3 Tips To Be The 1% in Hand Therapy
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[00:00:00] Hey there, it's Hoang with Hand Therapy Secrets, and welcome to my show. I am here every week to showcase to you a story of therapists that are breaking into hand therapy and making waves, and also to share with you other specialties that can really help support us in hand therapy world and even tips that you can use and skills that you can use, right?
[00:00:23] So today what I wanna share with you is my friend Aaron, he is a physical therapist in Jacksonville and he specializes in functional manual therapy treatment. And he's gonna share with you some great things you can start doing right away with shoulder types of injuries and share his story, how he works very collaboratively with other occupational therapists in his area.
[00:00:49] Enjoy the. Hey, Aaron so wonderful to have you on the . This show is all about connecting occupational therapists or physical therapists who want to specialize. And [00:01:00] hand and upper extremity to other therapists who learn different techniques.
[00:01:04] And I'm really excited to talk to you today because you are specialized in something very specific and I want to let other OTs and PTs know about it. So tell us a little bit about you and what you do, where you. Hey, thanks for having me on. Again, my name's Aaron Robles. I have a clinic here.
[00:01:23] I'm a physical therapist and in Jacksonville, Florida. And I actually got three locations now. What I am certified manual therapist in. Functional mobilization through the Institute of Physical Art, and what we do is take the principles of P n F and develop a dynamic treatment and evaluation approach with using those principles for manual therapy to get hands-on.
[00:01:49] Get to the root of the problem faster. So for me, it really fit my brain and my hands well, and it's really made me successful in trying to get to the root of the problem, not just [00:02:00] the diagnosis when patients come in. And how long have you been specialized, should I say? I was I've been a therapist for over 25 years now, and probably in 24 and a half of those.
[00:02:13] Training to be where I am now, . Oh wow. That's awesome. And I I had a direction of, I knew I was good with my hands because all my classmates were asking me to help them. And I was like, okay, wait a second. I don't know anything more than you guys we're classmates. And they're like, no, we can't do what you can do.
[00:02:30] We can't feel that. So I sought out, What kind of treat training I could do that really fit my hands and my brains. Okay. So that's such a great important point. So you knew that you were good with something, and then you picked something where you could enhance that. Exactly. Am I hearing you okay?
[00:02:48] Yeah. Cuz I think that's important for people to hear because sometimes people wanna be good at everything. But sometimes when you do too much, you. You ki in a way water it down, but you [00:03:00] specifically knew you were really good with hands-on type of stuff, techniques, and so you, you sought that out.
[00:03:05] Did you find a mentor? Or taking classes. Yeah. It started with a a pt. We had an adjunct pt instructor at my PT school. She was mainland based, lot of joint mainten, so she took me and another therapist under my w under her wing and showed us how to do those kind of things. Okay. From there, then I knew, I was like, all right, this is what, how I want that.
[00:03:29] That's what you liked. I'm really excited to have you show. Some of the things that you do in your clinic, how did you get connected to occupational therapists in your area? There's actually it ended up being a patient of mine and now's a patient slash friend. We got really close there.
[00:03:46] OT is the best people to be friends with. They're just so social . We're so much. Fun. I try to tell all the PTs that I meet. I'm kidding. . So we started, [00:04:00] she, she started having, she came to me for neck issues. Yes. And she had long history of shoulder issues, but she's when she first came in, she said, just don't touch my shoulder.
[00:04:09] And of course me, I'm like, if you have an issue, let me see it. How can I get to the root cause of your ? Sorry. I had to gain her trust. But then through that she's cuz she's had bad experiences in the past with other therapists. Pt, we all, she didn't want, had anybody touch it as a therapist.
[00:04:29] She knew know. And she's you have to prove it to me. And she's after the first visit, she's like, all right, can you check my shoulder out? And from there she just was like a sponge and was like, okay, what are you doing there? How do you do that kind of thing. And she incorporated a lot of the principles and cuz she get, have empathy now for our patients.
[00:04:46] Wow, this is gonna hurt, but this is gonna help you feel better. ? Yes. Let me ask you How difficult is it to treat another therapist? For myself, it's the hardest part is I have to tell 'em often. I said, [00:05:00] okay. Let me be the therapist cuz they'll tell me, okay, it's my bothering me right here.
[00:05:05] It's this, it's this, skate forward and it's not extending. And I, and it's not letting me let me to see what's happening. . Yes. That working with other therapists is so hard. Yeah, it's so hard. But you also cuz I've worked with other therapists, whether they're OTs or PTs or speech therapists.
