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Raising the Bar in Rehab

Total Motion Release

Published February 18, 2010 5:18 PM by Lisa West
A fellow therapist was telling me about an inservice he had that explained a new treatment philosophy called "Total Motion Release."  The basic concept of this practice involves using non-affected body parts in normal ROM and functional activities to strengthen the involved area.    

The specific techniques used are difficult to understand based on the Total Motion Release Website (http://www.totalmotionrelease/).  With an example of a patient with a stroke, the message board question and answer suggests having the patient perform bicep curls on the strong side and then continue with active assisted bicep curls on the weak side, to eventually full return of function.  A patient and therapist exercise form titled "FAB 5" follows an outline of finding a restriction, being aware of the issue, testing different motions and ranking the difficulty of those motions.  Step four asks the patient to rank the motions in terms of difficulty, followed by "exercising the good side until the issue is fixed."  Finally, the patient and therapist are instructed to recheck awareness of the issue. 

The Website also clarifies that no formal research has been conducted with this method of treatment. 

What raises my attention is this- there are probably thousands of experienced therapists who have found techniques that work.  Perhaps the therapist who started Total Motion Release recognized a pattern in some patients where treating the strong side helped the weaker side recover.  However, there needs to be some universal agreement as therapists that we all have a responsibility to maintain the integrity of the profession.  Holding inservices to educate others on new treatment ideas is a good start, but providing detailed information, mechanism of action, supporting literature and case studies should also be included. 

What have you seen in your work place regarding unique treatment options?  Have you ever tried something, with no clear anatomical reasoning, that worked? 

posted by Lisa West

6 comments

Disclaimer first:  I am a PT patient, not a therapist.  Last year I was lucky enough to see a local PT who introduced me the TMR therapy method.  Boy, am I glad she did!  This method has allowed me to be cured of intractible tennis elbow and gets rid of any muscle tightness, soreness, or strength imbalance that manifests from working out, sitting too long, stress, etc.  This system works.  I am surprised more PTs do not jump on board with this methodology because the results are immediate and obvious, something difficult to produce in the PT setting.  Just my two cents as a TMR 'guineau pig' :)

Alice June 7, 2012 11:25 AM
Spokane WA

I think this is one of the things that clinicians and schools can work with. Students are always looking for things to study on in research classes. Perhaps TMR can team up with schools in NC to see if there is an interest. It is a win-win-win situation. 1. win for Dan as finally, there will be a study on his topic. 2. win for the students. They are actually doing something that is relevant in the clinical field and 3. win for all the PTs as they will learn more about this technique.

Liza Tan October 2, 2011 1:11 AM
RIDGEWOOD NY

I have not attended any seminars about TMR but from your description it appears that it's very similar to what i learned in PT school called "exercise overflow" if done on the contralateral side and "muscle overflow" (PNF technique) if performed ipsilateraly but proximal to the target site. I have been practicing this technique and there is evidence that it works.

Edward Refundo , , PT Midwest therapy network February 11, 2011 3:21 AM
Chicago IL

1st I want to say - great job on your blog.  Nice to see active participation by student PTs in our profession.  

Let me provide a little framework about TMR that perhaps will provide the reader more insight about the principles of TMR.  

In PT school we learn that perhaps a shoulder dysfunction is stemming from the neck.  We are taught to look above and below the injury for other potential causes.  

Rarely are you taught to look at the opposite shoulder or even the trunk or hips to provide information as to how those areas may be playing into the shoulder dysfunction.  

Total Motion Release sets up a scientific & structured approach to determine if non-involved areas play a more significant role in reducing an injury or dysfunction.  

For the students that are reading this and for even experienced therapists, let me ask a few questions.

If someone comes in with shoulder pain, what area are you most likely to start working on?  Why?  

The response predominately is the injured shoulder.

Have you ever treated the neck to see what effect it may have on the person's shoulder pain?

The answer is often times yes.  We were taught to look here.

Now let me ask:

Have you ever treated the opposite shoulder or opposite hip or opposite ribs or same sided hip or same sided ribs to see what results they may have on the person's shoulder pain?

Often times the answer is no.  During our seminars we explore these other areas and the majority of time treating the area of injury provides the slowest response.

The TMR system allows you to quickly determine if your current protocol for treatment is the most efficient & effective or if you can quickly go to another area and have faster and longer lasting results.  Our structured form & process allows any therapist & patient to quickly determine if what they are doing will provide optimal results.

The videos you see on the website simply show how quickly a person's pain/dysfunction can and will change if a more "primary cause area" of the body is addressed rather than the site of pain/dysfunction.

"System Interdependence" coined by Brent Swartzlander, PT best describes how other areas can and do play a significant role in the involved side.  Here is his link to the article:

http://physical-therapy.advanceweb.com/Article/Outside-the-Box-5.aspx

Evidence Based Practice is imperative in our field, and TMR sets up a structure that each and every technique a therapist uses can be easily compared to another technique and immediately know which one will provide a better result.  

Our process allows for this to be done not just on a daily basis, but with every set of exercises/techniques used.  Not even the Mckenzie form is more thorough in its process.

Hope that sheds more light on how TMR is providing a immediate process for therapists to use to test and monitor if what they are doing is really the most efficient & effective.  

Tom Dalonzo-Baker, Physical Therapy - Owner, Total Motion PT March 31, 2010 12:43 PM
Raleigh NC

Interesting post. For a few years I too was amazed at the marketing efforts/claims by the TMR community.

I decided to take a course so that I could have first hand knowledge of it so I could make an informed decision myself. I find it is always good to have "first hand" knowledge. Makes me accountable for decision/opinions that I have.

For me the course was a "win/win" situation as: 1) I'd get the Cont Ed hours 2) I was going to meet up with some collegues I hadn't seen in years. 3) If it was a joke I'd have a great time messing with the instructor...because I would have.

Well the first hour I couldn't wait to leave and grab a beer. Then we did demonstrations and I found there was something to this stuff.

That was a couple of years ago. TMR is now part of my PT arsenal. In a nutshell it is exercise...no voodoo...exercise. And since "exercise" has been found to "work" there is no reason not to use it.

While there is no "specific TMR research" there is a lot of research that can support it. That is on the website. Check it out.

You can also sign up at the website to get some free info that may clarify some issues.

Thanks...

bill jones

Bill Jones, Momentum Physical Therapy/Sports Enhancement March 30, 2010 8:42 AM
Columbus GA

This is why the article in the NY Times, "No Voodoo Please" raises some difficult questions and why Dr. Lewis' response is so important. We need to treat with evidence based practice in order to be taken seriously.

I'm not discounting this technique because I know nothing about it. However, if the originators put time and effort into producing a study about it as they do marketing it, we might have something to work with. Until then, you can't justify using it to treat your patients.

Dean Metz February 18, 2010 5:49 PM

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