More Ways to Set the Stage | Modern Manual Therapy Blog

More Ways to Set the Stage

I have blogged many times about the importance of patient compliance. Patient interaction is most likely even more important than the assessment and interventions you choose.

Part of my interaction is setting a positive and encouraging stage on the first visit. This is also repeated over each follow up. Here is an example of a recent patient who came in because she wanted to avoid right knee surgery.
  • Pt was very concerned about how "crooked" her knee was and that the arthritis the doctor and specialist kept talking about was causing her pain
  • after the pain science education on threat and arthritis as a normal change over time, she still was not entirely convinced
  • this went on for several sessions until one day I said, "You are not allowed to use the word 'arthritis' anymore when you talk about your knee."
  • after this, I also asked her if her hands or right great toe hurt
    • she had moderate degenerative changes in all of her IP joints, which were stiff, but not painful
    • her right great toe used to hurt years ago, and has only progressed in it's valgus, but it does not hurt at all
    • I explained how much weight and force goes through push off, and that her toe was quite a bit more "bent" than her knee, yet it does not hurt
  • this seemed to do the trick in regard to the light bulb going off and decreasing threat perception based on a word and the structure of her knee
  • she recently flared up after doing some half kneeling chops, and then also twisted her knee walking through an unplowed parking lot
  • by the time she came to see me, she was almost at baseline again, but very discouraged from the flareup
  • the message I conveyed is that flareups happen, but they also end, it can be discouraging, but you have to look at it that you're almost feeling as good as you were prior to that
To sum it up... take control of the interaction and empower patients by having them not focus on thought viruses like "degenerative changes." All flare-ups are transient (technically nothing lasts forever).

Keeping it Eclectic....


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