Thursday Thoughts: Be Mindful of Your Word Choices | Modern Manual Therapy Blog

Thursday Thoughts: Be Mindful of Your Word Choices

Unless we're talking gait, this is NOT HAPPENING

It drives me nuts every time a patient is worried about their bone on bone, degenerative hip, pinched nerve etc. Here are my current word replacements for common Thought Viruses.

Pinched Nerve - Replace with Nerve Irritation or Sensitivity
  • what sounds better to you? Pinched sounds like something is getting damaged
  • educate that your sciatic nerve, one of the largest in the body, pretty much gets sat on all day, nerves are wonderfully strong, flexible, and resilient
  • they can get irritated like any area of the body, but also new ion channels, can get made and replaced in a short amount of time
Protruding Disc (D-bomb) - Replace with Flexion or Extension Sensitivity
  • it may be amazingly convenient for us clinicians and easy to understand, but the jelly donut theory should not be used, because as a theory, it kind of stinks
  • educate that 87% of cervical patients males, and females even in their 20s have disc herniations, but no symptoms
  • instead of saying, bending causes protrusion, and extension reduces it, I call it "Flexion Sensitivity, and intolerance to loading."
  • Repeated loading or graded exposure to the novel position (often extension, unilateral loading, or retraction in the case of cervical spines) is what decreases the threat assessment, not reduction of nuclear material protruding
Degeneration with Crepitus - The Click 
  • doc says I will need a hip/knee replacement because of the bone on bone or severe degeneration plus spurs
  • I probably get asked about a clicking hip, or shoulder that also just happens to be painful with movement 1-2 times/week
  • my first response is, "if it did not hurt, would the clicking bother you?"
  • example - yesterday a patient who was told she would need hip and or back surgery, is on pain meds and has been seeing pain management for years, is worried about the snapping in her hip
  • however, when questioned, her right shoulder, which also hurts, but not nearly as much, also clicks
  • I stated that due to the threat assessment for her hip, because of all the bad news she has received from other clinicians in the past, the clicking is "just another thing" that adds up to the summation of danger
  • most people do not care about clicking or snapping in the presence of full pain free function
  • with clicking/snapping, you have two options 1) keep moving 2) stop moving
  • we can modulate the pain and reduce threat with movement, but it may be harder to make it 100% sound free, what would you choose? - most are fine with pain reduction
These are just some examples I cover regularly during my patient interactions. Maybe someday Pain Science will be standard in more health care curriculums so those of us who are fighting the good fight won't have to die a little inside every time someone says their back is out.

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...


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