Top 5 Fridays! 10 Steps to Effective Rehab Part 1 | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 10 Steps to Effective Rehab Part 1

You may have heard the saying:

“Give a man a fish and he shall eat for a day. Teach a man to fish and he shall eat for a lifetime”

The moral of this story is clear. In place of dependence and a single avenue for sustenance, it is more valuable to have knowledge and a method for continued self-sufficiency. It is more valuable to know how to fish than have a single fish given in a time of need. It is more valuable to learn how to provide for yourself and manage on your own than it is to allow yourself to be in a position in which your health, happiness, or life is completely dependent on others.

I prefer to view my approach to patient management as well as the framework in which I approach rehab much the same way. I am very fond of what Jason Silvernail and Diane Jacobs have referred to as the interactor mindset over that of an operator. This idea is eloquently written below:

“Traditional instructional books and courses on manual therapy often refer to the therapist as an ‘operator’. The implication of this terminology is that the patient is a passive recipient of the manual act. This seems at odds with not only the common practice of physical therapy, but the balance of research evidence which favors active over passive approaches. We feel a more current understanding of the mechanisms and processes of manual therapy leads naturally to a different understanding of the therapist’s role – that of an ‘interactor’. This interactor model of manual therapy is consistent with the authors’ statement that ‘the context of the treatment including the technique, the provider, the participant, the environment, and the interaction between these factors may contribute to patient outcomes.’ It is precisely this interaction between various factors that we need to consider, and not simply the performance of one or more techniques as an ‘operator.’ We believe this interactive model to also be scientifically congruent with the emerging explanatory model of the multifactorial, biopsychosocial pain experience, the neuromatrix.”

Many clinicians prefer to place their value in a “tool box” or bag of tricks approach in which treatments are applied to patients that fit a predetermined diagnostic criteria or subgroup often based on poorly defined or unreliable examination findings. These clinicians wear initials after their names like badges of honor. They strive to take as many tool-based courses as they can, often forgoing deep critical thought and building a comprehensive and systematic evaluative framework. Frequently, this leads them down a rabbit hole of cups, tapes, scrapers, rollers, electrodes, virbrators, and highly specific manual therapy techniques (oxymoron) they apply to patients. If this clinician only has a hammer, they only see nails. If they have a screw driver, they only see screws. However, no matter how many tools they acquire, without the blueprints they will rarely see the big picture or know what they are building. Meanwhile, the patient hangs in the balance constantly being batted around to whoever has the next tool to apply to them. The patient becomes chronically “operated” upon rather than “interacted” with. This inevitably leads to a passive mentality in their own care. The patient slowly learns helplessness and seeks more tools with the hope they just haven’t found the right toolsman yet.

Conversely, the interactor approach recognizes the immense complexity of human beings and their lived experience of pain. This type of approach reflects a thought process that attempts to facilitate patient independence and increase internal locus of control. Being an interactor teaches a patient to fish for themselves rather than making them dependent on the fish you provide them. Possibly of even greater importance, teaching clinicians to be interactors equips them with a framework and understanding that much reflects teaching them how to fish rather than mindlessly eating the fish that their current toolbox assortment permitted them to. The interactor chooses to focus their time understanding the blue prints and innerworkings of the system rather than stand on the assembly line hammering, screwing, tightening, loosening, scraping, etc.

Below, I’ve listed the first 5 steps in my personal 10 step approach to providing effective rehab through an interactor mindset. In the second half to this post, I will provide steps 6-10.

These 10 steps create a framework and are not intervention specific as I believe the specific intervention is only a fraction of the importance of the framework in which you use them. These steps allow you to choose specific interventions that meet your own preferences as well as the preferences of the patient.

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