Top 5 Fridays! 5 Points on Rapid Responders and Slow Responders | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 5 Points on Rapid Responders and Slow Responders

Want a one sentence wrap up? Here's a hint, in general, most patients walking through your door will be rapid responders... ok, enjoy your Friday. If you want 5 ways to do this, read on!

1) ROM
  • Rapid Responders 
    • major loss of motion in one direction
    • this loss is a neurologic loss, motor control/stability, decreased movement tolerance due to perceived threat
    • have a directional preference
      • repeated end range loading into this makes them better rapidly, conversely repeated unloading in the opposite direction often negates that improvement or makes them worse
      • important to educate on avoidance of the opposite direction or position
  • Slow Responders 
    • moderate to major loss that is multi-planar
    • frozen shoulder
    • status post prolonged immobilization
    • they actually need tissue deformation to occur, which is why none of us have a magic cure for frozen shoulder
    • tissue deformation happens like hypertrophy, as in eventually with work
    • no directional preference, although using repeated mid to light end range loading can modulate pain rapidly in the common directions I teach in this video

2) Onset
  • Rapid Responders
    • typically insidious onset
    • typically has intermittent pain
    • varies with movement, position, activity, time of day
    • even if the pain onset originally was "chronic" the episodic nature often means rapid responder
  • Slow Responders
    • may have been traumatic, leading to excessive guarding, and eventual adaptive shortening
    • possibly occuring over time (still do not believe in the insidious onset of frozen shoulder - last one I saw was a rapidly responding cervical spine that limited the shoulder in all planes)
image courtesy of LadyTuesday17 via

3) Response
  • Rapid Responders - can have a significant and rapid response in
    •  ROM
    • pain - location, intensity, frequency
    • strength
    • function
    • DTRs
    • basically anything you can measure objectively
    • *** remember, you can also make a Rapid Responder worse rapidly
  • Slow Responders 
    • can still manage pain with education and OMPT modulatory techniques, so the pain response can still be rapid
    • by nature, you cannot make a slow responder worse rapidly - as in make a frozen shoulder rapidly more frozen, or ROM of an s/p immobilized limb dramatically decrease
    • you can flare up their pain, but it should gradually decrease in a normal response with rest, education and treatment

4) Length of Treatment
  • Rapid Responders
    • biggest changes should be within the first two visits with the rest to clean up movement patterns, and stabilize them 
      • stabilize means able to handle repeated load in the direction opposite to the directional preference that made them better
      • testing this should not
        • reproduce any complaints
        • reduce ROM in the directional preference
    • on average, 4-6 visits for a rapid responer
  • Slow Responder
    • since you're working with mid range movements and a gradual response to treatment, you expect a minimum 6-8 weeks for full restoration of function, strength, ROM
    • it's the ROM that there is no "quick fix" for since true structural changes cannot be made rapidly
    • which brings us to the next point

5) Educational Differences
  • Rapid Responders
    • great news! You fall into the majority classification that means I can show you how to make major changes in your condition today!
    • educate them that intermittent pain is great news, I always say it simply means 2 things
      1. You're doing things to perpetuate it
      2. you're not doing enough to keep it away
    • we should be able to find a direction and/or position that allows you to self treat and make rapid changes on this first visit
    • those rapid changes are up to you to keep between visits with a very simple program I'll give you consisting of 1-2 things for you to do repeatedly all day
  • Slow Responders
    • the good news first: we can help with your condition and I can show you self treatment for between visits
    • this type of condition luckily does not flare up by it's nature... it's slow both ways
    • the other news (not bad news): this is a tortoise and hare thing, slow and steady wins the race
    • if we keep up with weekly treatments (more than that will make them sore if you do too much too soon) and you're compliant with your homework, this absolutely will get better
    • give them a realistic time frame - 6-8 weeks of time and work
Bonus: Educational Similarities
  • both conditions can self treat
  • pain can be modulated (changed) rapidly for both conditions
  • light at the end of the tunnel for both - just one tunnel is very short and the other one is medium length
Keeping it Eclectic....

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