Top 5 Friday! 5 Answers to a Patient's Common Questions | Modern Manual Therapy Blog

Top 5 Friday! 5 Answers to a Patient's Common Questions

A long time ago, someone once told me I had an answer for everything. While that is definitely not true, it is one of the reason why I take courses, read research, and think about explanations and mechanisms behind what we do.

Many of the explanations I use are either metaphors or just simple explanations to reduce threat/anxiety.

1) Why do I hear sounds in my ears when I do neck retractions? - Because you have joint sounds and your neck is your only joint with ears. - edit: Dr Greg Lehman on twitter said "Because your neck has the ability to move."

This was with a high anxiety patient, who recently had two bouts of whiplash, is stuck in a sternal breathing pattern, and now very limited cervical rotation. RockTape to cervical and upper trap patterns after light IASTM helped, and working on her scapular stability, along with a balloon to emphasize diaphragmatic breathing. However, the biggest help was the Explain Pain approach, and also recommending the Mindfulness text. We're only 2 visits in, but she's is also a marathoner and fitness model so I think she'll do fine because of her drive.

2) I did exercise "X" two days ago, is that why my body part "Y" hurts now? - No, that would be like saying your stomach is upset today from a meal you ate two days ago.

In MDT, a simple mechanical explanation for whether or not a certain exercise, workout or activity is worsening your complaints is

  • if it hurt during the exercise, and remained worse, yes, it was that exercise
  • if you worked out and did not worsen until hours later or the next day, it is most likely not the workout
  • that's it! - while there are some exceptions, for the most part the whole 1-2 hours of positive changes we get from manual therapy/exercise also go for negative changes
  • this leads to the...
3) 2 Hour Rule! Hey, that technique/exercise you did on me really.... hold your breath because it could be either a) Made me so much better! or b) Killed me!
  • I'm always clear on telling people their upper trap is not KILLING them... I say, "Your upper trap is not slowly leaking poison into your body, I know it hurts, but let's face it, it's not killing you."
    • to sugar coat it, "You're flared up! Great! Rapid onset = rapid resolution!"
  • my next question is, how long after were you flared up? If it was more than 2-3 hours, we do not take responsiblity for it
  • especially using MDT as a primary form of HEP, I end up doing sometimes upward of 30-40 end range repetitions before they leave, most patients will probably not get to the same end range and be lucky to do that many before they go to bed
  • so if we did 30-40 over the course of 30 minutes, and you did 30-40 the rest of the day, but spread out over several hours, most likely it was not the exercise that flared you up
  • case in point today, a patient just told me this, HEP review, was rotating head instead of SB toward the involved UE for sliders, plus she was hiking and tensing upper trap while doing median nerve like sliders instead of radial nerve
4) How long do I have to do these exercises? - Only as long as you want to remain better!
  • often patients start to fall off their HEP as they start to get rapid improvements
  • the frequency/mode depends on their improvement and obviously most patients stop much of their HEP
  • the habits and movements/postures that brought the complaints on in the first place should be avoided for the most part and they should have a built in self check to see if they need to double down on their HEP
5) Do you mind if I see another practitioner for the same condition? - Short answer, Yes
  • the other practitioner, often is someone they were seeing for maintenance, like the biweekly massage or monthly adjustment
  • if these things were making you better, you would not need maintenance as only a small percentage of the population needs maintenance
  • also, PT works best when it's a dictatorship that helps you meet your goals. This also means that any previous exercise/stretches given by another practitioner should be stopped. Too many cooks in the kitchen as they say!
  • I do tell patients they may go back once we're finished, but just give me 4-6 visits to see what we can do together (in our little dictatorship)


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