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My last two blogs have been in relation to subjective & objective assessment. It feels right to have a closer look at the ‘planning’ stage of treatment plans.

Within the practice, we treat many patients with long term chronic pain, which some have been experiencing for anything between 10– 50 yrs. With these patients it can prove challenging to create meaningful, purposeful treatment plans.

In treating such people, their original problem can quickly become lost, as solving one area of pain will lead you to further areas of discomfort and pain in a completely different part of the body.

Once you have completed a subjective & objective assessment, you then begin to build a picture of what the issues are for your patient. Sometimes they have passed on so much information, gained through the subjective & objective information gathered, that clarity is needed as to what would be a good outcome for them from their perspective. This can often be different to the view the patient originally arrived with. It can be useful to revisit the aim/objective of the treatment regularly.

Treatment has to be flexible as the pain messages will change both in quality and areas of the body. Sometimes the plan is to increase mobility before the pain eases, as this, in our experience, often leads to calming down the autonomic nervous system.

Subsequently, we have to be open to short term plans, with space to revisit the objective assessment procedure, adapting your plan with the progression the patient makes. The ability to measure outcomes made within the treatments is important for both the patient to understand and recognise any progress made, and for you as the therapist to maintain focus on how to plan and move forward with treatments. Returning to objective assessment skills is a useful tool in enabling that process.

All the books below lay out clear protocols for objective assessment – active, passive, resistive. These are often full range movements, so the question that often comes up at the workshops is “How do we discover the cause, when people are too much in pain to move!”

Our anatomy has to be at its best understanding, piecing together the antagonist/agonist/synergist. Always keeping in mind, ‘Red Flags’, and the quality of their pain. We make a plan, outlining which techniques we are going to use, the depth of treatment and how much pain free passive movement might be useful.

Over the next 2-3 treatments, improvement may occur then we can re-assess with all our objective assessment skills and measure new ranges of movement (ROM), checking the ease that may have been brought about with the tissue. This may challenge what we first assessed, which is fine, and now we develop a new plan.

Objective assessment is such a great procedure as an initial assessment to create a plan. To re-assess, it gives the patient a picture of where they started and how far they have come, it gives us the ability to be clear, and it promotes reflection both for us as the therapist and the patient.

Books:

Thomas Hendrickson, Massage and Manual Therapy for Orthopedic Conditions, Second Edition, (Lippincott Williams & Wilkins), 2009

Nicola J Petty, and Ann P Moore, Neuromusculoskeletal Examination and Assessment, Second Edition, (Harcourt Publishers Ltd.), 1999, 2001

Nancy C. Cutter, and C. George Kevorkian, Handbook of Manual Testing, (The McGraw-Hill Companies, Inc.), 1999

Florence Peterson Kendall, et al. Muscles: Testing and function with posture and pain, Fifth Edition,(Lippincott Williams & Wilkins), 2005

Our Aims of the day:

• To be able to palpate nerves with new confidence
• To review the : Cervical Plexus, Brachial Plexus, Lumber Plexus, Sacral Plexus, Coccygeal Plexus
• A wider understanding of the Autonomic Nervous System
• Clearer goals and treatment modalities when treating people with acute and chronic pain

We had a really thought-provoking time investigating the plexus’s through the spine, starting with the cervical ending with the much un-addressed coccygeal, relating it the nerve implication with regards to chronic low back pain. I have found in some chronic LBP, the rectum and pelvic floor are holding on too tight, and feather light intended light strokes to the coccygeal plexus start to ease the tension in a way that is non-threatening to the neurological system.

I created space to re-visit the quality of our palpation skills, by as a group palpating ribs to enquire with our hands how the person was breathing. We discovered with a lighter touch you gained more information, also noticing how our own breath fell in-line with the person we were palpating. I believe most importantly it creates stillness within ourself, leaving a clearer mind for gathering assessment procedure.

John Olsson, Massage Therapist:

“Cheers Sue and Ros, already treated coccygeal plexus with profound result wow! Great day and takes the fear about palpating nerves. Loved seeing you all and can’t wait to tickle more nerves.”

Laura Frankin, Charted Physiotherapist:

“From a physio background it was an excellent to recap anatomy in a more holistic manner, taking into consideration the body system and the effect of our hands.”

I feel very honoured to be able to bring the Hendrickson Method to the UK.  Back in 2003/4 I had been searching for a technique that would allow me to treat musculoskeletal conditions that didn’t create a secondary inflammatory response; one in which the patient would have conscious awareness to the change taking place; and one that would increase my precision as a therapist.

I had built a practice on treating patients with long term chronic pain and layers of dysfunctional postural patterns. Using the Hendrickson Method enabled many of the treatments I provided to my clients to hold for longer periods, and patients made greater recovery. Tom Hendrickson, creator of the Hendrickson Method, works hard at developing his skills and knowledge and has passed on his expertise and wisdom to myself, enabling me to teach his work here in the UK.

 

The Programme

The programme is led by Sue Bennett, the UK’s first Certified Hendrickson Method Teacher, and is open to all remedial massage therapists, sports therapists, physiotherapists and others certified in movement therapies.

The Hendrickson Method training programme and certification is made up of a two-day introduction (18hrs) followed by four, four-day workshops (32hrs each), and concluding with a three-day workshop (22hrs) totalling 168hrs in training.