[00:05:27] They have a tendency to they have a tendency to maybe come in a certain way. But let me ask you, do you also have a tendency to think of them as a certain way when the therapists come in? Yes. Because you, we can't help but make assumptions sometimes. Or you're a therapist, you make assumptions that they know certain things, wouldn't you say?
[00:05:51] Yeah there's things like I learn a, you know what? Assume, right? , right? We're not supposed to assume. We're not supposed to assume, but let's be [00:06:00] honest, we're human beings. Oh, we're through. So I, the good news is I treat everyone whether I have, because I have a lot of doctors in town as well.
[00:06:07] I was a patients and I treat them. Those are worse soon. I'm kidding. , they're terrible. Cause they can't get in. They can't get in. You only have one shot at 'em typically, but once you, and then and once you combine 'em, like what I find once you get past okay. They think they have insight, but once I find things on, I'm like I didn't even know that bothered me.
[00:06:26] I didn't know that hurt. I didn't know that was an issue. So once I get into the treatment wise, then they're like a regular patient, so that doesn't take long to transfer. Yeah. It's the, they changed their mindset as well. , that first visit. Exactly. Sorry. . Very cool. So yes, the OT became your friend.
[00:06:44] She was your patient. She became your friend. Exactly. So she's so she was really able to really expand her treatment when she's just took a lot of principles as she learned from me. Just from our treatments. Yes. And then if they go [00:07:00] advanced, she's oh, you gotta go see Erin. So she will, she'll transfer her patients over to me to get over all the hard things and, okay.
[00:07:06] So that'll take it from, So she has a new grad OT that I was just shadowing her over the last month, and he's like, how do you know how to do all these things? She's Let me tell you who. And then she says, can we set this up where I could show, see how he does things? And we are trying to, we're brainstorming how to do it.
[00:07:26] And she was thinking can you do a treatment on me and have him observe? And that's how it started. It started from that to we taught. Told a couple other OTs in our work and soon it was like two more, three more. It ended up being, before you knew it, you had a workshop, a class workshop, , a therapist, , and it was a great hit.
[00:07:45] It was very successful. I started with giving them some kind of basics with just manual therapy. Okay. And some things I like to share with you guys today. So yes, please. So that the therapists that are watching, believe it or not, it's so funny, but obviously. [00:08:00] Speak to majority occupational therapists, occupational therapist assistants and stuff like that.
[00:08:04] But there's a lot of PTs that, a small portion of PTs that do reach out to me because they wanna specialize in hand therapy too. And then within. Our own like net my network of PTs that I know they've, some, sometimes when there's like little issues with like hand stuff, they've reached out to me too.
[00:08:25] So I think it's a great space to share knowledge and techniques. Yeah. Oh yeah. Crew. So show us who's your model there? Woo-hoo. This is Mark. Hi guys. Hey Mark. So I recruited him to help us out and Haley's our camerawoman behind the scenes here. She'll be moving us around. Haley, that's my daughter's name.
[00:08:46] I love that. All right. Study Hailey. That's how I talked to my daughter. Turn on a third. Voice. Staley. It's . Steady. Steady. Now Hailey. I'm kidding. . Let me start with, give you a [00:09:00] couple principles here with manual therapy. So the first one is like I alluded to, I naturally had a, the. Which I didn't even know I had until, it was compared to my other classmates.
[00:09:12] So that's when I sought it out further. First thing, everybody has to know you. You have to understand that it is a skill, but it is a skill that needs to be worked on and can be improved upon. So even if you don't have the natural propensity to feel it at first. You have to first understand that there you can, and it is possible to do and once you do it, then you could actually work on it and feel it. Number one thing. Manual therapy. Here's the first principle, is what you're doing with is en field. So if you could think en field, that's why I tell all my, if I have PT students that come in town or in the classes I teach, if I ask you a question, if you answer N field is you're gonna be 99%.
[00:09:54] . So this is what we're gonna talk about is en feel. Cause you can't really. . What's [00:10:00] wrong? Know what's wrong to really feel it, in my opinion. Yes. So every joint in the body, the matter where it is, whether it's mechanical and to joint wise, articular surfaces or soft tissue mechanical issues, you should have a springy Enfield.
