is good.
Also: We'd rather demo than debate.
Remember to RSVP!: Dionne is at (+63) 905 426 9496.

Ideal Audience:
Practicing Manual Therapists, Doctors progressing into Soft Tissue and Neural Work.


"There are no problems we cannot solve together,
And very few that we can solve ourselves."
(Lyndon Johnson, Former US President)

This is a call to our Colleagues, almost a plea.

I heard a German Quote last year which translates roughly to:
"How you shout into the forest
Determines the echo you get."

So we shout: Help us evolve this healing field.

I think it was the hockey sensation Wayne Gretzky that said:
"Invariably, The Goals I never make are those I never take."

Why not do in minutes what others do in sessions or follow-up days?!

Session I-b (February 21, 2010)
Rapid-Reflexive De-afferentation Techniques:
(R.D.T.) Foundation Techniques Dissected
Tech Base: Neuromyofascial, Muscle-Energy Techniques, Positional Releases.
The Head, Neck, and Jaw in Focus

Advanced Reading: http://en.wikipedia.org/wiki/Muscle_energy_technique

The Point:
We would suggest as a personal Goal for everyone (on top of their own goals) after proper completion of this session: Be able to treat headaches in minutes (sometimes in seconds!)

Evolving Outline:

Notions / Theories:
1. How to use Bayliss Collapse / Engagement to determine local versus distal / compounded bony locks.
2. How cervical locks differ from other subluxations.
3. The Therapeutic pulse and how to use it.
4. Tracing vectors as a way of noticing Neuromyofascial Full-Body Unwinding.
5. Descriptions of the Cranial Mechanism (Interactive, Participant-based Sub-session)
6. Introduction to "Brain and Beyond" Techniques.
7. Neurologic Integration:
How to fit in Neural Sliders
How to use Reflexes as a treatment tool (Introduction to the Reflexive De-afferentation Technique Paradigm)
8. Protocols and how to dissect and modify them: (the "Inglorious Basterds" Paradigm)
9. RDT checkpoints
10. Parasympathetic Reboots
11. The Still Point and Beyond
12. Identifying the primary biomechanical pathology

Individual Techniques:
1. Cervical Rotation taken into flexion-extension cycles; active nodding; side-bending. Compare with pre-harmonic patterns.
2. Spaceman / Floatation Unwind, Supine. Can you imagine what it would be like to let your patient's body guide you into its own healing mode?
3. Mandible Disconnection from Cervical Back-bending. Biomechanics meets Proprioception.
4. The Non-surgical Facelift
5. Upper Masseter Intra-oral
6. Maxillary Lift
7. Epicranial Aponeurosis Release (CI: lateral Sphenoid Wing Compression)
8. Cranial Vector Releases:
AP
L,R
Fronto-Occipital
Diagonals L>R, R>L
Occipital L-R
9. Cranial-sacral dural release posterior hookup
10. Posterior cervical wedging, advanced, RRDT modifications
11. Cervical FB-BB in rotation, supine; Facet opener variations and LVLA openers
12. Cervical side-bending in rotation, supine
13. Multistack unwind (ever seen Eight Degrees of Freedom?), focal, vector-locking openers
14. Digastric release
15. Masseter release, local, direct, external-internal
16. Palatal arch-basing
17. Maxillary anterior lift
18. Galea aponeurosis & aponeurotic releases
19. Disconnecting jaw drop from cervical backward-bending
20. Laryngeal anterior release

NOTE that Content of proposed Session I-b above may change at any time, without prior notice, and may be modified by how many participants are present, and how much good coffee we've had.
Yes, that's a hint! Bring coffee. Bring food. (We’re at the A.I.C.A. this time)
Bring more coffee.

Cost-sharing for this Practice Upgrade Investment:
For those who register / commit to participate during the
February 21, 2010 Seminar-Workshop
Manual Medicine: Going Beyond Cervical Treatments
An Introduction to Scope, Synthesis
And Clinical Bases of Reflexive De-afferentation Techniques
(An Overview of Manual Medicine Techniques)

The following cutoff dates and corresponding fees apply:
Date of registration: cost share:
Up to December 29, 2009: P500 (closed, thank you)
Up to January 31, 2009: P555 (closed, thank you)
Up to February 07, 2010: P777 (closed, thank you)
Up to February 14, 2010: P888 (Slots limited. Book now or forever hold your peace.)
February 15 onward: P1,200
On-site: P1,555
And if you think we should really charge what we think this material is worth, please bring a few hundred dollars so we can get really good food for the workshop!
Regret that free slots are already taken.
Here’s the deal, though:
If you bring in 4 new registrants, we’ll count you in for the incredibly low price of ABSOLUTELY FREE!
Yes, we are essentially rewarding (1) early commitment and (2) a sharing of this evolving technology.
Many already understand that this is valuable information we're sharing. The techniques themselves are, in practice, invaluable.
Still, some people do not value what comes free. Yes, we know you're not like that. You know what we mean. So they are also most welcome to register late. And anyone who registered early is still most welcome to bring enough pizza for a baranggay. Or coffee. Or both. My cat likes Whiskas Ocean Fish Flavor. Yes, she asked me to tell you that. The rest of this post is very serious.

