Applying MDT Treatment Rules to OMPT

I once heard a patient tell an intern, "Ow, it hurts when you do that." He quickly replied, "No, it only hurts when I move it. When it's not moving, it doesn't hurt at all." That was meant as both a joke and a truth.

Patients often ask me, "Is that supposed to hurt?" My simple reply is, "It only hurts if there is a problem." If you take a page out of the MDT rulebook, you are almost guaranteed not to make someone worse. with both OMPT and MDT, you can make a rapid change. That change can be an improvement, or a worsening of their symptoms. Worse as defined by MDT, is a position or movement that increases symptoms during repeated motion testing, and remain worse. Worse can further be defined as

• an increase in the symptoms
• 3/10 baseline, goes to 6/10 during a treatment, and remains 6/10 for over 10-20 min afterward
• post treatment "soreness" like after a workout does not count
• peripheralization that lasts
• Sx felt in the right cervical spine during treatment, peripheralize to the right UE, and stay after your treatment for 10-20 minutes
• worsening of function

When I am doing a treatment that is normally uncomfortable, such as a 1st rib mobilization, IASTM to the ITB, pec minor, or a psoas release, education comes first. I always

• explain why they need the treatment, especially if it is in an area that does not hurt
• explain that they may be sore or tender to touch the next day, but sore is not a "worsening of the complaints that brought you here."
• ask if they have any questions
• ask them to give regular feedback during the treatment, or repeatedly ask "How are you doing with this?"

If they say, "that really hurts!" I immediately stop the technique, if the pain immediately goes away, as it often does, I explain that we are not creating a chemical irritation and to give it more time. I find this to be very educational. The technique, when indicated and and effective, often becomes less uncomfortable. It may also remain the same, but should never increase as the treatment progresses. In the end, the most valuable thing you can do for a patient with an uncomfortable technique is to quickly improve any deficit. Test and re-test a painful shoulder arc, or supraspinatus strength prior to and after a lateral upper arm release. If the technique was indicated, you should notice a rapid improvement. Just make sure not to do one of my top contraindications - the patient DOES NOT want you to do it.