After completion of the two-day introduction, the programme is divided into four sections, detailed further below.

At the close of each four-day workshop there will be a 20 question quiz, requiring short answers. There will plenty of practice time, in pairs with another student, to ensure that there are no misunderstood strokes and provide an opportunity to ask any questions you may have.

Finally, at the three-day workshop, the practical assessment will take place. On these last three days we will explore assessment more deeply, create treatment plans,  and focus on clinical application. We will spend time linking the strokes together as one would in clinical practice. You will have the opportunity to develop clear, sensitive, patient-empowering communication skills.

With all of the workshops, there will be support assistants at practice times.

Required reading for the course:
Massage and Manual Therapy for Orthopaedic Conditions® by Thomas Hendrickson DC. ISBN-10: 0-7817-9574-5

 

Introduction to the Hendrickson Method – 2 Days

This introduction gives a comprehensive overview of the three treatment modalities that are Hendrickson Method: Wave Mobilization®, Muscle Energy Technique, and Joint Mobilization.

Students will learn the theoretical foundations and hands-on applications of this unique system and be able to give a treatment for the hip, spine, and shoulder.

The Introduction course is required for students taking other Level 1 workshops in the comprehensive Certification Programme.

These two days will cover:

• Insights of Lauren Berry, RPT and the concepts of Vladimir Janda
• Science and practice of Muscle Energy Technique (MET)
• Wave Mobilization, a new style of soft tissue mobilization
• Anatomy and physiology of connective tissue
• Soft tissue dysfunction and injury. Recognizing stages of inflammation and repair in soft tissue
• Treatment protocol for acute, sub-acute, and chronic phases of injury
• Joint mobilization

There will be pre-course reading to enable therapists to gain the most out of the two days. There will also be support assistants over these two days with the aim of ensuring that students leave feeling confident in their new found skills.

 

Upper Extremities Level One – 4 Days

• In this section we will cover the musculoskeletal and neurological system within the thoracic and cervical spine, shoulder girdle, arm, wrist and hand
• Understanding the use of soft tissue mobilization, muscle energy technique (METs) and joint mobilization within a treatment
• Explore the function and dysfunction related to the upper extremities
• Refining The Wave Mobilization® stroke

 

Lower Extremities Level One – 4 Days

• In this section, we will cover the musculoskeletal and neurological system within the lumbar spine, hip, knee, leg, ankle, and foot
• Understanding the use of soft tissue mobilization, muscle energy technique (METs) and joint mobilization within a treatment
• Explore the function and dysfunction related to the lower extremities
• Refining of The Wave Mobilization® stroke

 

Level Two is an essential enhancement of everything learnt in Level One:

Upper Extremities Level Two – 4 Days

• In this section, we will cover the musculoskeletal and neurological system within the thoracic and cervical spine, shoulder girdle, arm, wrist and hand.
• We will refine our stroke to address deeper structures of the musculoskeletal system, for example in the ligament, joint capsule and tenoperiosteal sites.
• We will refine assessment skills to enable a clearer understanding in the development of treatment plans.
• We investigate patterns of muscular dysfunction and the neurological basis behind them

Prerequisite: Completion of Upper Extremities Level One

 

Lower Extremities Level Two – 4 Days

• In this section, we will cover the musculoskeletal and neurological system within the lumbar spine, hip, knee, leg, ankle, and foot.
• We will refine our stroke to address deeper structures of the musculoskeletal system, for example ligament, joint Capsule and tenoperiosteal sites.
• We will sharpen assessment skills, to enable a clearer understanding in the development of treatment plans
• We investigate patterns of muscular dysfunction and the neurological basis behind them.

Prerequisite: Completion of Lower Extremities Level One

 

Clinical Application and Communication Skills – 3 Days

• In this section will spend time linking the ‘strokes’ together.
• We will spend time exploring clinical application. Delegates will be expected to present a case study for peer review
• Time will be spent on creating treatment plans with clear definition given to the use of ‘flags’ as indicators of patient issues
• Exploring some basic NLP principles to add greater communication skills, vital at the stage of subjective assessment.

There will be 30 minute practical assessments in pairs, which will take place at the beginning of each day before class commences.

 

To book your place on the Hendrickson Method Certification Programme today, simply visit our Events Page.

We have three new Hendrickson Method Practitioners, Jacqueline Ashworth, Nicola Ramshaw (based in North Yorkshire) and Deirdre Adamson (based in Scotland).

The last four days of the program covered the Lower Extremities, with the focus on Tom Hendrickson’s level two strokes which reach into the deeper structures of the musculoskeletal system, for example in the ligament, joint capsule and tenoperiosteal sites. We took time to explore assessment procedure, consider our findings, develop confidence in our curiosity, examine our findings, and reflect on the chain reactions of muscle function. We then practiced gathering all the information to piece together a treatment plan, and gain an understanding of when to re-assess.

We also took time to consider how we could acquire softness through our bodies, leading to soft hands to develop deep strokes that come with ease for the patient.

As it was their last weekend, Jacqueline, Nicola and Deirdre took part in their practical assessment – all three could demonstrate their understanding of the ‘wave mobilization®’, Tom’s unique soft tissue mobilization, and assessment procedure, so it was celebrations all round.