Thursday Thoughts: Is Your Patient Sore from Treatment? They Shouldn't Be! | Modern Manual Therapy Blog

Thursday Thoughts: Is Your Patient Sore from Treatment? They Shouldn't Be!

Sore from general strengthening and conditioning is one thing, sore from manual treatment, particular soft tissue work or joint mobilization/manipulation is another.

If your patient is sore, you are most likely over treating. Your paradigm should be to introduce the least, but most effective manual therapies/inputs to help reduce threat and get the patient moving. There are a few ways to accomplish this

  • start with light IASTM across broad tissue patterns and re-test movement
  • choose one other intervention to stimulate the nervous system, joint mobs, neurodynamics etc

The next 2 points are the most important
  • use each treatment you choose for LESS duration
    • it's often not only choosing too many treatments, but spending too much time in one area and doing the same technique over and over can be irritating
    • I recommend for IASTM/general mobs to perform for 30 seconds to 2 minutes per area depending on how large, and patient response
  • move on to another to another area quickly
    • example: shoulder patient
      • IASTM to cervical, scapular patterns, lateral upper arm, 30-60 seconds each
      • cervical retraction with SB repeated motions 20-30 reps
      • should mobs another 1-2 minutes in various wiggles
Most evaluations and follow ups should follow a similar pattern. If the patient has many asymmetries to address, choose first the proximal DP and then move onto the more asymmetrical or relevant distal DN next. You do not have to do everything at once. Things have a way of working themselves out once threat is reduced and confidence in movement is restored.

Keeping it Eclectic...


  1. Great stuff Dr. E. This is one thing I discuss quite a bit with my student right now. Quick follow up question. When working with post-op (Rotator cuff for example) where docs may want full ROM by week 8ish where do you fall on the soreness discussion? I often find these patients are extremely sore and if we didn't push into some of this soreness perhaps we wouldn't get the results we need. That being said I feel I fall on the spectrum of causing less pain / irritation then some of my colleagues in this population. How do you address these patients?

  2. Thanks, as always for the excellent post. How long are your average treatment sessions? Or do you have so much variety in patients that it varies too much to estimate an average?

  3. After surgery or any other trauma, there is natural peripheral sensitization of the primary area and surrounding secondary areas. When the nervous system is ready (if it gets ready) the soreness will decrease. If they're already sore, they should not be MORE sore, if they have no pain/soreness, you should do your best not to create soreness with your techniques.

  4. Anywhere between 30-60 minutes, but some are as low as 20 minutes. In general I move around and treat a lot of areas as their SFMA dictates and as necessary. I rarely spend more than 1-2 minutes per technique and area before moving on.