Q&A Time: Homework and Resets as Preventative Measures | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Q&A Time: Homework and Resets as Preventative Measures

A frequent reader and OMPT Channel subscriber recently asked a question regarding patient HEP and pain relief.

"Dr. E - I'm encountering pt's who tell me that I've given them exercises that help them feel better (reduces their discomfort) but they are still feeling "pain." Am I correct in encouraging them to perform their exercises more frequently and before their pain sets in? I've told them to use the movements not only to improve movement quality, but as a preventative measure as well. But most seem to wait until they have pain before doing them. Thank you."

Thanks for asking Sam, that is a very good question! There are a few ways to interpret this and of course this is just my take. I will assume that when you say, "feel better (reduces their discomfort)" added with, "before the pain sets in," and "preventative measure," that the Resets are relieving the complaints either significantly or completely.

It's human nature to take the path of least resistance and studies show up to 60% of patients or more are not compliant with their exercises. This is why I....
  • keep the program as simple as possible, 1-3 resets/movements/exercises at any given time
  • tell the patient any relief they get from the visit MUST BE reinforced by their homework
  • if they leave feeling better, or the exercises give them relief, but it does not last, it could be due to several reasons
  1. They are not reinforcing the resets enough with
    • enough frequency
    • end range motions
  2. they are negating the effects of the reset via moving or sustaining in positions that are opposite the directional preference
  3. They do not know why or believe that simple movements/positions will relieve their complaints
However, if they already get relief, I tell them it's not only enough to keep The Window of Improvement open for a short time. In order for the CNS to really remove it's lockdown due to perceived threat, it must be convinced for at least 2 days or more of continuous pain free function (for Rapid Responders).

Some do not want to hear that there is no magic fix, or that you cannot fix them, but it's often as easy as changing their mindset with the proper education. Show them that the resets decrease their pain and improve their function via test and re-test. Tell them that Window of Improvement lasts anywhere from minutes to hours, and to reinforce the resets with continuous performance of the same movements/positions.

A common scenario that it sounds like you're encountering is that they get relief, but they wait until the pain comes back. I often instruct,
  • "If the pain comes back at 4:00 pm, double down on your resets the hour and 30 minutes before the onset."
  • "The same movements, as long as they are novel, can be preventative." "Head it off at the pass."
Hopefully these explanations and examples help. Never under estimate the power of just having a good interactive conversation with your patient. That is often way more powerful and long lasting than any passive manual therapy, Remember to reinforce your own education. Repeatedly ask if they have any questions or concerns. Be available over email/text, or use an app like Vinitial to maintain contact with those patients who cannot go between visits without a little verbal reinforcement.

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