This past weekend I traveled to Toronto to attend Dr. Andreo Spina’s Functional Anatomic Palpation course (lower extremity). I was really excited to take this course as it covers a topic that I think is extremely important for anyone working in a profession where they are performing hands on soft tissue therapy (Chiropractor, Physical Therapy, Massage Therapist, Osteopath, etc). This course is one of three palpation courses offered by Functional Anatomy Seminars (lower extremity, upper extremity, and spine) and they must be taken prior to attending the treatment based courses – Functional Range Release – which goes in depth on how to hone your palpation skills for specific treatment.
I know most are thinking, “A course on palpation? I already know how to palpate. I have been doing it for years!!”
No matter how good you are (or how good you think you are) at palpation you can always stand to get better – more precise, a better touch, a better knowledge of anatomy, etc. While many may disregard this course as being a “basic course” or a “waste of time…just let me take the treatment courses already!” I can assure you that you are surely mistaken.
Palpation literacy is a crucial component to be a great therapist and most people are not as good as they think. It is something that I try and invest a lot of time into and feel that I can always get better at. I also feel that a course like this is much needed in the field of manual therapy as even therapists who have been practicing for years can be pretty sloppy with where they put their hands.
Saturday began with Dr. Spina giving us a lecture on the thought process and approach his company takes in teaching their Functional Anatomy Seminars and covered everything from the importance of palpation to the approaches they take in their treatment courses – Functional Range Release. I found myself nodding along in agreement with much of what Dr. Spina was saying and this was a good feeling as Dr. Spina has been a practicing chiropractor for a lot longer then I have been a massage therapist so it nice to see that I have come to some similar conclusions about therapy and treatment approaches (and it is also helpful because it inspires me to keep on digging deeper, learning more, and getting better).
Dr. Spina laid out his three step approach to being a good manual therapist:
1. Pin point the pathology – This comes from listening to the client/patient during the subjective assessment.
2. Determine the histology of the involved tissue – Palpation is the key to understanding the histology of the tissue. In order to get this right you must be highly specific and be able to differentiate “normal vs. not normal” tissue.
3. Choose the right tool for the job - Once you have pin pointed the pathology and determined the histology of the involved tissue you then choose the right tool for the job. Too many people are “one-trick-ponies” and do only one single technique or have a singular thought process. When this doesn’t work, they simply then start “trying” other things (“Lets try acupuncture…have you tried that?” “Maybe we can try ultrasound or stim? What about massage? Have you tried cold laser yet?”). Instead of bouncing around and wasting time, if you can get very specific, it will help keep you from chasing your tail and keep the client/patient from sitting there waiting for something to work.
What I liked most about this opening lecture was that Dr. Spina highlighted a thought process and didn’t just give us a bunch of techniques. So often, in hands on therapy courses, the instructor will just go into doing a bunch of treatments and not give the underlying theory or concepts behind these treatments. Dr. Spina took the time to give us his thought process, the principles behind his system, and the science he has read to come to the ideas he has developed (and I really like that he is still reading the science and not complacent with what he knows now). This was not only helpful but it also ensures a level of consistency between courses. Rather than just doing or learning stuff you end up coming back to something more concrete and thought out.
The key reason that you must start with the palpation courses is too ensure you know exactly where you are placing your hands during the treatments (learned in the follow up courses). This attention to detail and specificity is not found in other soft tissue courses I have attended where they simply show you techniques with a very haphazard approach to palpation. In addition, this sort of detail and structuring of the courses ensures consistency both between practitioners and between instructors! In other courses there is a high amount of variability between the instructors which makes things frustrating from a learning standpoint. This course however was very specific and both Dr. Spina and Dr. Chivers (his assistant for the weekend) were very consistent in both their message and approach. The consistency that is provided to those attending shows that Dr. Spina has a genuine interest in certifying qualified individuals who will represent the system properly.
Following the opening lecture we dug into the anatomy of the lower extremity (this occupied the rest of Saturday and all of Sunday). This was fantastic! Dr. Spina did a very thorough job of the anatomy and spent time explaining different ideas he had on treatment, various clinical pearls to take with you to remember, and discussing some of the science and research of the anatomical structures as well as fascial anatomy of the region and how that is influenced by what we do in our treatments. After every 10-20 minutes of lecture we paired up for hands on time to work diligently on palpating the structures being discussed. Prior to each hands on, lab session Dr. Spina or Dr. Chivers would sit with a few of us, go over the anatomy again as they showed the palpation on a student, and offered more clinical pearls, thoughts and ideas before we went to try it on each other. A key concept that Dr. Spina kept stressing was the idea of listening to the tissue. Basically, going slow and not blasting through things. Waiting for their body to adapt.
Dr. Spina and Dr. Chivers were really helpful the entire weekend and very approachable during the break out sessions. They made sure to get around to each table and it was an acceptable ratio of tables to instructors (5 tables for each instructor) to allow them to spend time with each pair of attendees to ensure they got it right.
In all honesty, I loved this course! I am really excited to take more courses from Functional Anatomy Seminars and cannot recommend them highly enough. Dr. Spina has a high attention to detail, is extremely well read, and very knowledgeable in his craft (qualities which appeal to my OCD nature when it comes to these topics). As I often say of all the smart people I meet, “He has a big brain!”
I’d really like to see these courses make a bigger push in the States because I think they are not only extremely helpful but also very much needed in the manual therapy field.
If you haven’t done so already, I highly recommend checking out Dr. Spina’s BLOG as it is chock-full of ideas and thoughts and he updates it relatively frequently.
For information on courses, checkout Functional Anatomy Seminars.
If you are interested in reading some of my ideas on treatment that I have written about over the past few years on soft tissue therapy and fascia, that may be inline with some of the stuff Dr. Spina discussed over the weekend, here are some I recommend (and you can of course use the search function on the blog to check out more):