At a recent The Eclectic Approach UQ and LQ Assessment, a participant pulled me aside at lunch and had a few comments.
He really liked the concept of a positive interaction and threat reduction. He realized long ago that introducing painful techniques to a caseload that was in pain made little sense. He worded it very eloquently, "When a patient has a painful technique done on them, and it's successful at decreasing pain, improving motion/function etc, the success is associated with the pain." I'm paraphrasing it, but I want you to think about that. How many times have you done a painful or uncomfortable neurodynamic stretch, 1st rib mobilization, pec minor "release," gotten some amazing results, and a patient commented, "No pain, no gain, am I right?"
If we know that pain can persist, altering perceptions of body awareness and motor control, why is it acceptable for any but a small minority of techniques under specific conditions to be painful? My short list of techniques that are temporarily uncomfortable would be
- lumbar shift correction for true shifts
- repeated loading strategies to a directional preference that changes within 1-2 sets
- after 1-2 sets if no changes are made, that's when I introduce another input (IASTM, joint manip/mob, compression wrapping)
- then I retest the repeated loading strategy
- if a patient already has true constant pain, you should at least try not to increase that pain during any movement/technique
David Butler says it best when it really should be, "No pain, no pain." Plenty of rapid gains can be made with completely pain free and non-threatening techniques. Once you learn that nearly every technique you can perform on a patient can a should be pain free, and you persist in causing discomfort, what does that make you?
Keeping it Eclectic...