Since adapting much if not all of my techniques to have pain free versions, I am becoming known as someone who preaches "never cause pain."
That's great! However, never and always are two words that should be avoided as there are always exceptions.
Exception - Constant Pain
- true constant pain that is not relieved by any motion, position, or modulatory technique
- in this situation, your goal through manual therapy, position, or repeated loading strategy should be to either minimize pain or make movement and positions more tolerable
- exercise and movements should not worsen it, and if temporarily increased or irritated, should not remain worse for more than 1-2 minutes after the activity is over
Exception - Eccentric Loading for Tendinopathies
- eccentric loading is a great strategy that has been proven in multiple studies and also validated in the long term (up to 5 years later)
- however, it can be very uncomfortable
- I would definitely instruct that hurt does not equal harm, and give the patient a level they should not exceed
- I am also careful to word it as "discomfort" during exercise is ok, but "pain" is not
- manual therapy such as light IASTM along the chain/pattern or compression wrapping with an EDGE Mobility Band can modulate this discomfort, this making the loading strategy more likely to be dosed correctly
Exception - Painful Lateral Lumbar Shift or Cervical Torticollis
- in most of these cases, it is key that you reduce the shift first and worry about peripheralization or pain second
- in many cases, the pain does improve with returning to neutral
- just remember when performing either lumbar or cervical repeated loading strategies to "straighten" someone out, to be careful and give them frequent breaks and to go slow
Interested in live cases where I apply this approach and integrate it with manual therapy and repeated motions? Check it out on The OMPT Channel!
Keeping it Eclectic...