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The ecosystem, or overall health of your patients is probably something you do not have to take into account in most of your cases.
Many patients have
- a minimum level of health/fitness so as to be able to respond rapidly
- a nervous that has not been peripherally or centrally sensitized for chronic or continuous periods of time
- do not have an overly negative home/work environment
Whether it's research by Chad Cook or the McKenzie Institute, up to 80% of patients, regardless of how long they have had their complaints have a readiness to improve (mentally, physically).
In patients that have chronic complaints, consider the ecosystem
- how much sleep do they get
- what is their diet like
- what is their home life like
- stress on the job
Here are a few examples of cases I have seen this year
Case 1 - Woman with subacute low back pain
- mostly attributed to having to take care of her mother who moved in with her 3-4 months prior
- pain started shortly after mother moved in
- she also had to wake repeatedly during the night to tend to her
- I saw her for a mentee who was discharging her after she called saying she was relatively pain free
- on that day she said
- she finally moved her mother into good nursing home
- she got the best nights of sleep in 3-4 months the last few days
- she is no longer repeatedly lifting/transferring her mother
- my mentee in the meantime, had to check on another patient, when he leaves the room the patient tells me, "The worst part is, my mother used to live with my brother, who it turns out stole all her money. After he bled her dry, he kicked her to the curb, which is why she had to live with me."
- hard to say it's just mechanical....
Case 2 - House cleaner with chronic right hip and low back pain
- lives paycheck to paycheck
- lumbar and hip scans, plus multiple orthos have told her she needs surgery on her lumbar spine and hip
- has "failed" traditional PT
- cleans several houses a day, every day, from morning until evening
- easy to think this is a lack of variability, but.....
- her daughter has several children, all with different fathers
- every single one has been taken by CPS
- most baby was just taken in by the patient
- she is also married to a less than caring husband
- she has responded to pain science, repeated loading, etc... but can also only come in for PT once a month or less
Every patient has their story, and it's important to note the overall health and well being of those that are just not responding to your conservative care. What would you do for the second case? Chime in below, on the forum, or facebook page.
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
Keeping it Eclectic...