Thursday Thoughts: The "What, Why, or How" - What is More Important? | Modern Manual Therapy Blog

Thursday Thoughts: The "What, Why, or How" - What is More Important?


If you have been implementing any ideas from my blog, you should be moving away from pathoanatomy during your patient interaction.

Here is a recent example of the Runner Case I posted about in August. On the second visit, he asks, "I know you're the expert, but when I got home, my wife asked, 'So, what do you have?'" He could only reply, "I'm not sure, he actually didn't give me a diagnosis."

My reply was, "You have knee pain." I told him about the recent study that showed patients who received MRIs for their lumbar spine had worse outcomes than those who did not. This possibly planted Thought Viruses in their heads, lowering the pain and movement thresholds.

I am transparent with my patients often saying

  • the "What" you have is less important than the "Why"
    • what often leads to Dr. Google, which leads to erroneous or bad advice
  • The "Why" is still often described as asymmetries in
    • movement and motor control (coordination)
    • lowering of pain/movement thresholds due to perceived threat by the CNS
    • loss of ability to load or bear weight on the spine - my modern take on MDT
  • The "How" is the most important, as in how do you self assess and treat
This may be difficult at first, moving away from the "patellofemoral syndromes," "shoulder impingements," "disc derangements," etc. However, it is the most realistic based on current evidence regarding pathoanatomy and how little it relates to what a patient's perception of their pain and condition.

Can you be transparent, and focus more on the "How," then on the "Why," and very little to no of the "What?" Trust me, in the end, it's very liberating and most patients appreciate honesty and the ability to self assess and treat. For those that do not, give your best educated guess.

Keeping it Eclectic....

3 comments:

  1. Any chance you have the authors and title of the study handy so I can read the article? I'm not sure if I have the one you are referring to or not.

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  2. Never mind I believe it is this one? http://www.bodyinmind.org/spinal-mri-and-back-pain/

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  3. Hi Dr E
    Big fan of your blog and approach.
    I agree wholeheartedly that it i about time that the medical field reflects modern understandings of pain. I do however feel in the acute setting there is still a place to consider the biological cause of pain. Not all patients will have the mental toughness and resilience of pain that others may show. If we can somehow determine the biological changes, particularly in central problems, we can both manage the driver for pain (biological) and all things that amplify it(everything else) much more effectively

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