One of the reasons why I passively repeatedly load a patient into directional preference is because I want them to feel and see what the limits of their range are.
I am also not as patient as a pure MDT practitioner and do not want to spend 45 minutes of different cuing to get a patient to end range. Here are 5 ways I have found useful to make sure a patient is getting there.
1) A fearful patient
- if they are still very fearful after explaining the stop light rule and not quite buying the yellow light, you need to change strategies
- since I start with passive motion first with clinician overpressure, these patients will trust themselves more than a clinician they just met
- have them perform the cervical retraction and SB or overpressure into retraction themselves
- if they were touch adverse, often they will get to their own end range with a bit of verbal and/or visual cuing
2) Self overpressure
- think of the cervical retraction plus overpressure as active first, with a little passive help at the end
- occasionally if a patient tries to push during the mid range retraction, the scalenes, upper traps and other muscles will resist the contraction, often increasing their complaints
- telling the patient to use "just enough" effort to do the motion, and "not too much" will prevent this irradiation, then they self overpressure with their hand webspace on the maxilla
3) PNF
- having pain during the motion (or at end range) is often a deterrent for a patient to perform their HEP as prescribed
- a little hold relax (self pressure into the painfully perceived barrier) often eliminates it after 2-3 second hold
- the patient can then non threateningly proceed through to end range
- this works great for cervical retraction with SB and overpressure, or cervical retraction with rotation and overpressure
4) A little push
- occasionally the nervous system needs a little nudge to reduce the threat, especially when the directional preference is the direction they have been avoiding for a long time
- after trying 2-4 sets of several clinician or patient generated forces into my hypothesized directional preference, it's OMPT time
- very light IASTM to the
- bilateral cervical paraspinals and upper trap patterns for central or bilateral pain
- ipsilateral cervical paraspinals and upper trap patterns for unilateral cervical pain
- occipital patterns for HA patients
- for just 2-3 minutes often reduces threat, and often makes the repeated loading strategy go from painful to pain free
- just yesterday a chronic HA patient who I thought may have been centrally sensitized was adverse to posture correction and cervical retraction with overpressure
- however, after some light IASTM to B paraspinals, she let me do subcranial shear distraction, which abolished all complaints and gave her "clarity" she did not have prior to Tx
- there was much less threat to posture correction and cervical retraction in sitting
- however, there still was to overpressure, until I explained the shear distraction was taking her much farther than I or she was in sitting, thus reduced the perceived threat to the technique
- even if you get them to end range in NWB, it's a regression
- they most likely will not be able to perform the same self treatment repeatedly enough to keep the improvements between visits in NWB
- you should try to progress back to WB within the same visit if possible, only for the practicality of a WB vs NWB self treatment frequency
Any other topics you want me to cover for Top 5 Fridays? Leave a comment below or on the facebook page!
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