My name is Dr. Sue Leger and I am a Physical Therapist. When I graduated from PT school in 1979, I had many unanswered questions. There had to be more. More components. More detail. More progress. Who had the answers?
Signing up for every continuing education (CE) class I could get my hands on, I was quickly informed by my employer that only one CE course would be approved and paid for every two years. That was ridiculous. My first year after graduating I attended 8 CE workshops and I have not slowed down yet. I began giving trainings at work my first year out, and this evolved to now having taught hundreds of times, speaking locally, regionally, nationally, and internationally.
Excelling in one component after another, I soon became aware that I was not a purist. The masters themselves revealed to me that there was no one magic bullet to progress a person past the plateau of traditional predictors of outcome. Putting the components together was the key. ‘One-on-One’ treatment ratio permitted me to optimally focus my protocols. Understanding the precise timing and sequencing required for the ‘Multiple Component Cycle’ began my journey of gaining outcomes well beyond traditional rehabilitation. Acknowledging the role of the autonomic nervous system (ANS) and the Mind Body connection in recovery, as well as mastering techniques for enhancing repair and regeneration physiology, became the ‘Global Start Up’ needed to progress these protocols into a true Symptom Recovery Model (SRM).
SRM = ‘One-on-One’ + ‘Global Start Up’ + ‘Multiple Component Cycle’.
SRM is a collection of workshops and manuscripts featuring Symptom Recovery Programs (SRPs) that have had significant outcomes for hundreds of patients well past traditional predictors of outcome. I also am sharing advanced Manual Structural Correction (MSC) that is a necessary component for making these optimal changes possible.
Of all there is to know, I know very little. I know enough to move a patient off the plateau of traditional rehabilitation outcomes into the realm of true Symptom Recovery. Striving to find the parts that make up the whole.
– Sue Leger, PT, MS, PhD, ND, IMD, DPT
The Developer’s Historical Perspective on Symptom Recovery Model Physical Therapy
Physical therapy was born during the polio epidemic in the early 1900’s. There was a critical need for a specialization beyond nursing, that focused on a symptom recovery model for this vast group of patients. The field of physical therapy, founded as a symptom recovery model (SRM), consisted of one-on-one attention, utilizing a precise component cycle of five separate but distinctive interventions. The founding five component cycle included sensory (therapeutic touch, tapping and massage), manual therapy (deep tissue massage, range of motion, and light stretching), modalities to promote circulation (salt baths, heat units, electrical stimulation and whirlpool), and joint alignment strategies (constant joint positioning, body wraps and bracing). The fifth component of this original SRM PT was exercise, forming the basis for muscle re-education, therapeutic exercise and gait training.
Research and development greatly expanded the effectiveness of each of the individual therapy components and drove the single-component study focus, stimulating the formation of single-component models. Single-component programs for manual therapy developed, such as Janet Travell’s Trigger Point Therapy, Lawrence Jones’ Strain Counterstrain, Upledger’s Cranial Sacral Approach, The Alexander Technique, and Integrative Manual therapy. The single-component model for exercise speared single component programs such as Proprioceptive Neuromuscular Facilitation, Neuro-Developmental Treatment, and Feldenkrais. Jean Ayers (occupational therapist) began the single component focus on sensory with her Sensory Integration and Praxis movement.
Over time the original multiple component cycle defining SRM of Physical Therapy treatment to alleviate symptoms during the Polio epidemic was vastly diluted. Current rehabilitation does not resemble the historical Physical Therapy start of one-on-one multiple component cycle intervention. It is difficult to find a One-on-One PT program of any type. PT programs have evolved into 2 to 1, or 3 to 1 exercise factories, and it is difficult to find a program with more than 3 components even available, let alone precision sequenced for the patient’s benefit. Even the electrical stimulation used in the early 1900’s to reduce pain, protect the joints, and begin functional return has not yet been re-established, let alone sequenced with other interventions. When there is excellent performance based exercise, where is the structural manual therapy, sensory preparation and cuing, low level electrical stimulation, corrective pattern resistance, followed immediately by lymph drainage and taping!
Returning to a Symptom Recovery Model (SRM), Dr. Sue Leger demonstrated functional progress well past predictors of outcome with 9 persons with spinal cord injury (2004 doctoral dissertation) and in a 60 person study with persons diagnosed with Charcot-Marie-Tooth Disease (2012 doctoral dissertation). This Symptom Recovery Model of Physical Therapy orchestrates one-on-one focus of timing and sequencing between and within a precise multiple component cycle. The components include mind body assimilation, manual structural correction, modalities such as cold laser, low level electrical stimulation and dry needling, sensory and vestibular assimilation, corrective pattern resistance exercise, alignment through taping and bracing, and beyond.
Good Health to All,