You now know how to use the Therapeutic Pulse.
Next up: How do you maximize that gift?

GUARANTEED RESULTS!
Simple, straight, no-B.S. 100% Refund Money-back Guarantee:
Take the techniques you get from this into the clinics, into your patient's homes.
If you don't make up your money in professional fees from using at least one of the techniques here, we'll refund your money.
Experiment. Try it for eighty days. Use it! Prove us wrong! If, in that time, you have not recovered your costs because the techniques have not worked (one possible reason: whatever you DO NOT TRY does NOT WORK. Laziness voids offer.)
Next, if you have ANY technology that works better, faster for any of the indications we overlap technologies with, we'll refund your money, and pay you to show us what you have!

P.S.:
If this Challenge feels rude,
Who is it that's reacting?
If you have any resistance to this,
Why is that?

Ever notice how peak moments and life-changing events can be scary right before you get a grip on them?


WHERE IS EVERYONE'S REGISTRATION DATA?
To confirm registration, please leave a note with your nearest coordinator, to be forwarded to Dionne with your coordinator's endorsement, with the following data:
1. Your name, designation, institution, position occupied or maintained
2. A brief statement declaring why you're attending
3. The names of your two study-buddies
4. A brief list of what you already know, what you're certified to practice, and what you have mastery of.
WE RESERVE THE RIGHT TO TURN AWAY ANYONE WHO DOES NOT COMPLY WITH THIS REQUEST. This also lets us free us your seat to others who are raring to join us. Did we mention we overbooked early?
P.S., We truly are sorry. ["I am sorry."(Philippine political figure)] While certificates will be issued, if you are merely looking for a piece of paper to stuff your portfolio or crowd your wall with, please offer your slot to any colleague you believe will more benefit from this. Your understanding with regard this matter is much appreciated.


ATTIRE:
Please come in either loose, comfortable clothing (anything easily removable is preferred) or in thin, body hugging clothing (no neoprene dive suits or Gortex body armor).


EQUIPMENT:

Please bring a large towel. One neuro hammer per group would be useful. One goniometer per group would be great. Those who prefer to bring along an anatomy atlas will be most welcome to do so. One skin marker or eyeliner pen per group may prove useful. One small, thin, long towel (Barbero towel) would be useful as well. A skin marker or eyeliner per group would be very useful for newbies.


SUGGESTED WORKSHOP FORMAT:

Preferably, three people will be assigned per group / table / plinth. They will alternate roles: patient, practitioner, and preceptor. This enables each participant to see each technique twice in their own time. Corrections and adaptations may be incorporated during each second demo.

Group numbers will be assigned. Each group will rotate a member at the main demo table at the front of the class at the start of each new technique demo. That group's two other members come closest to the main table to observe and ask questions re each new technique. This enables each group of three to become the resource persons for at least one technique. They can then proceed to master that technique and pass it on. They are thus encouraged to learn each technique they are decked to a degree worthy of peer review and learning. One or more groups may thus, over time, pass their mastered technique onto others. This will also engender a collaboration between colleagues (and perhaps between institutions), who may choose to meet to master each other's sets in between workshops. They are encouraged to pass on well-mastered techniques to uninitiated colleagues.

As in life, these are mere suggestions. (They do, however, make the ride much more worthwhile.)


(Per request, this is now starting to look like a manual! That's a hint, colleagues! Anyone want to volunteer to have their name printed as a co-author on a manual?)


One of the best ways we know of
to get out of a rut
is amazingly simple:
ASK GOOD QUESTIONS.
So,
Here’s a little attempt at that.

Have you ever walked away from a workshop remembering nothing?
Have you ever walked away from a workshop with a bunch of techniques and no idea how they all fit?
Are you regularly using techniques from the last few workshops you've been to?
Have you ever wanted to design your own workshop?
If you could do things better, what would you do?

It's happened to us, so we're asking.
And now we're asking you.
Help us do this better.
Help us so this works for you.



Paraphrased from the Late Pope John Paul II:
"This is one way,
not necessarily
THE way."

WHAT IS YOUR WAY, and where does it lead?


May you be blessed abundantly in every way.

See you at the Sessions.

Yours in the Evolution of Manual Medicine,