Thursday Thoughts: Evaluation and Pain | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Thursday Thoughts: Evaluation and Pain

Today's Thursday Thoughts was inspired by a recent DPT student who was filling me in on how his first semester of ortho was going.
As an avid reader of my blog, he naturally questions treatments that hurt. I've gone on enough the past few months about treatments that hurt, and applied that to exercise last Friday. Granted, I have to take this with a grain of salt, because it's just one person relaying information to another, but the student said, "The professor says treatment is not for the evaluation, because you have to spend your remaining time of the evaluation relieving them of the pain you caused during the exam."

Ok, if I was drinking something, I would have spit it out all over the place. Let's think about this logically, when someone comes to us in pain, should we be performing provocation testing? If a patient says flexion, texting, slouching, bending, and driving increase their complaints, are you really going to start your repeated motion exam out with, let's see what happens when you flex your neck or back forward 10-20 times?

You can rule things in and out without provocation tests, right? Goals of your evaluation should be to
  • establish a rapport
  • educate the patient on The Science of Pain
  • treat them via whatever means necessary to get them on a home program which is where the carryover and the lasting changes take place
I do not expect readers or course participants to go all the way in with giving up testing for pathoanatomical diagonses, but there is no reason you need to be poking, prodding, or having the patient assume positions that may contribue to perceived threat, or further sensitize an already peripherally and/or centrally sensitized nervous system.

I have stated this many times as well, sometimes the best we can do is not worsen a patient's existing pain, if we cannot find any position of relief or directional preference. However, if I were a patient, paying my hard earned $$ for a copay or cash based visit, and learned prior to the visit that I may be so sore just from the exam that real treatment for the actual condition I was coming in for would not start until the second visit, I would probably go elsewhere. Wouldn't you? Let's turn "pain and torture" into "patience and tenderness" - Thanks to blog reader Dr. V for that one!

Keeping it Eclectic...

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