I’ve been an RMT for 18yrs and I instruct manual therapists in Ligamentous Articular Strain Techniques (L.A.S.T.)
I help manual therapists improve their precision and skill in treating joint dysfunctions.
Challenges!
When I first started my career as an RMT 18yrs ago, I wondered what else could I be doing for my patients? Was there something that I’d been missing or a reason why this injury hadn’t progressed as we had hoped? I became frustrated because what I had been told would work, hadn’t in many cases. I felt that there was something missing from my education, from my treatment techniques, something more that could be done to help a patients.
My story of struggle
I grew up in a small town in Moose Jaw, Saskatchewan Canada. In high school, I had a couple of serious injuries
In 1987 while in grade 10 gymnastics class I suffered a spinal chord injury. This injury initially came with the somewhat typical effects of inability to breath, full body numbness and tingling, altered sensations and so on. It herniated 3 vertebral discs (C3, 4, 5) centrally into my spinal chord.
It’s quite an experience knowing that you are supposed to breath, knowing what happens when you don’t and not being capable to do so.
To make a very long story short, I was incredibly fortunate. The injury did not completely sever the chord. It bruised the meningeal tissues which allowed me to recover to a point where now my symptoms are minimal in comparison to what others have gone through. I am truly blessed.
In 1989, while being a typical teenaged boy, I foolishly slid down a stair rail, lost my balance and fell backwards. Performing a somersault in mid air, I ended up landing on all fours first with my left knee, next my left wrist and then the other side. I shattered my left pelvis, left distal radius and ulna and suffered a comminuted fracture to ALL the carpals of my left wrist.
Once again I was on the long road to recovery. Although we all think that at an early age we are all made of rubber and magic, these injuries have taught me that they honestly never go away. Injuries that your patients may have suffered from at an early age, most likely are contributing to the current physical environment that they are attempting to be functional in today. I know mine are!
I’d had treatment from physiotherapy that although taught me how to walk again, didn’t address the inefficiency of my gait due to my dysfunctional alignment. Although the casting position and the orthopedic surgeon did an amazing job at positioning and setting the bones to allow my little osteoblasts to perform their construction duties, the dysfunction that was present within the ligamentous and membranous tissues was never dealt with. The concern once again was learning how to walk and gain some use of my whole left side.
I have always had a sense that I would be employed doing something constructive with my hands, but didn’t know what that was. Massage Therapy presented itself to me and I knew instantly during an introductory course at the West Coast College of Massage Therapy, this was the direction my life was meant to go in!
Due to an enrollment wait list at WCCMT, I enrolled at Canadian College of Massage & Hydrotherapy in Ontario where I graduated in 1994. Massage during school felt great and was able to deal with a majority of the muscular compensation issues I was having, but I continued to have these compensations.
I received chiropractic treatments, which although felt good at the time and had longer lasting results than any other treatment, was ineffective in that it was missing the soft tissue component and was too quick of a technique.
Finding a solution
I’ve always been concerned with my patients “alignment” since it was one of my main concerns. If I was out of alignment in some fashion, I became dysfunctional. My patients were no different. I have great empathy for how they feel and the decrease in quality of life they suffer. After graduation, I took 1000’s of hrs of courses that dealt with alignment techniques. I took courses from all my mentors and people I looked up to in the industry and I learned a lot from them. I read books watched videos, took the cadaver courses from Gil Hedley. I implemented all of their techniques and got some great results, but I was always left wanting to be more specific, more precise.
I became aware of a distinct, immediate and on-going problem. There was a lack of knowledge and instruction in the effective treatment of the joint tissues and how they were connected, contributing to the muscoluskeletal complains of my patients. I’d gotten to a point where I realized that utilizing aggressive painful techniques that assaulted the tissues was not an effective form of treatment. I needed something that co-operated with the tissues, allowing them to dictate the pace and course of treatment.
I started reading manuals and books from A.T. Still DO and learned what he was doing to treat alignment issues in his patients over 100yrs ago. L.A.S.T. is primarily an Indirect Osteopathic technique developed by William Garner Sutherland DO based on principals and techniques developed by A.T. Still DO.
Over the last 12+yrs, I’ve spent more than 15,000hrs researching, learning, updating, and practicing the techniques. I’ve thrown some out and developed some new ones to take their place. The whole reason for practicing this technique has always been to improve my patient’s quality of life!
Results/What I’ve achieved!
The one thing that possibly sets me apart from other manual therapist is my injuries. They have taught me a lot about how tissue reacts, what it needs and how it is trying to show the therapist what it needs in order to function more efficiently.
Day to day, in my full time practice, I have new patients that present some of the most difficult injuries and conditions to treat. Although no injury is easy to “fix”, I definitely do not get the easy patients.
Examples of patients that have benefited from L.A.S.T. range from the common office worker, MVA injured patients, MMA fighters competing for the UFC, elite athletes ranging from triathletes to soccer players, patients suffering from autoimmune diseases such as Rheumatoid Arthritis, Osteogenisis Imperfecta amongst others.
Old world, new world
I’ve discovered that some of the old world theories about how to treat didn’t fit into what I was finding. I’d gotten to a point where I realized that utilizing aggressive painful techniques that assaulted the tissues was not an effective form of treatment. Loading through the barrier didn’t seem appropriate any longer.
I needed something that worked with the tissues, allowing them to dictate the pace and course of treatment.
Today we have an ever growing amount of research into how the tissues respond to manual techniques. We know more about how the tissues interact with one another and how they provide information not only about our surroundings but the process’s within our own body.
There is a wealth of information the body is trying to relay to us as therapists about what it needs in order to function effectively… we just need to slow down to listen to it and follow its lead.
The solution
In my courses, we talk a little about a few of the mechanoreceptors that are located with in the various tissues of the body and how they work and interact with our systems.
We discuss moving from an efferent to an afferent perception of how we attain information from our patient’s tissues. We move from palpating or looking for information to sensing the information the body is relaying to us.
We look at the 3 basic principles of L.A.S.T.:
1. We talk about how we “Disengage” the tissue from its holding, compensating dysfunctional patterns.
2. Then we “Exaggerate” the end position following the barrier, but never loading through it or forcing it to go in a direction “WE” think it needs to go in.
3. After the position has come to its end point or “Balance” point, we allow the body what ever time it needs to make the correction from being dysfunctional to functional.
Most common mistakes
These are some of the dos and dont’s that you will need to consider when implementing these techniques into your treatment plans.
We discuss clinical Principles which include CI’s Precautions & Indications.
We must always remember that each patient is completely different from each other and how they were from the last time you saw them.
Each patient feels pain & discomfort different from one another and from one day to the next. The tissues hold a multitude of emotion and information about your patient’s lives that may not have been brought to the surface until you started treating with this technique.
Remember to sit and wait. Have some patience in “co-operating” with the tissues. Don’t do to much to fast all at once.
Thanks for reading. I look forward to meeting you in one of our courses.