[00:10:14] So that's what you want to make sure that all things, if you have no clue what's going on, especially with the wrist, with all the things going on in there, if you just poke around and you think that is springy spring and that's hard. There's a dysfunction and that's where you. . You don't even have to know what's going on with it.
[00:10:29] You don't have to wait a second. Aaron some directions. There's gonna be a hard end field, though. It's majority springy, but some are hard end fields, wouldn't you say? No, I beg to differ all the joints even in the elbow. This is where a elbow is a true hinge joint. Yes, it is springy. If it, if the joint is moving in an efficient state, even though this is gonna be a bone and bone yes, it'll still be springy at the infield.
[00:10:57] If it's moving efficiently. Okay, [00:11:00] perfect. Oh, you see how like, I'd like that . I'd like to challenge you. Ok, that's good. I think Mark liked it too. Mark was like, oh, here he goes. market. He should be able to answer. So now the main thing, I'm gonna teach you guys something else. This is. Basically the three principles and of all manual, all therapists actually, so occupational and physical therapy.
[00:11:25] This, if you guys know this, you will know more than 99% of other therapists out there. We treat the three things in our professions, okay? We treat mechanical. Dysfunctions. We treat neuromuscular dysfunctions and motor control dysfunctions. Okay? If you understand you, we do those three that, give you concept that ha, that's how you get a person to the root of problem.
[00:11:49] Get the person better, faster as well. Cause mechanical. Is any kind of movement that is limited or just deficient, [00:12:00] right? Neuromuscular is whether you have a strength or flexibility issue and or endurance issue that you wanna get to, right? And the motor control is, can you move it when you need it, right?
[00:12:11] So often give example of having soccer team. So if you could think of it this way so the differences like a soccer team requires 11. per team. So mechanical issues, like two of your players got lost on the way to the field, and so now you're nine on 11, can you function?
[00:12:27] Yes. Can you function well? No. You're hampered cause you don't have everything there. You don't have all your facilities. So the neuromuscular end is you have all 11 on the field. They all made it there, but they all. , they have no dribbling skills. They can't shoot, they have no strength, and they really have no endurance.
[00:12:43] They they can barely run across a field. . So when you get to motor control issues, you have 11 players on the field. They're all excellent skilled, and they could go through every drill, every possibility they have, all the strength they could run all day long. The only [00:13:00] problem is they don't own their positions.
[00:13:02] You have the goalkeeper running down after the ball and the other side of the field, and nobody's protected. Yeah, and nobody knows how to play defense or offense, and that's where we have to incorporate those three principles, and that's our pillars of our treatments. I understand that We can get to the root of the problem so much faster for you.
[00:13:19] Yeah. I love your analogy, . . I love it. That's awesome. Okay, so what I'm gonna use Mark four. So one of the main things for manual therapy, so once you get to understand this is n, is it's important with the tactile cuing that you give patients. So if you've taken NDT or any pnf, you'll understand some of this what we're gonna show you.
[00:13:44] Okay? Good, mark. Good. I'm gonna raise it up a little bit. Okay. So if you could see here, mark this right-handed. Yeah. Okay. Even though he's my example, he doesn't know what I'm doing. Tell what to do. Okay. So he's a little bit higher. Okay. So you can see this. [00:14:00] So what I'm gonna do is, mark, I want you to hold your hand there.
[00:14:02] I'm gonna try to pull down any problems with his shoulder. No. Any excuses you're gonna have. Okay, good. I don't think so. All right, so now I'm gonna have him hold here. So this is one of my pre posttest. I always pre and posttest my patients. One of the things I wanna show you is this. Hold it there. Don't only pull you down.
[00:14:18] And come on, mark. Are you serious? Is that all you got this? Everybody's watching. That's pretty. He's not a good example, or he is a really good example. Okay, now I'm gonna show the principal, which is unintended. We'll see if it happens. Look up. Put your weight into your left foot, push down and look up to your hands.
[00:14:36] Now lemme pull you down. And now he's a lot stronger. Okay, that was an unintended print PNF principle I wanted to show you, but it's about the patterns Now don't look at your hand mark, okay? Don't hold it there. And he can't do it. He has nothing. So he's missing unless he consciously engage. His core to help protect him.
[00:14:58] He can't hold his shoulder [00:15:00] up there. That's not what I was trying to teach you today. Lemme show you something else. Hold it up. Look it up there. Hold it there. Don't only plea down. So he hasn't, don't change the thing. Keep looking out there. Now what I'm gonna do is different. Hold it there. Don't only plea down.
