PNF Basic Principle - Therapist Position

“Having good body mechanics” is typically brought up in conversation in regards to therapist position and protecting yourself from injury as a manual therapist. This is absolutely true, but the conversation should not stop there.

When performing neuro manual therapy the therapist’s position/body mechanics can be the pivotal factor in a successful treatment of facilitating the desired motor response in an otherwise “flaccid/toned” extremity.

When performing Orthopedic Manual Therapy, the therapist’s position/body mechanics can be the reason why the joint/soft tissue mobilization “doesn’t work”. Being meticulous about the details of therapist position/body mechanics can help you continuously grow and excel as a manual therapist.

Below are just a few helpful checklist questions to ask oneself in regards to this principle. If you are aware of these details when performing most manual techniques, you will find yourself constantly refining the technique as you grow and that the technique becomes more and more effective.

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1.     Where should I stand?  
2.     How should I position my feet? Or… What direction should my feet be pointing?
3.     What direction should my forearms be pointing?
4.     Are my shoulders hiked up to my ears? If so I need the awareness to cut that out.
5.     Are my scapulas connected to my trunk?
6.     Am I effortlessly creating a stable spine so I can transfer ground reaction forces from my legs, through my trunk and arms and into the patient to effectively deliver the desired treatment?

Questions 5 and 6 are the key elements in order to allow your arms and hands to be relaxed and serve as “stethoscopes” to “listen with your hands” and feel the response of the patient and adapt accordingly, rather than the arms being the primary source of force production. You can begin to appreciate how the basic principle of Therapist Position is interdependent with the principle of Manual Contact.

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Unbelievable advances in diagnostic and treatment technologies have been made in both orthopedic and neurological rehabilitative medicine over the past several decades, such as Xrays, MRIs, diagnostic ultrasound, and the list goes on.

Unfortunately, these advancements seem to have taken attention away from, and even replaced, the basic principles, and the art of manual medicine, such as therapist position and manual contact, which has consequently atrophied our ability to have a “stethoscopic” sense of touch during assessment and treatment of movement dysfunction. 

A highly trained manual therapist with this sensitive form of skilled touch can add a very insightful perspective on possible causes of movement dysfunction and supplement the information provided by diagnostic technology; especially when diagnostic technology can’t give us a good answer. 

Ramez Antoun