Top 5 Fridays! 5 Points on Rapid Responders and Slow Responders | Modern Manual Therapy Blog

Top 5 Fridays! 5 Points on Rapid Responders and Slow Responders

Want a one sentence wrap up? Here's a hint, in general, most patients walking through your door will be rapid responders... ok, enjoy your Friday. If you want 5 ways to do this, read on!

1) ROM
  • Rapid Responders 
    • major loss of motion in one direction
    • this loss is a neurologic loss, motor control/stability, decreased movement tolerance due to perceived threat
    • have a directional preference
      • repeated end range loading into this makes them better rapidly, conversely repeated unloading in the opposite direction often negates that improvement or makes them worse
      • important to educate on avoidance of the opposite direction or position
  • Slow Responders 
    • moderate to major loss that is multi-planar
    • frozen shoulder
    • status post prolonged immobilization
    • they actually need tissue deformation to occur, which is why none of us have a magic cure for frozen shoulder
    • tissue deformation happens like hypertrophy, as in eventually with work
    • no directional preference, although using repeated mid to light end range loading can modulate pain rapidly in the common directions I teach in this video

2) Onset
  • Rapid Responders
    • typically insidious onset
    • typically has intermittent pain
    • varies with movement, position, activity, time of day
    • even if the pain onset originally was "chronic" the episodic nature often means rapid responder
  • Slow Responders
    • may have been traumatic, leading to excessive guarding, and eventual adaptive shortening
    • possibly occuring over time (still do not believe in the insidious onset of frozen shoulder - last one I saw was a rapidly responding cervical spine that limited the shoulder in all planes)
image courtesy of LadyTuesday17 via

3) Response
  • Rapid Responders - can have a significant and rapid response in
    •  ROM
    • pain - location, intensity, frequency
    • strength
    • function
    • DTRs
    • basically anything you can measure objectively
    • *** remember, you can also make a Rapid Responder worse rapidly
  • Slow Responders 
    • can still manage pain with education and OMPT modulatory techniques, so the pain response can still be rapid
    • by nature, you cannot make a slow responder worse rapidly - as in make a frozen shoulder rapidly more frozen, or ROM of an s/p immobilized limb dramatically decrease
    • you can flare up their pain, but it should gradually decrease in a normal response with rest, education and treatment

4) Length of Treatment
  • Rapid Responders
    • biggest changes should be within the first two visits with the rest to clean up movement patterns, and stabilize them 
      • stabilize means able to handle repeated load in the direction opposite to the directional preference that made them better
      • testing this should not
        • reproduce any complaints
        • reduce ROM in the directional preference
    • on average, 4-6 visits for a rapid responer
  • Slow Responder
    • since you're working with mid range movements and a gradual response to treatment, you expect a minimum 6-8 weeks for full restoration of function, strength, ROM
    • it's the ROM that there is no "quick fix" for since true structural changes cannot be made rapidly
    • which brings us to the next point

5) Educational Differences
  • Rapid Responders
    • great news! You fall into the majority classification that means I can show you how to make major changes in your condition today!
    • educate them that intermittent pain is great news, I always say it simply means 2 things
      1. You're doing things to perpetuate it
      2. you're not doing enough to keep it away
    • we should be able to find a direction and/or position that allows you to self treat and make rapid changes on this first visit
    • those rapid changes are up to you to keep between visits with a very simple program I'll give you consisting of 1-2 things for you to do repeatedly all day
  • Slow Responders
    • the good news first: we can help with your condition and I can show you self treatment for between visits
    • this type of condition luckily does not flare up by it's nature... it's slow both ways
    • the other news (not bad news): this is a tortoise and hare thing, slow and steady wins the race
    • if we keep up with weekly treatments (more than that will make them sore if you do too much too soon) and you're compliant with your homework, this absolutely will get better
    • give them a realistic time frame - 6-8 weeks of time and work
Bonus: Educational Similarities
  • both conditions can self treat
  • pain can be modulated (changed) rapidly for both conditions
  • light at the end of the tunnel for both - just one tunnel is very short and the other one is medium length
Keeping it Eclectic....


  1. If not insidious, what do you believe to be the precipitation factor in frozen shoulders and why? Thanks!

  2. I should have clarified. What I meant is that I have never seen a sudden onset of complete loss of ROM in all planes that was from true adaptive shortening. Sudden onset of pain that limits motion, sure... tissue is slow to shorten and to adapt to forces.