[00:15:13] And again, he's weak, but he's looking at your hand. He's now holding there. He's now looking into your. So what was the difference? I dunno if you could see it a little bit higher. Oh, I can see it, but my, can you see my hand here? . So I'm the whole circumferential tactile sense to him and he can't hold it.
[00:15:30] But if I just put my surface on, oh, okay. Then he was able to, I'll hold it there. Has it there? Those very important are tactile sense. So we wanna make sure if we're trying to find weakness in the patient, that it's actually in the patient and not us, not in our, yes. That make sense. Yeah. So another thing here is this.
[00:15:53] So for testing the shoulder muscles and he's just weak here, we wanna isolate the shoulder muscle groups that [00:16:00] actually his weakness. Okay, hold it there, mark. Lemme push down again. My tactile sends us here. If I push my down, he's strong. If I just wrap my fingers down, push down and he's a lot weaker.
[00:16:11] Yeah. Make sure
[00:16:15] the intended motion, even if I say you. push down Mark and I push down even my tactile and verbal sense. Verbal cues are contradicting each other. Yes, he's gonna go with my tactile sense. Does that make sense? Yes. Yes. Now, if I say hold it there, he's strong. If I put my hand on his Del torch, which is holding there and test him again, he stays the same.
[00:16:40] It really doesn't. I dunno if I put my hand on his scaffolder stabilizers. Okay. Which is here in back now. Hold it there Mark. And now he's weak. Okay, so what happened? What does that mean? Okay, so when I put my hand on a muscle group here, he's indel towards, [00:17:00] he's strong. If I put on the scapular, He's weak.
[00:17:04] So it may seem that it's a scapular stabilizer, not his deltoids. But if I put my hand on a muscle we want to do, we're adding another tactile sensation to that to help enhance that traction. So if I'm putting my hands on his deloid and he could hold it, this is his weakness. Okay. I'm putting it on his scapula and pushing down and it doesn't make a difference then it's not a scapula.
[00:17:34] and that's the basic of K take. If you know all the K take , it's that add that tactile queuing. Yes. Initiate that muscle. So it's working with the hands so you can initiate that as well to figure out where is his weakness into where it is, you are putting your hand on there. If they're stronger with your hand on there, that is the muscle depth you have to target for strengthening.
[00:17:57] Does that make. Yeah, no, [00:18:00] absolutely. The first, that's the first, chronic principle. So now with Enfield, no matter whether it's salt tissue or whether it is a joint, it has to be springy. So if it's a springy Enfield and it moves like a poster to, if it's not like here, this is his handmaid. So that's right now is not.
[00:18:24] Springing. You feel that? Yeah. And it's in an extension. You can also do And that's what you wanted to feel. Yeah. The end feel. So if you can feel the end feel, and you have to understand. If you don't have ideas of what that means is, find, and you have to practice that every joint. When you go to the end, it should just bounce back.
[00:18:44] Just like if you were down on a self-service. It should be bouncing. It shouldn't be like on my desk and pushing hard. Yeah. Where it. Do you recommend for people to feel on themselves or feel on a normal joint so that they can get an [00:19:00] idea of what that's springiness or that normal sensation feels like?
[00:19:04] That's normally what I do is just, test on yourself see how your joints move, or like even your wrists, you should feel it a certain way or you can test on someone else who doesn't have a problem. That way you can learn what normal feels like so that you can know what abnormal feels.
[00:19:22] That is a, that's the best point in terms of manual therapy. Yeah. So how do you know how many dysfunctions there are? You can't memorize them all, but if you know what it's supposed to feel like, yes, and you know that it's not there, then you know there's something wrong. You know something is wrong.
[00:19:36] Even if you don't know how to fix it. That's not wrong there. Your hand Handmaid's supposed to move. Mark. I think you. Problems. So this is something that follow up with what you're saying, you could feel with soft tissue on yourself. Yes. So when you push, like if I push to a certain area and I engage my soft tissue myofascial, I should be springy.
[00:19:57] But you could even see it's [00:20:00] hard. I don't know if I could see that, but you could see I have little mole here. If I push this way, the mo moves away from me. If I push this way, the mo goes closer to my finger. Yeah. That's a hard end feeling. Yeah. So that's what you're for. And solve issue. Yeah. Do you have people look around too?
