Top 5 Fridays! 5 Questions You Should Be Asking to Non-Responders | Modern Manual Therapy Blog

Top 5 Fridays! 5 Questions You Should Be Asking to Non-Responders


Back to basics is a great principle! The more you learn, the more you realize asking simple questions often gets you enlightening answers.

As physical therapists, especially those of with MDT backgrounds are used to asking chronicity, MOI, and what makes the complaints better and worse. This fits in well with most neuromechanical/rapid responding patients. However, there are always seemingly confounding patients that elude our best efforts at treatment and education. Other than central sensitization, which there are no easy answers for, something is often triggering or contributing to their condition. So over time, here are 5 things I started asking about for the non-responders.



1) General energy levels
  • you would be surprised how many patients admit to abnormal fatigue during the day
  • fatigue could be caused by
    • lack of exercise
    • diet
    • dehydration
    • overbreathing

2) How is your diet?
  • you are what you eat, and in this day and age, that is usually highly processed foods with a lot of sugar and a general lack of good protein
  • cases like this one, where gluten was triggering her headaches, made me think more about diet
  • research estimates anywhere between 20 and up to 40% of individuals may have gluten intolerance
    • you can only test for Celiac's, not intolerance
    • the only way to check for this is to give up gluten, and see if any unexplained complaints improve
  • patients with chronic paraesthesia sometimes benefit from B complex (I did - what completely abolisehd the paraesthesia I was having last year in my right LE was B complex - I was low)
  • vit D supplementation has been shown to help pain, sleep quality, and quality of life
  • Here is a Quick Link to 12 Baby Steps to Optimal Nutrition by Authority Nutrition, a great blog

3) Do you drink enough water?
  • while that whole 6-8 tall glasses a day was pretty much made up decades ago, it's still a good recommendation
  • my guideline is that your urine should be the color of water or close to it
  • mild dehydration can cause headaches, dizziness, and fatigue in younger individuals
  • after I found out case #2 from this blog post barely drank any water at all, because "she did not like the taste" I finally stopped seeing her for chronic HA

4) Do you take time to yourself?
  • in this day and age we are often all too busy, and working out does not always count if you do it obsessively, it often does not function as a stress reliever
  • I often tell chronic pain patients to listen to an hour of their favorite music daily, or to in general, just do something they like
  • one chronic pain patient, a former dance instructor, with severe LE, lumbar, and foot pain told me she really missed tap dancing
    • I told her to gradually start tapping in her studio for a few minutes twice a week and work her way up
    • this literally changed her entire attitude about her condition and she was much less anxious (she often came in crying) - and that level of emotion has not happened since

5) Do you get enough quality sleep?
  • a recent study linked the quality and not necessarily the quantity of sleep to chronic pain sufferers
  • it bears repeating, but for those who do not sleep well, get off your tablet, phone, pc, or kindle 1-2 hours prior to sleeping
  • if that sounds like a boring 1-2 hours (does for me), you can block out the blue blocking sunglasses - here on amazon - and read/surf away prior to bed
    • this eliminates the signal that makes your body think you should be awake

Are there any other questions that are basic, but you added back into your histories that you'd like to share?

Keeping it Eclectic, and trying to get quality sleep (forget quantity!)....

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