Pieter de Smidt, PT, DPT, shares his thoughts, concepts, and applications
For many years, physical therapy treatment was primarily directed by the medical diagnosis and often protocols were created regardless of the presentation of the patient.
How does this relate to movement-based therapy? Using a comprehensive movement evaluation, we can develop treatment plans that are specific to each individual patient, regardless of their diagnosis.
Pieter de Smidt, PT, DPT, Cert. MDT, MTC, FMS-C, is the owner and operator of Reset-Wellness Physical Therapy in Houston, specializing in manual therapy via an evidence-based approach. Dr. de Smidt teaches CE courses for Elite Healthcare, and one such course is entitled ‘Movement-Based Therapy.’
“Basically, we’re using a movement screening to dictate the type of treatment we will provide,” he simplified. “We don’t just base our treatment plan on the medical diagnosis or the results of imaging”.
For example, an individual who presents with back pain might have a diagnosis like lumbar stenosis, lumbar HNP, or even just LBP. In movement-based therapy, the focus switches to how the individual moves. Which movements are most painful? Which movements are most restricted? Which movements relieve pain? Is their movement screen consistent with their difficulties performing daily activities?
We then prioritize these different movements and use soft-tissue treatments, joint mobilization and exercise therapy as indicated by their presentation. “If somebody responds to flexion, or needs more flexion mobility, we might use IASTM and cupping to improve flexion, combined with joint mobilization to improve flexion prior to progessive exercises to address mobility, stability and strength & endurance with an emphasis on flexion,” de Smidt explained. “The movement directs the treatment focus. Once flexion is improving we move on to the next movement.”
Patients with stenosis do not automatically need flexion-directed treatment. A lumbar radiculopathy does not alway respond to extension. Evaluate all movements and base your treatment on how the patient can and cannot move.
This course covers soft tissue treatments and mobilizations, but the emphasis of this approach is exercise programming: mobility exercises, motor control activities, and most importantly strength training, necessary for positive long-term outcomes. The ‘back-to-basics’ approach can be used for any patient regardless if you have an acute or a chronic presentation.
“Consistency of the movement screen is an important indicator to determine whether the emphasis needs to be on mobility or motor control as a starting point for your treatment,” said de Smidt. “You evaluate loaded versus unloaded movements. You assess AROM versus PROM. The more consistent the presentation, the more likely it is that this patient might need joint mobilizations to help with their mobility problem. Patients that are able to move passively, or unloaded might need more emphasis on motor control and stabilization-type exercises.”
“It comes down to your evaluation dictating your treatment, regardless of the diagnosis. You are focused on what they can or cannot do.”
Instrument-Assisted Soft Tissue Mobilization and Cupping
Instrument-Assisted Soft Tissue Mobilization (IASTM) and/or cupping can offer quicker effects from treatment when compared to traditional soft tissue therapy. “It’s a rapid means of producing some changes,” explained Dr. de Smidt. “It can help reduce pain and muscle guarding, which is essential in helping patients to move better. IASTM is an adjunct to exercise in that it makes it easier for the patient to perform each exercise. IASTM and cupping are treatment accelerators.”
Dr. de Smidt prefers combining IASTM or Cupping with movement – for example, if the individual is having difficulty with overhead reaching, the treatment can be applied during exercises that improve flexion, making the patient less guarded and able to progress to more advanced exercises afterwards.
Recently, research has shown the importance of strength training in gaining mobility. Many therapists haven’t evaluated patients or athletes who regularly lift weights, and may not be familiar or comfortable with using strength training in attaining the desired long-term outcomes. But with the popularity of CrossFit and other intense training programs, many patients want to be able to return to at least some level of strength training exercises after injury.
“Some physical therapists aren’t comfortable evaluating a deadlift or a squat,” explained Dr. de Smidt. “But part of movement-based therapy is the belief that strength training is very important, and if you want to incorporate that into your treatment philosophy, you need to expand knowledge in that subject. So we spend a good portion of the course breaking that down, looking at the movements involved in traditional weight lifting, and the corrections you can offer, because loading the body leads to resilience which is need for long term results”
Who Should Take the Course?
Dr. de Smidt recommends the movement-based therapy course for any practitioner interested in expanding their knowledge or becoming an expert in orthopedics, or interested in expanding their abilities to treat athletes. But the course is also valuable to anyone from new grads to experienced practitioners.
“The longer you’re a physical therapist, the more different techniques and different approaches you’re going to learn along the way,” he explained. “Like we discussed, this course is centered on getting back to the basics, the most central elements of helping people get better and move better.”
In conclusion, Dr. de Smidt returned to his central philosophy of understanding the individual patient and what they hope to achieve in PT. “If you don’t understand the patient’s beliefs and their expectations, and if you don’t incorporate that in your treatment plan, you’re likely to miss the mark,” he said. “Just because I figured out the right treatment plan for you doesn’t take away the need to educate on the ‘why.’ Ideally, we spend a good amount of time explaining the importance of pain science and how it ties into treatment and exercise to ensure that we address all the questions and concerns the patient may have.
For more on Pieter de Smidt’s movement-based therapy course, visit here.