[00:20:16] Because we work with odd people and then we, it's not just where you're pushing, but like around, cuz you're, it's supposed to move and there's a certain amount of tension that's supposed to move everywhere. And when you can see, when you're pushing in different directions, like certain spots, if there's a dysfunction, it just doesn't.
[00:20:32] Exactly. That's the hard end feeling. And that's what you're doing. That's what you're feeling. Yeah. So all those soft tissues should be free, flowing free. Yeah. Okay. And that's how you isolate the pain motion. If it's moving, if it's moving in this direction distally, that's what's dysfunctional.
[00:20:50] And then you get isolating little bit further. Is it more distally to the left or is it Right? Yes. The hardest end feel is the hardest in the. [00:21:00] Restricted area and that's what you want to hit first. Yeah. So now the next principle I wanna show you, which is this foundational for the shoulder complex.
[00:21:08] shoulder joint, the most important motion that you have to engage with the shoulder to get the full mechanical issue because, you guys understand the shoulders of most mobile joint body obviously is gonna be the most complicated part because of that. Switch we threw pain in it is inferior glides.
[00:21:27] If you could get that articular surface to inferior glide, and that's the first thing I have. Yet, over 25 years to have a patient have any kind of pain or upper cord or dysfunction and not had this issue. So if you could get this issue down, they'll, not only impingement, but every other motion in terms of Yeah, the carpal tunnels.
[00:21:48] This affects, yeah. Okay. So lemme show you how to do this. Okay.
[00:21:54] Here, chair, put your arm on your shoulder. Can you come a little [00:22:00] bit closer now? Right there. So now what I tried to do is get the table up.
[00:22:11] Oh, you so fancy. Look at you with your table up here in this motion here. , body mechanics. It's all about body mechanics, I'll tell you. So now what I want to do is take his, let joint and just glide it in. Feel, in feel. If I push straight down again, I want to get to his end range. So that's it in the spring end.
[00:22:33] And once it, it should be springy. It's not really springing. It's hard, but not too bad. Mark, what's wrong with you, man? Is Aaron making you work too hard? That I'm kidding? I'm kidding. Yeah. One of the post pretest protests I like to do to see effective here is do a passive abduction with their palm.
[00:22:54] So relax for me, mark. Let me do it for you. So if I bring him up, I'm gonna feel where the first tension he. [00:23:00] And this is right about there. So he's about 1 10, 1 15 where he's getting tension. I could through it. You could, but you can feel the restriction. I want to feel the first tension that's right there.
[00:23:11] First restriction. Yeah. But he's only there. He's only about 1 25, 1 30. Yeah. Look, that's his my pretest. Obviously I sh I do active and then show them the difference between active passive cause. Circumduct and move around at dysfunction, which you don't know. So if I push down, so Avi obviously has a shoulder Glen dysfunction.
[00:23:33] I push straight down. It's hard. I'd give it, a medium dysfunction there. But if I push more anteriorly, it's hard. It's much harder. Doesn't move nothing. I dunno if you can see it. And if I push him posteriorly, you could even see it in his body. So if you take a look at his shoulder, , right?
[00:23:52] It's like I always describe that as a clock. So if you're pushing straight down versus like you're pushing a little bit more toward, no, you're [00:24:00] pushing downward, but instead of it being like six o'clock, you're pushing a little bit more. More five o'clock, right? Exactly. And then you're pushing posterior, you're pushing seven or eight o'clock.
[00:24:10] Correct. That is just as a description for everyone who's watching that might not be able to, you're exactly right. That's what I'm doing. First assessing 12 to six. If I'm looking straight at clock in this motion here. Yeah, he's has a moderate, you could see it. He, if I push straight down, he has a little moderate here.
[00:24:29] If I push straight down. , I'm starting at 12 now. I'm going toward seven o'clock. Seven. , the inferior glide with a posterior bias. He is much springier. You can actually see his body spring. Yeah. . But if I go now toward five o'clock from 12. He has an inferior glide with the handcar bias.
[00:24:48] He is hard. That's, it's solid. He does nothing. Yeah. So the good news is that's easy to find. Yeah. And the best news is, this is on every patient you're gonna have. They're gonna have this issue, [00:25:00] otherwise they wouldn't be seen. Okay. So now, yeah. The simple treatment with this is I'm gonna push 'em down to that end range.
[00:25:07] Okay. I'm gonna have him there and then I'm just gonna hold that in range. Okay. And I'm just gonna hold it there. Sometimes that's all you need. Just a prolonged hold and a joint will. So the principles that we adhere to is we hold it and if it doesn't move, then we do add some, either indirect or direct mobility to get it moving.
