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Top 5 Fridays! 5 Things Your Patient Needs for Successful Outcomes

Assuming you do not have a true centrally sensitized chronic pain patient, there should be a relatively simple solution for your patient to feel better. Remember, the majority of patients fall into a Rapid Responder category.

Here are 5 Things Your Patient Needs for Successful Outcomes

1) Education

  • from educating them to what their condition is (normally fixed with some hard work and some hands on work plus exercise)
  • to what their condition is not (degeneration, pinched nerve, slipped disc, shredded hip etc)
  • make sure to de-emphasis on scans, EMGs, and tell them about the false positive rate, or how scans do not correlate to the level of pain
  • pain does not equal damage
  • need to educate yourself on how to educate patients on pain science? Look no further than Therapeutic Neuroscience Education, probably the number one text I can currently recommend to ANYONE working with patients who have pain. 

2) Mobility
  • this is an obvious one, if a certain area or an adjacent area, or anything related to their performance has decreased mobility, work on it to improve it to as close to "normal" as possible!
  • give them a simple way to check to see if it is close to where it should be
  • this is why I like the SFMA's Movement Patterns, they are simple tests that a patient can test-retest before and after their homework

3) Symmetry
  • several FMS studies show that asymmetry may be predictors of future injury
  • if you are looking at FMS or SFMA, or using your own movement screen, work on the most asymmetrical pattern first
    • i.e. one with the bigger ROM deficit, or one with pain on one side and no pain on the other

4) Stability/Motor Control
  • Many patients with seemingly less mobility actually have stability issues when tested actively first, then passively, or in WB then NWB
  • if they have limited and/or painful movement in one test, then repeating the same test passively or in a different position have full or not painful ROM, it's a motor control issue, not real motion dysfunction
  • another way to look at it as a MC/S issue is if you have continued improvement in ROM that is dramatic, and then it rapidly decreases again
  • it takes a long time for tissues to truly adhere and become dysfunctional as a result of immobility, so ROM isn't "lost" from tissues "tightening" up 
    • in other words, if you keep performing "stretches" or mobility drills and your ROM improves and then gets worse again quickly, work on your motor control and start with rolling patterns
  • here is a post where I learned this first hand

5) Simple Homework

  • have you addressed the above 4 things?
  • great, now give your patient 1-2 things to do repeatedly for homework until they're symmetrical, stable, and their fear avoidance is lower thanks to your great, soothing, interaction and pain science education
  • the frequency is performed at the mode that makes them keep their improvements
  • compliance of course, is key to success!
Bonus: The Mobility and Stability is the minimum compentency your patient needs! Do they have the capacity once they are mobile and stabile? Some do, some do not! That requires further training and conditioning depending on their activity/sport. If you discharge too early, they'll either be seeing you again, or seeing someone else who addresses it!

Keeping it Eclectic...

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