When you’re learning new manual techniques, don’t work too hard!

Just relax

In all my years of teaching musculoskeletal medicine, the tips I found myself saying the most were ‘relax your shoulders’, ‘shake the tension out of your hands’ and ‘let your body do the work’.  

Even if you’re already a skilled manual therapist, when learning new techniques beware of concentrating so hard on which hand should go where that you forget to focus on the target tissue and the effect you want to achieve. 

If you feel yourself tensing up, then your patient will be tensing up too. If you’re comfortable, your patient will be comfortable. 

After positioning your patient, it’s okay to stand back for a moment and think the technique through. Then just approach the patient and do the minimum that needs to be done to get the desired effect.  

Spinal Techniques

If you’re applying spinal techniques, soften your shoulders, arms and hands.

Keep them soft as you place your hands on your patient and rock or move your patient confidently into a position that’s easier for you to apply the technique.

If you try to adapt to the patient’s position, that’s when you can start to work too hard. Your body tenses and the technique ends up being uncomfortable for the patient – and probably ineffective. 

Get feedback from your patient, as well as through your hands. 

Eyes Closed

If it helps, close your eyes, either as you rock or coax a patient into position or as you palpate the tissues. You’ll be amazed at the extra info you’ll gain through touch alone.

This is really effective when you’re learning on each other as students, but beware you don’t spook real patients while you’re doing it!

Learn from Others

When fellow students are practising on you, remember my advice and give them honest feedback.  Seek and welcome every bit of feedback that you receive on your performance too. 

If you can, observe experienced manual therapists in your workplace, and think about what makes them ‘expert’.  

Reflect on your own skills and apply those tweaks that will lead to an easy, effective technique and the development of your own competence.   

Dr Elaine Atkins MBE, FCSP

Dr Atkins is a retired MSK physiotherapist with a doctorate in ‘Orthopaedic Medicine Education’ and has been awarded a Fellowship of the Chartered Society of Physiotherapy.  Elaine was awarded an MBE  in 2018 for her services to physiotherapy.  As SOMM’s MSc Programme Leader for many years, Elaine also co-authored the course textbook ‘A Practical Approach to Musculoskeletal Medicine’.

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