Top 5 Fridays! 5 More Mistakes I See in the Clinic | Modern Manual Therapy Blog

Top 5 Fridays! 5 More Mistakes I See in the Clinic

Some of the more popular Top 5 Fridays Posts involved 5 mistakes in the past, here are 5 More Mistakes I See Others Make and Have Made Myself.

1) Assuming there is a one size fits all to a certain patient presentation
  • I have been guilty of this for many conditions in the past
  • whether it's no orthotics, everyone needs orthotics, everyone needs Pain Science Education, or everyone should run with a midfoot stance
  • there is no one size fits all, one treatment or assessment to rule them all because there are ALWAYS exceptions to the rule
  • there is also too much variability in patient's activities, beliefs, nervous systems, overall health and variables in general for any one treatment/assessment to cover all cases

2) Trying to get a patient to buy into a certain assessment/treatment
  • Whether it's these exercises will reduce your low back pain (or disc protrusion), or Pain is an output from the CNS in response to perceived threat
  • you ARE going to lose some patients with your explanations, rationale, treatment and assessment
  • experienced clinicians know when patient's eyes are glazing over and can immediately switch gears to a presentation they feel the patient will more readily accept

3) Buying into any particular guru or system's approach
  • this gets a good amount of clinicians into trouble somewhere along the line
  • I've said it many times before and I'll repeat it again, no ONE commercial model is going to get you their promised 80% or more success
  • in order to get a particular faculty member's success rate, you have to BE that person, using the same mannerisms, confidence, charisma, interaction, placebo and more
  • learning many different easy to understand and implement systems, and keeping it simple to a few treatments and home exercises work well for most cases

4) Trying to force compliance out of a non-compliant patient
  • some patients are not buying that you (or anyone short of surgery or miracle drugs) can help them
  • basically, my 2 visit leash for zero changes also applies to non-compliant patients
  • you’ll save yourself a lot of frustration if you just refer out to someone they think can help them

5) Treating too locally, or treating too globally
  • sometimes, a neck patient is just a neck, and you do not need to address breathing, thoracic spine, core stability
  • other times, an elbow patient with medial epicondylalgia has previous history of knee surgery and their lack of hip, tibial IR is contributing to their complaints during golf
  • what works for me is to address the proximal complaint/function first, then look at least one joint proximal and distal to be sure, then go after distal asymmetries

Check out our Therapy Insiders Podcast on Common Clinical Mistakes and How to Avoid Them here!
The next few weeks, there will not be regular updates until after the holidays. Maybe 1 blog post a week until after New Years. Thanks for reading and making The Manual Therapist what it is today!

Keeping it Eclectic...


  1. Late to the party on this blog post but it is so dang true, all of these! Trying to force compliance out of a non-compliant - that is something to heed. I've learned this through experience - I used to beat myself up thinking those patients who, let's face it, won't ever do their homework, was the fault of my approach. There are just certain ones who want passive everything and finding this out right away is so helpful. On the other hand, sometimes it IS my approach and something else will stick in having them be compliant.

  2. Great reminder. I work with some good physicians. I doesn't hurt my ego to refer out to them

  3. Great Summary and reminder Dr. E that there is no one size fits all and what works for your colleague in the next room over may not work for you. What we do after all is an art form and each of us must develop our own style and be flexible enough to change the approach when the patient is not buying in.