[00:25:27] So direct molding, I just gonna oscillate into that chart. ? . You can do this with every joint in the body. Just oscillate to see it. Help move. Okay. If it's too painful, then you have him do something more indirectly. I could hold there and say, mark, take a deep breath. as he is taking deep breath, he's actually mobilizing his plan into, yeah, I love deep breathing.
[00:25:47] They're doing that. They're just thinking, oh, I'm holding my breath kinda thing there. Okay. I could add him also just to external rotation. Lift your hand up and down off the table for me and have a little bit of motion [00:26:00] and I could, what I'm feeling for is that hard end feel improving and it is now, it's improving.
[00:26:08] Now that's good. So that's more of an indirect pressure. I go back and reassess and he actually has some motion now. Can you feel difference Mark? Yeah. He actually is moving better and that's all he did. What was that? 30 seconds worth of treatment. And he is got better. Your glide. So this is something that you can take straightened now, right now in all your patients and assess it and have them feel better.
[00:26:31] Alright, so now what I wanna do is see how much motion he. And that is a lot better in terms of just in general big motion. So I want to retrain that motion because every time you get a new range, we want to train that range or I'll still lose it again. So I ask Mark, hold it. I'm gonna push 'em down to that new range, anterior toward five o'clock and say, hold it there Mark.
[00:26:53] I'm gonna switch my hands and don't let me pull you. So now he's gonna do a little shaking. I don't know if you can see him, but [00:27:00] he's little shaky because he hasn't activated these muscles in a long time. I'm just pulling straight up. What I'm doing is just keeping my hands and just pulling up careful breaker plexus under here.
[00:27:09] Down. Put 'em back down. Hold it there again. Mark. Don't only lift you up again. Prolong holes. And the best way to initiate and engage muscles is in prolonged holes, especially if they haven't gotten a. and then have 'em do some content. Ecentric, work. Let me pull you up slowly in says work. Now pull back down.
[00:27:30] Let me pull you up an inch more and pull back down. Now pull functions more and pull back down. Now let me pull you all the way up. All the way down. Be all the way up and all the way down. Very good. Now he has that motion because with impingement, you know it has to have that interior glides, inferior glide.
[00:27:50] Yes. So it doesn't, what we're establishing now, you have to establish his reconnection to his brain, to his shoulder to get those muscles to automatically. [00:28:00] So with that treatment, I'm gonna reassess his passive range. Let me move you, please. Okay. Relax until I feel attention. and now it's right here till I feel tension, so it is a lot better.
[00:28:11] He started at probably 1 10, 1 15. Now he's probably about one 40 or so. Still hard and feel here, so he needs a little bit more work. But yeah, that is no much here already for his shoulder, and that didn't take long to do as long as we know what we're targeting. So what my homework for him is now because of his shoulder impingement issues.
[00:28:35] Mark, I want you to think about when you lift shoulder up, you're supposed to automatically do this to raise it up. You're not doing that. So anytime you're gonna raise up, I want you to think about dropping your shoulder and then keep going up for. That makes sense. , so do abduction for me. When you get about one 10 there, drop your shoulder there and keep going.
[00:28:53] Very good. That's something he has to think about to do first and then until it's automatic and. [00:29:00] Cool. Very nice. I appreciate it. You. Of course. Thank you. Very awesome. I really appreciate you taking all that time Yeah. To show all of Mark's dysfunction for the world to see. He's no problem. I got a pretreatment.
[00:29:15] I'm good to go for another two days. No, I'm kidding. . No, that's awesome. . I really appreciate you sharing a lot of what you know. It's funny because sometimes when we've been doing it for a while, we have our version of saying it, or maybe we do certain things and we don't know why we're doing it.
[00:29:32] And I think that a lot of what you spoke about today was a great way for people to really remember and think about that. Cuz sometimes when I'm training my own team and I'm talking about like, where are you touching people? Why like I really like the way you explained that about, cuz I, I talk about that too, and like hand placement and you shouldn't be grabbing people and stuff like that.
[00:29:52] But really liked how you explained it. Really tied into like your specialty, your functional, manual specialty. How can [00:30:00] people learn more about your specialty that you've been spending the last 25 years? Oh. True. There's classes that will teach these principles and they're, they were founded by Greg and Vicky Johnson, and they're out as Colorado Springs.
