More on Rapid and Slow Responders | Modern Manual Therapy Blog

More on Rapid and Slow Responders

Here are some points from my recent lecture on Soft Tissue Patterns on Rapid and Slow Responders.

I also wrote about this here. Also, try google image for deranged person or derangement. Some odd results in there! Anyway...

I chose those terms as classifications instead of derangement and dysfunction because MDT clinicians often call a patient deranged. Who is deranged? A patient who is responding quickly to repeated loading or the clinician for calling a patient that to their face?

1) Rapid Responders
  • will have a greater than 25% change in
    • ROM
    • pain
      • location
      • intensity
      • duration
    • function
  • are often limited in one direction and have a directional preference (DP)
  • they are acute or subacute
  • if chronic, they most likely have episodic Sx presentation, despite having it for months/years, it goes away for long periods of time
  • do not exhibit signs of central sensitization typically
  • respond to repeated end range loading, and most manual treatments, but mechanically need the right direction to start moving and feeling
  • will have greater improvements lasting between visits
2) Slow Responders
  • are usually chronic in nature
  • may or may not have central sensitization and fear avoidance for movement
  • usually have poor motor patterns developed in response to pain and/or lack of mobility
  • will have less than 25% improvement in pain, ROM, strength, etc after a treatment
  • respond better to graded exposure to movement
  • need a lot of education on the importance of movement, but end range is usually not tolerated well
  • this may be an area that is adjacent to a rapid responding one
    • i.e. Rapid Responding lumbar spine, Slow Responding Hip
  • it's not no pain, no problem - get the slower responding DNs moving better to improve the greater picture!


  1. Way to put this in very simplistic terms E. I agree with your examples above. I usually teach that you should be able to get a 50% improvement in symptoms on day 1 so slow responders being at 25% makes sense. Never just flipped the coin in that direction.

    A big goal of all of us should be to get slow responders to fast responders and how the best way to fix this. I don't have an answer per say but could be future research and discussion.

  2. Something like the elusive true adhesive capsulitis is difficulty to get true and lasting significant changes on day 1. How to get them to respond faster? Most likely through education, decreasing catastrophization, and mid range movements. Also, treating more distal dysfunction that helps the painful area would be another way.

  3. Yeh good example. Unfortunately, a lot of these exmoles would fit nicely in easier to prevent than treat. But, good to know we are an option. Gotta get it out to public though.