I’m sure every therapist has experience of these Magic Tricks! Whether you’ve done them yourself or observed them on courses. The seemingly miraculous happens and it is one hell of a rush when it does 🙂
Had 2 of these involving shoulders in the last couple of weeks.
Magic trick 1!
I was treating a significant shoulder fracture that had settled well and was being treated conservatively. Treatment had gone well and progress in some areas was actually way ahead of schedule. However, as is often the case, there are stubborn clinical signs that were starting to frustrate me! In this case it was abduction. Lying on the treatment table passive FROM was easy and unrestricted. However, in function the movement was severely restricted.
In function shoulder abduction was compensated from 40* and limited to about 80*. All my traditional manual therapy skills and all my functional exercise and FMR strategies had no impact. It’s hard to say exactly why I tried the next strategy, but something told me it was what the shoulder wanted. In standing I abducted the shoulder through full FROM, repeated about 10 times and then asked the patient to try AROM…MAGIC…full pain free range!!
I have my theories as to why this might occur, but they are just that…theories! I was keen to see how well it carried over from one week to the next, turns out pretty good!! about 90% carryover and after another session was FROM and stayed that way!
Magic Trick 2
The second one was more predictable, I’ve had a fair few of these over the years and I love it!! When I hear the history, do my assessment and then feel like saying….watch this!! Obviously, I don’t do that, but I know that in a few minutes shoulder motion that is currently restricted and painful will be full and pain free…and it will stay!!
The give away signs for me are…it’s an old injury that will have well healed by now, function is good, but ultimately limited and painful and when you watch them move you see a very distinct pattern in the scapula-humeral rhythm. It’s sad to say that my eyes light up when I see it…but I’m a geek and I like helping people.
The strategy for this was is a simple FMR for the shoulder in the planes of dysfunction. When you are hands on you can feel when the desired effect has happened. You get a very palpable change in shoulder mechanics.
On re-testing it is both blinding obvious that the shoulder now has full ROM and also the pain…gone!! It’s lush and I never get tired of seeing it happen. It’s sometimes hard to tell whether it’s me that’s more excited or the patient!!
Why does this Happen??
Like I said it is only a theory, so I can’t prove it in any way. I can say with a fair degree of certainty that I’m not really creating any physiological change, I don’t really believe that I am ‘breaking down’ scar tissue or anything like that.
I believe the secret to these massive and sudden changes lie almost entirely in the nervous system. Maybe partly down to what the brain will allow you to do, maybe simply showing the movement is possible in a different way removes the fear (conscious and sub-conscious??). Maybe it’s breaking down the movement pattern and allowing a new pattern to be established.
I appreciate that this is a lot of maybes!! But I’m not sure anyone knows for sure. All I know is it works and it has helped a lot of people over ht years!!
Would love to hear your thoughts and your experiences with Magic Tricks 🙂
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