If you assess, treat, and educate patients, you should be using repeated motions. If you want the short of it, you can just stop reading there.
1) Repeated Motions Are Reliable
- the least any of your assessments should have is reliability
- research shows that a repeated motions exam is a reliable means of classification
- classification also tends to enhance clinical decision making and improve outcome
- validity, is another question, but depends on the model and framework/mechanisms of explanation you are using behind repeated motions
2) Not Based on Pathoanatomy
- at their purest form, repeated motions are a form of Graded Exposure
- the more you dose and repeat a motion into a direction that was threatened, the less threatening that motion becomes
- upon restoration of end range, other planes of motion in the same area seem to be restored, just like doing any other reset/input to the area
- this is assuming you are not using convenient, but inaccurate mechanisms of explanation like the jelly donut theory
3) Replication of manipulation/mobilization effects
- if the effects of all manual therapies are transient, how do you expect the patient to remain better?
- they can't exactly perform most mobilizations/manipulations on themselves
- however, using repeated motions someplace in your treatment, along with the explanation that the effects are the same as your passive manual therapies is empowering
- this enables them to continue to dose, and keep the brain as safe as it does in your clinic
4) Built in special tests
- if you follow a pure repeated motions exam, and check most planes of movement, you're bound to find repeated directions that increase and decrease the patients motion and Sx
- why do tapping, palpation, or positions/movement of provocation separately? - they only tell you what not to do and potentially further sensitize the nervous system
- the repeated motions exam is a natural step after checking motion actively and passively so you can skip many of the so called special tests that typically just take up valuable patient interaction time
5) Patient Empowerment
- nothing empowers the patient like the ability to both self assess and self treat
- the patient can easily check for pain/perceptions of tightness during a self movement screen
- then they can re-test after performing a simple repeated motion self treatment which can change anything from
- pain location/intensity
The way to reach Rapid Responders and keep the improvements going between visits is with appropriate education and dosage of HEP. Doing stabilization, corrective exercises and other effective strategies is just not as practical as doing repeated motions. A patient does not often need equipment, bands, or anything to complete a repeated motion based HEP.
On my facebook page I recently shared two articles that showed
- a majority of patients do not perform HEP correctly
- the exercise did not affect outcomes with both groups (general ex and custom tailored) - both had significant improvements for chronic LBP in the long term
How do you apply these to clinical practice? Make their HEP as simple as possible!
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...