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)
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| image courtesy of LadyTuesday17 via deviantart.com |
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
- You're doing things to perpetuate it
- 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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