This edition of Thursday Thoughts is inspired by Bruce Lee!
We know from modern Pain Science that you need to keep every single one of your patient interactions
- positive
- compassionate
- interactive
- educational
- empowering
- patient centered
What happens when a patient comes in dropping "D" bombs all over the place? As in they have been told they have a "slipped disc" and they need someone or some thing to put it back into place? We should first try to educate on the realities of the "kisses of time" you may find on scans, etc (recent research here); we should stray them away from thought viruses like standard pathoanatomy.
If you're a MDT clinician, do you force repeated motions on them? If you're a PRI clinician, do you force left AICs and right BCs on them? What about using the SFMA? MC/SDs? With time and experience, and dealing with a lot of different patients, you will be water. You will sense when someone's eyes start glazing over as you tell them about neurophysiology and pain as an output, not relating to damage. You may need to perform the same assessments, treatments, and exercises you know will address their complaints, but fudge the explanation behind the mechanisms to get their buy in.
To facilitate getting the buy in, ask the patient, "What do you think is wrong, and what do you think will help?" Sometimes they're right on track, and sometimes they need to be slowly educated that pain is a normal reaction, and that it does not always correlate to damage. You should incorporate treatments that they believe will help (i.e. The Cervical Manip Clinical Prediction Rule). Be an active listener, find the patent's motivation, and use that to improve compliance and your outcomes will surely improve.
Getting back to a patient example. If someone walks in with a "rotated pelvis" and believes that they need it to go back into place. I may still choose sidegliding in standing as an assessment and/or treatment. If they ask, "Will this put my pelvis back into place?" Plus, they were not buying the proven fact that manipulation, MET, etc does not move and reposition bone, I may say, "Yes, it will help with your complaints." By complaints, in my head I think, "it will give a novel, non-threatening input to your CNS that will eventually and rapidly raise your pain and movement thresholds."
Keeping it Eclectic...
If you're a MDT clinician, do you force repeated motions on them? If you're a PRI clinician, do you force left AICs and right BCs on them? What about using the SFMA? MC/SDs? With time and experience, and dealing with a lot of different patients, you will be water. You will sense when someone's eyes start glazing over as you tell them about neurophysiology and pain as an output, not relating to damage. You may need to perform the same assessments, treatments, and exercises you know will address their complaints, but fudge the explanation behind the mechanisms to get their buy in.
To facilitate getting the buy in, ask the patient, "What do you think is wrong, and what do you think will help?" Sometimes they're right on track, and sometimes they need to be slowly educated that pain is a normal reaction, and that it does not always correlate to damage. You should incorporate treatments that they believe will help (i.e. The Cervical Manip Clinical Prediction Rule). Be an active listener, find the patent's motivation, and use that to improve compliance and your outcomes will surely improve.
Getting back to a patient example. If someone walks in with a "rotated pelvis" and believes that they need it to go back into place. I may still choose sidegliding in standing as an assessment and/or treatment. If they ask, "Will this put my pelvis back into place?" Plus, they were not buying the proven fact that manipulation, MET, etc does not move and reposition bone, I may say, "Yes, it will help with your complaints." By complaints, in my head I think, "it will give a novel, non-threatening input to your CNS that will eventually and rapidly raise your pain and movement thresholds."
Keeping it Eclectic...
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