[00:30:16] Steamboat Springs in Colorado. Okay. And Their organization is called the Institute of Physical Art, and their courses are open to OTs as well as PTs, especially. There are several courses that we're actually hosting a course here in three weeks and it's the upper trunk. So everything from upper trunk manual techniques on how to understand a paradigm of how to.
[00:30:42] Work on the mechanical, the neuromuscular, and the motor control issues in the same treatment and evaluation approach. And that's what helps with this with me and my brain. Cuz I can't think about, 1, 2, 3, 4. I was like, you know what? All I can know, I know. That's not moving, I know. To get, [00:31:00] and that's all I need.
[00:31:02] That's awesome. . I like that. But simple is, sometimes the best. Now I wanna ask you real quick. Is this a I've seen certain manual certifications, right? The one that you're recommending, the one that you've done, is it a series of just classes that you can take over time or is it like a certification program where you're taking it almost like within a year that gets you certain letters behind your name and stuff like.
[00:31:33] And that's good to question. This certification is actual I think they may have changed it cuz they've expanded the course schedule, but they were, when I took it, there's eight courses you have to take. So if you're taking one, two year, that's gonna at least be, four years.
[00:31:47] Yeah, no, it, it takes time to develop specialties. It takes time to develop specialties and I think that's what people need to realize. It's just not like a one time wham band. Thank you ma'am. Type of course. Those courses [00:32:00] can be great, like online courses can be great or various.
[00:32:03] Targeted specific courses can be grades, but certifications take a lot longer. Certifications are worthwhile for sure. Yeah. But it's worth, it's like one of those things where you can take a series of courses over a period of time to get that specialty right. That's the one. , right?
[00:32:22] Yes. So I studied for over 10 years to make sure I got it down. Yeah, no, I knew this is the way I wanted to treat, so I wanted to Yeah, for myself, see if I've accomplished that level of competency and expertise in this since I wanted to be, this is, I again, I said, Hey, I'm cheating this way no matter way.
[00:32:41] Yeah, no, for sure. And I think, when it comes to becoming a certified hand therapist, Tend to focus a ton more on postsurgical cases. Versus like nonsurgical cases. Now there's a lot that we do in nonsurgical cases, but it's not very targeted [00:33:00] specifically to a different to a particular technique, but more like the background, the biomechanics of how everything moves and how it affects each one of 'em, but so much.
[00:33:12] The certification to be specialized in hand therapy is about treating postsurgical and all the, versus the nonsurgical. But I, we do a ton of nonsurgical here at my clinic too, and I think it's a great way for OTs to. To treat cuz not everyone has surgery. Not everyone needs surgery.
[00:33:31] And there's a ton of people with upper extremity, upper trunk, upper body types of issues that really need our specialty. And there's a lot of different things, just like what you said and part of it's you have your observational skills, but then you have your tactile. And then you have your communication skills.
[00:33:51] Yeah. I tell em all time what we have to do is we have to enable them to move before we can expect them to move. Yeah. You can't say, oh, your [00:34:00] risk is weakness. Do some exercises. Yeah. But if they can't fully extend, yeah. They're not gonna get the full benefits from those strengthening exercises.
[00:34:08] No, for sure. Absolut. . I really thank you. I'm gonna include your links below. So anyone who's interested in finding out more about your clinic and the courses that you recommend to take out, include all of that in the links below. And I hope that in your area you continue to support OTs and potentially even hire an OT one day in all your clinics.
[00:34:32] you can totally expand into tons. Surgical stuff too. I can talk to you about all of that. . All right, Eric, I enjoy I joined. Thank you very much. Appreciate. What were you gonna say? I said I always enjoy the camaraderie without a therapist, and this is where I feel like we could all help each other, understand more about getting our patients better, faster.
[00:34:58] Yeah, totally. I believe [00:35:00] it. I believe it.
[00:35:09] Hey, thanks for listening to Hoang's world podcast. If you are brand new to the hand therapy world, head over to my website, www . Hand therapy secrets.com, where you can get started with some of our free guides and paid programs for both OTs and PTs diving into the world of hand therapy. Or if you've been listening for a while watching on our YouTube channel and you think you could benefit from developing and moving your career further along in hand therapy, reach out to me and my team at info @ Hand therapy.secrets.com and tell us exactly what you're looking for, By the way, if you know someone who could benefit from today's show, please share.
[00:35:46] Thanks. See you on the next episode.
