I worked with a therapist last week (setting up a new clinic in northern Wisconsin) who has many years of experience in PT. It was interesting to work alongside him and see his approach to patients and the sometimes immediate results his patients had with his effective treatment style. We had some time to discuss and a few conversations about mechanical pain (within the joint) versus soft-tissue pain and the differences in treatment style based on the therapist's interpretation of the source of the pain.
We learned about different sources of pain in school but I didn't recognize my own bias toward soft tissue until I had this discussion this week. We started talking about a patient with plantar fasciitis and I ordered some sensory stretching cones made for stretching plantar fascia for our new clinic (I often use the cones to have my younger patients jump over objects too). When I treat plantar fasciitis I usually include ankle ROM exercises, dorsiflexion stretching, modalities (ultrasound and iontophoresis) and some soft-tissue release along the calcaneous and medial arch.
My new therapist explained to me his approach to correcting plantar fasciitis was to have the patient stretch into end-range plantar flexion, three sets of 10, comfortably. He said the most important components are stretching to end range and repetition. He told me that most patients can toe-walk comfortably but have pain with heel walking (and pain in the morning), so he has them try heel-walking after each round of end-range plantar flexion stretches and usually sees a fairly substantial improvement in symptoms.
Hearing this treatment approach was somewhat unique as I don't believe I've ever heard anything like it previously. The therapist explained some of his education under the McKenzie model of treatment and his experience seeing its effectiveness. I was introduced to the McKenzie treatment as it relates to back pain in school, but have not learned much about it since then, and know almost nothing about the approach as it relates to peripheral joint pain. What about you? Have you taken McKenzie courses or are you certified?
Stories like these make me appreciate the opportunities I have in my job to travel to new locations and work with a variety of therapists who all have skills or talents to learn from. I'm anxious to see what it is I'll be learning next!