Technique < Knowledge

For about a decade, I read all of the research surrounding the McKenzie Method, also known as Mechanical Diagnosis and Therapy.

I felt confident in seeing a patient on the first day and being able to discern, from the details of the history and movement exam, what was happening regarding the person’s pain experience.

This could only be done through an MDT lens. I couldn’t treat post-surgical patients well because protocols weren’t my cup of tea. Protocols required little thought and I believed that a πŸ’ could do that type of treatment.

I couldn’t do chronic pain because I didn’t feel comfortable not having an answer to the questions.

All these years later, I’ve become better versed in treating patients with chronic pain, stinkin thinkin, poor health and post-surgical.

The problem was never in the patient, but instead in how I perceived the patient and subsequent treatment.

Having spent hundreds of hours learning about these types of patient presentations, I feel that I can relatively effortlessly slip from MDT classification to a pain based classification, and do all of this within a protocol if it is required.

Spending time in the trenches to learn your craft will allow you to use many different weapons of choice when enacting you’re craft.

Courage to act

Image: Kaufman SF. The Martial artist’s Book of Five Rings: The Definitive Interpretation of Miyamoto Musashi’s Classic Book of Strategy

This holds true in many forms.

I will continue to relate these quotes to those passions that I have such as Physical Therapy.

In the field of physical therapy, it is not uncommon to be asked/told to perform unethical and illegal acts.

As an employee, one has a decision to make:

1. Do said unethical/illegal activity, make my boss happy and possibly lose my professional license

2. Don’t do said unethical activity, go against the corporate line to protect my license and run the risk of losing my job.

You can see how this plays out in a day to day world if you work in healthcare.

I’ve met many that don’t understand the rules of the insurance that they are billing and therefore have no issues doing the company’s bidding because…they don’t know any better.

Once they know better, then it becomes an ethical dilemma. The job keeps food on the table and a roof over the head. Does anyone really want to risk that?

Many don’t and unethical and illegal activities continue to happen.

Every once in a while, someone speaks up and decides that they won’t toe the line.

This decision takes a couple of forms.

1. The employee flat out says no and that he/she won’t compromise integrity

2. The person goes to a higher authority and informs them of what is actually happening in the clinic.

Here is an example of the second example.

If you are a patient, know that these decisions are being made behind closed doors.

As a PT, do you have the “courage” to “act”?

Ankle strength

Some people have lost strength in the ankle due to a litany of issues such as:

Nerve damage

Muscle strain

Shin splints

Ankle fracture


Getting a stronger ankle joint doesn’t have to be complicated.

Some people have the ability to get stronger, but others may not have that ability.

Check with a licensed professional to see if the nerves are working properly before starting a structured exercise program for the ankle.

This is a basic exercise and is intended for general education.

Great teachers build students to be great

Image: Kaufman SF. The Martial artist’s Book of Five Rings: The Definitive Interpretation of Miyamoto Musashi’s Classic Book of Strategy

I have had many students over the course of my career as a PT.

It is not hidden that I practice with a base of MDT (Mechanical Diagnosis and Therapy). This is the base from which I begin every new patient evaluation. It allows me to keep information in an order that makes sense to me and keeps me thinking systematically.

When I take students, I don’t dictate how they practice. I want for them to learn about what is their passion within this profession.

Everyone has to follow his/her own dreams and goals.

I frequently get students that ask me how did I get to where I am at in this profession.

I tell them about reading textbooks, thousands of pages, two to three times in order to understand the words. The students go from feeling great about the energy that I bring and the mentoring and teaching that I have done through the clinical to telling me that they don’t think they can do it.


You do you. Don’t try to do the things I’ve done in my career. Becoming better at anything takes work. I can feed you my information and this can put you a little further in your quest for information, but you will never own the information in the same way that I own the information. It takes time and work to own the topics.

I only hope that the students can take from me an inspiration that this profession has a lot to offer. Each professional could be great at any one niche AND there would still be enough information, topics, niches for everyone to be great at something.

In the end, the responsibility is on the person…the student.

It is not on the teacher, for the teacher has already paved his/her own way.

The student must choose the path and forge forward.

What path have you taken as a student…professional?

Training for game day…everyday

Image: Kaufman SF. The Martial artist’s Book of Five Rings: The Definitive Interpretation of Miyamoto Musashi’s Classic Book of Strategy

There is so much to unpack here.

First, don’t do as I do because you may have different goals than I.

When I worked at Sams Club, I could have two conversations: gym stuff and Sams stuff. I was so single minded. I would go to school in undergrad and read Ironmind, Flex, Powerlifting USA and books by authors such as the great Mel Siff, Mike Menzter, Fred Hatfield and others.

I wanted to make myself better at the things I enjoyed and school was just something I had to do in order to eventually make money.

I became employee of the year at Sams Club in 2003 and quit the same year to go work at a gym making half that money and to start PT school.

Once in PT school, I still devoted my time to learning about lifting. I went deeper into methodologies and theories of exercise.

Once I graduated from PT school, I devoted all of my free time to becoming a better physical therapist. I want to be the best (warrior) at this craft (physical therapy) that I could attain.

This is not necessarily healthy. I want to start by saying this because it’s been told to me my entire career.

I studied research between sets at the gym. I read textbooks multiple times over. I sacrificed personal relationships to become better…I won’t even say good, but better than the day before.

I’m glad I put all of that time in during those first ten years.

This does not conform to the thought of work-life balance. Again, I’ve heard this my entire career.

When looking at balance, it has to be what makes you happy. Not everyone has the same definition of happiness. When I go to work, I’m sure my patients are grateful that I sacrificed a decade of my life to get better at my craft. When I believe in something I give it my attention. In giving it my attention, I give my time. In giving my time, I am giving my life.

I understand that not everyone is devoted to their craft, but I would hope those depending on that craft can see the difference between those who do and those who don’t.

Guard your ears

Patients want to know why they hurt. πŸ€·β€β™‚οΈπŸ€”πŸ™

They want to know what we can do to help them get rid of their pain to get back to life. πŸŒˆβ˜€οΈ

They want to know that movement is safe. β€οΈπŸ‘Š

They want to know that nothing serious is wrong. 🚩

How many healthcare practitioners are answering the first one with a definitive answer of β€œxyz” is why your experiencing pain


then goes on to put limitations on the patient


tells the patient that it will take 3X/week for 4-8 weeks in order to get better πŸ’΅πŸ’Έ



There are many factors that can have a role in pain that for me to give you a single answer may do more harm than good.

I will tell you possibilities and we can have a discussion of how you think these possibilities ply a role in your symptoms, but even then we will not narrow it down to a specific tissue.

What we won’t do is

1. Increase your fear of movement

2. Create a restriction to specific movements without a timeline to reintroduce movements.

3. Overtreat you because we have created a fear of movement, taken away your mobility and then told you that you need to see me for 36 sessions.

If you are spending any money on your health care, don’t you want to see the person that keeps you for fewer visits, listens to your complaints, comes up with solutions to your issues and has a heart of a teacher.

Any πŸ’ can take your money, but not every professional can provide you the help you’re paying for.

Ankle dorsiflexion range

The ability to pull your toes/front of the foot towards your shin is called dorsiflexion.

You may not realize how important dorsiflexion is, until you lose it.

The lack of dorsiflexion can cause a person to walk with the feet/toes pointed out.οΏΌ

A loss of dorsiflexion can cause the heels to rise when attempting to do a squat. On that note, there is a difference between a squat and a crouch.οΏΌ

There are ways to improve this.

Watch the video below.