Top 5 Fridays! A 5 Item Checklist for Difficult Cases | Modern Manual Therapy Blog

Top 5 Fridays! A 5 Item Checklist for Difficult Cases


Some patients have recurrent sports injuries, others have persistent pain or conditions that flat out don’t respond. Whether it’s sports medicine research or research on nutrition or wellness, there are 5 things most people can do to overall be healthier. These are back to basic essentials, except they are all modifiable ways to improve health and wellness.

1) Get better sleep
  • Poor sleep patterns/habits seems to be a pattern for
  • Athletes with recurrent injuries
  • Athletes who are underperforming
  • Individuals with headaches, chronic lumbar pain, or general persistent pain states
Actionable/Objective steps
  • No blue light exposure 2 hours before bed
  • Try to get 7-8 hours of sleep (+/- 1-2 hours depending on the individual) 
  • This can easily be tracked with a Fitbit or similar smart fitness tracker or smart watch, log it daily in your calendar
  • Use white noise, avoid alcohol and caffeine after 6 pm
  • If you have to, time block your sleep time to be consistent every night - no smartphone, games, tablet after this
2) Move more often
  • One of my favorite nutrition websites, nutritionfacts.org recently stated your blood literally starts to have a semi stasis after only 1 hour of sitting
  • Even studies showing people who have 1 moderate-heavy workout but are overall sedentary the rest of the day are at higher risk for CV diseases than people who move regularly throughout the day 
  • A simple solution one study found for chronic LBP was to take 2 walks/day
Actionable/Objective steps - use a fitness tracker, phone, or smartwatch
  • Move hourly - go for at least 250 steps/hour - my Fitbit notifies me to move and tell me how many steps I have
  • Try to go for the vaunted 10,000 steps/day - I was shocked after running a 5k I only got a little over 3000 steps!
3) Strength Train
  • General exercise, and particularly strength training has been shown to reduce injury rates in many sports
  • Even individuals with persistent pain states who are centrally sensitized obviously benefit, but they first have to accept they may have some degree of pain or discomfort for the rest of their life
  • You also have to be careful not to flare them up, and grade the training
Actionable/Objective steps
  • Get programming from a personal trainer or online
  • Time block in your calendar 3-4 days a week to strength train, time blocking makes it something you have to check off before you day is done and makes you more accountable
  • use Google calendar, which now integrates with both apple health and Google Fit - to find times in your calendar and block them off - then track using Fit/Health
  • Much better than saying, “I’m going to work out a few days this week.”
4) Mindfulness
  • Mindfulness has been proven to help anything from chronic pain states to addiction
  • Even if you do not have any pressing health/pain states, mindfulness can help your personal life and business mindset
Actionable/Objective steps
  • Download or join on desktop the app Headspace - it takes you through guided mindfulness 10 minutes a day
  • Time block it daily
5) Adopt a plant based diet
  • Another nutritionfacts.org citation stated that as little as one hour after eating animal based proteins (dairy or meat - yes even lean meat), there is a low level inflammation in your blood stream
  • Not EVERY one needs to go plant based, but it does improve overall health (reduces risk of CV disease, reverses it as well, also reduces the risk of some cancers)
  • even taking tumeric daily has been shown to reduce inflammation - does inflammation cause pain? No, but it sensitizes peripheral structures
Actionable/Objective steps
  • Used Dr. Michael Greger’s app, The Daily Dozen - available on iOS and android
  • Try for a score of 50 for 1 week, then 60 on week 2, 70 on week 3, and maintain 80 or higher for 4 weeks and on
An important part of going through a program like this is that it has to be accountable and objective. Patients also have to realize that it takes time for these changes to occur and they may not immediately feel better. Chronic pain patients may still have pain for example, but they may have more energy and endurance, while simultaneously prolonging their life. Who wouldn't want that?

When I get a chance (in all my free time), I’ll make this a calendar or excel based checklist you can give your difficult cases. I just gave this advice recently to a young DPT I have been doing online consults with. This was after most traditional treatments had failed to help his chronic low back and leg pain. The mindfulness and plant based diet was what he needed to get him over the hurdle and start graded exposure back to working out and running.


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