Let me tell you the 4 reasons why your manual technique didn’t work and how to prevent them.
Manual techniques are an essential part of treatment in physiotherapy. They’re not everything, but they are important.
It’s true that some children with more neuro-sensory-motor alterations require more stimulation or reeducation, in addition to a clear and well-systematized intervention on their environment.
I want to tell you that even though we put a lot of effort into learning techniques—and that’s understandable—there is something more important. It’s clinical reasoning. That’s where you should put your energy. Techniques come afterwards.
Here are the 4 reasons why your manual technique didn’t work
1. You did the technique wrong
I’m sorry, I have to say it. You didn’t do it right. You placed your fingers where they shouldn’t be, you used too much force or not enough intention. You didn’t have your finger on the C1 transverse processes. Your hold was superficial, not deep.
How you can fix this
Go back and watch the videos from the PIMT course you did. If you did another manual therapy training, go back to the videos you probably recorded—or at least to your notes.
The problem is that if too much time has passed or you didn’t practice much, it will be difficult to relearn the technique from the videos or your notes.
If you see that you need the technique and can’t access the information to do it properly, it might be happening to you with other techniques too.
Advice: retake the course, if it was worth it. No doubt, the best option—but few take it. Those who go far are the ones who do.
2. You didn’t choose the right evaluation parameter
This is a common problem. If you’ve taken the PIMT Essential or an advanced course, you’ll remember the teacher’s phrase: “How will I know I did a good job?” “What can I measure before and after?”
It’s important to choose your parameter well.
If you choose a parameter that’s too complex—like an activity or a complex function, which depend on many factors and usually need to be reeducated—you might think the technique didn’t work, even if you did it perfectly.
For example, if you’re treating a baby’s neck, a passive rotation parameter is better than an active rotation one. Passive is what will change the fastest. In contrast, active rotation depends on motor control and the environment. Therefore, it’s more complex.
How you can fix this
To evaluate the result of a technique, choose simple parameters of structure or passive function.
This way you’ll know exactly the result of your action, independently from the sensori-motor aspects that require more reeducation work.
3. You didn’t do preparatory techniques
Another common issue. You go straight to the area that needs treatment.
There’s a neck problem and you go directly with a cervical technique.
If you apply the technical principles of PIMT, this shouldn’t happen to you. Going straight to the problem area is uncomfortable, you have to apply a lot of force and insistence to resolve it. But even so, there are important influences you’re not taking into account.
For example, the aponeuroses. These should be treated before the joint work.
How you can fix this
Plan your techniques well to treat the most important area last.
The metameric and aponeurotic techniques you learned in PIMT allow you to gradually improve the tissues, without the risk of overdoing it.
But they also multiply the effect of your local technique.
4. It wasn’t the place you needed to work on
Oops, you treated the wrong thing!
You thought it was that, but apparently it’s not.
Example: you treated the digestive aponeurosis well, but the neck tilt didn’t improve. It’s possible that it’s the respiratory system that’s causing the stiffness.
Sometimes this may be a sign of a more serious underlying issue that requires medical treatment.
Other times, you’re simply in a place where nothing will change.
How you can fix this
Do a good analysis of factors and clinical reasoning before starting treatment.
It will allow you to identify the main areas of work, which you’ll gradually confirm or rule out as you go along.
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