2 More Ways To Motivate After a Flareup | Modern Manual Therapy Blog

2 More Ways To Motivate After a Flareup

Just as patients are thrilled when they rapidly improve, they are often equally if not more disappointed and anxious when they have a flareup or regression.

You've often read my standard "Your complaints just flared up? Great news! Rapid onset normally equals rapid resolution. It's a good thing you came in so quickly!"

Here are two more ways to motivate a patient during a flareup and prevent catastrophization

Scenario 1: Assuming a patient has progressed, and especially rapid responding after several visits, then they worsen for whatever reason....

"Don't worry, if you had pain for a much longer time, and we still improved you rapidly, there is usually no reason why we can't just do it again!"

  • unless there is actual physical trauma, an exacerbation can normally be dealt with rapidly
  • instruct them to double down on their MDT based HEP if they flare up and if there is no effect, give it some time
  • if in 1 day it does not rapidly improve with HEP/rest, call and we'll get you in ASAP
Scenario 2: If it was a patient who already been through step 1, or just did their HEP and/or rested appropriately and they came in better than the flareup

"This has been a great test of how well you're improving! Prior to PT and education, your flareups would last -insert longer time here- Now, it only lasted 1-2 days and you're already getting closer to the baseline prior to the flare up. Great job!"
  • any regression after improvement is worrisome for most patients
  • it's also part of our job to encourage and provide realistic expectations
  • part of those expectations are knowing how much is "too much too soon," or don't give on the HEP too early
  • it just happened today when a chronic pain patient had flared up after shovelling some lovely Buffalo, NY snow
  • at first she was going to call and try to get in, instead she located some spots along cervical patterns that I normally worked on, had her husband press on them
  • by the time she came back, her arm pain was centralized, and she was almost back to baseline
  • she said, "Instead of freaking out, I just tried what you normally do to me."

Bonus motivator:
  • I often describe some patient's ups and downs on a visual graph
  • "You have ups and downs, but if we drew a graph plotting them, it would go steadily upward, indicating overall improvement."

Now go out there and ease some anxiety!

Keeping it Eclectic...


  1. I find it harder and harder to get patients to NOT want the HEP early and often with the rising costs of therapy. Other than providing education on why continued skilled assessment is beneficial how else do you get your patients to slow down with their treatment?

  2. Dan, not sure what you're asking. You mean HEP to discharge? I give HEP immediately on day 1 and tell them that's the only thing that keeps them better, my treatment is just a secondary to what they're doing as homework.

  3. I think I misunderstood what you were saying above. I must have read it as not giving them a HEP early in the process so they didn't overdo it. I agree, you've got to give them the HEP very early in the process to get them on the path to independence without PT. Our manual techniques are adjuncts to allow them to complete their exercises with as little pain as possible.