In general, most patients fall into a Rapid Responder Category, here are ways to ensure you get a majority of the changes within the first few visits.
- Most patients will be in pain, and even if not, they still need the education on what pain is and more importantly,what it is not
- If you have not read it and implemented it already, get Therapeutic Neuroscience Education, it's my most recommended text
- education bookends all of my visits, from the beginning, with pain science education, the transient effects of any treatment, and how to maintain those effects with empowering self assessment and resets
- most people are pretty happy with "What if I showed you how to assess and treat yourself between visits so you wouldn't need to see me?"
- would you be rich if you had a dollar for every time a patient told you they have a high pain tolerance?
- some do, that is, until threat perception and pain and movement thresholds lower
- remember, most have intermittent pain, which I always tell them, "That is the best news you can give me!"
- even intermittent 10/10 pain means
- it goes away
- something is perpetuating it
- we can do things to keep it away
- even for slow responders, just be sure to get across that there is light at the end of the tunnel
- in terms of need, whatever you introduce to the patient, education, movement, manual therapy, is something novel and hopefully non-threatening
- education - dispels false beliefs perpetuated by well meaning clinicians (slipped disc, hips rotated, etc)
- repeated loading or corrective exercise - making movement less painful or pain free is one of the most empowering things you can provide to a patient
- manual therapy - harnesses placebo, the power of touch, and let's you hack into the nervous system to change unwanted output
- whatever it is they're doing, get across the point it has to be different
- even sitting upright (despite the lack of evidence correlating posture and pain) is still variability to most, and does for short periods of time reduce stress on many structures that may be under threat peripherally
- the bottom line is that the patient needs something different to be introduced to their routing that is perpetuating their condition
- just like how many patients need to work out with a trainer, athletes with a coach, or have an agenda to keep things organized, they need reinforcement
- now that I am cash based, I see most patients weekly, but make sure to be available via email or phone if there are any questions or concerns
- many patients also need to know to assess for asymmetries or loss of loading ability despite being pain free, the resets are also prophylactic
- for the more fitness minded individuals I tell them, "Use the same mindset for health/fitness as you do for self treatment. You don't stop working out/running after you attain a certain level, right?"
- “One thing we know, the better the therapist connects with the patient the better the outcome.” - David Butler
- this quote got a ton of retweets and shares from the online PT community and with good reason
- you patients need YOU!
- they need your compassion, humor, and equally important, your presence
- just because they're doing some exercise, does not mean you should leave them alone for more than 5 minutes
- we've all had patients perform an exercise correctly, then you come back after writing a SOAP and it resembles nothing you ever taught anyone in the history of movement
- the bottom line is, the patients and/or their insurance companies are paying for your expertise, not some piece of paper, or a bunch of passive modalities
I'm probably preaching to the choir here, hopefully, but I hope you enjoyed today's post and have a great weekend!
Keeping it Eclectic...