Matt Wallden | FC2O Episode 22 – Eyal Lederman Show Notes
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FC2O Episode 22 – Eyal Lederman Show Notes

Home > FC2O Podcast  > FC2O Show Notes > FC2O Episode 22 – Eyal Lederman Show Notes

2:08. Introduction – Eyal’s background

Eyal teaching his Process Approach
  • Yoga teacher
  • Trained in Osteopathy, London ‘82-‘86
  • Research: PhD
  • Centre for Professional Development for Manual & Physical Therapies
    • http://www.cpdo.net
  • PhD Supervisor: Functional Rehabilitation Post-Knee replacement
  • Books:
    • Fundamentals of Manual Therapy 
      • Do manual techniques have an effect on the motor control of the human body?  … “No”
    • Harmonic Technique
    • Neuromuscular Re-Abilitation
    • Functional Stretching
    • Functional Exercise Prescription 
      • How to exercise without exercising

7:37. Identifying the meaningful task

8:14. Active vs Passive Rehabilitation

  • Osteopathy almost 100% passive historically
  • All manual therapies needed an update
  • You can’t learn / enhance / improve movement if you’re not actively doing it
  • Passive techniques = input (sensory), but need to be coupled with output (motor)

12:22. Process Approach

Image borrowed from Eyal’s paper, “A Process Approach in manual and physical therapies: beyond the structural model”. Available on www.cpdo.net
Here, Eyal presents the examples of an acute back injury (top left), a person with persistent back pain (top right), and someone who has been immobilised – such as in a splint or cast. The amount of focus given to each of the 3 components of the Process of returning to a functional status vary from case to case.
  • What is a process approach?
  • Self-capacity, self-recovery
  • Functional Recovery – the ability to return to daily activity in some level of comfort
  • 3 overal processes:
    • Repair
    • Adaptation
    • Modulation / Alleviation of Symptoms
  • By which process will the person best recover?
    • Stimulation for repair / adaptation / modulation
  • Environment
  • Examples
    • Acute Disc Injury o/s 2/52
      • How will they recover function?
      • Repair will be focus
  • Limb immobilised – coming out of plaster cast
  • How will they recover function
  • Adaptation will be focus

 18:49. If repair is focus… do you recommend nutrition / lifestyle etc?

  • Repair process is robust
  • Malnourished?
  • 80% of patient advice is forgotten or remembered erroneously
  • Avoid complexity… 

20:31. If plaster cast is off – we’re more focused on:

  • Adaptation / Remodelling
  • Mimicking the motor action as closely as possible
  • “Breaking down a task to its components does not transfer back into integrated movement”  
  • Balance specificity is not transferable
  • Exposure is key – repetition & specificity

24:05. MET versus Squat in improving ROM in ankle dorsiflexion

  • Adaptation is driven by exposure
  • 1998 Stretching Research Paper: 
    • CORRECTION in the podcast I describe a paper from 1998… but this was it (from 1997)!
    • Gleim G, McHugh M 1997. Flexibility and its effects on sports injury and performance. Sports Medicine E1 24(5):289–299 
    • Stretching as adaptive load

28:15. Moving from Isolation to Integration

  • Task specific learning: 2 components:
    • Goal
    • Movement to achieve goal
  • These 2 are fully integrated
  • Isolation is disintegration
  • External focus (goal)
  • Internal focus (e.g. arm)
  • External focus results in 
    • more efficiency
    • lower EMG
    • greater transfer
  • Integrate in order to co-ordinate

32:59. Shirley Sahrmann:

  • Winging of scapula due to serratus anterior inhibition / weakness
  • Push-up with a plus does not help scapula winging
  • Functional exercises?  Or extra-functional movement?

34:52. Modulation of Symptoms: the 3rdcomponent of the Process Approach

  • We often have “pathologies” we’re unaware of
  • Can happen reflexively, spinal, higher centres
  • Game of Thrones analogy: when it comes to pain it is fantasy land… if you believe it, it’s quite likely to work well!
  • Next decade: understanding how people experience pain

37:22. Do we need to focus inwardly our outwardly?

  • It’s Fantasy Land so self-care can work for some, but not for all
  • Identify the process by which people can get themselves better… then amplify that process

40:01. How far do you go into Psychological Factors in your model?

  • Reassurance / cognitive tools / attentive to emotional & psychological state
  • Not depth psychology / psychotherapy

41:13. How to find Dr Eyal Lederman

  • Eyal’s papers, books and courses can all be found at www.cpdo.net