1) In response to, "Do I really have to do this?" - "Only if you want to get better."
- the home exercise program, it's not an option
- not only is ther ex and corrective ex self treatment, it's preventative too which leads to
2) "How long do I have to keep up with these exercises?" - "For as long as you want to stay better."
- this is mainly for derangement reduction and postural correction exercises
- patients may not be performing exercises hourly upon discharge, but repeated motions and movement patterns are self screens
- with any sign of movement loss or pain during movement, the exercises frequency should be increased for 1-2 days, then call us if there is no change
3) "The TMJ is not a weight bearing joint"
I cannot tell you how many times I have asked patients if they have any habits or repetitive postures that would have caused their increase in complaints after they have improved. I then do my notes after treatment and see them speaking with the office manager in "the thinker" position, often WB on the involved side!
4) "What does 10 times/hour mean?" - "It means 10 times/hour"
- a recent study showed the temporal neurophysiologic effects of a single mobilization last up to 5 minutes, and the hypoalgesic effects may last up to 24 hours
- why not capitalize on the neurophysiologic effects and have someone self mobilize several times an hour, all day?
- this would continue to promote a hypoalgesic effect, decreasing perceived threat, increasing movement tolerance, and thus also promote compliance, the perfect circle!
5) "Will you look at my x-ray/MRI/CT/EMG... etc?" "No, unless you have a tumor or fracture or something else I have no business treating, your x-ray is just confirming you have a shoulder/lower back, etc.." "I do not need to know what your neck/back looks like when you are lying in a tube. That does not tell me how well you move, or your strength and abilities." "I base my treatments on my examination, not a picture of your spine."
- patients find it amazing when you explain the statistics of positive findings in asymptomatic individuals with studies ranging from 30-80% depending on the study
- If they have intermittent pain, "Your lower back still has the same 'kisses of time' whether you have a good or bad day."