Top 5 Fridays! 5 Things That May Help That You're Probably Not Recommending

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This Top 5 Fridays is a humbling one! The more you learn, the more you realize you do not know. It's based on 5 cases I have seen in the past year that eventually got full resolution, but not because of anything I recommended or treated directly.

1) Dentist with weakness and neck pain after MVA

female mid 40s
involved in 2 MVAs within a few months
had chronic neck pain, perception of L hand weakness (but not measurable), and left arm paraesthesia
cervical retraction and SB L plus neurodynamic sliders helped, but only about 50-60%
I saw her several months later, and she had lost 30+ pounds and she reported feeling great
what did it?
joining a gym and working out regularly with a good amount of strength training

2) Gym owner with chronic neck pain

female in late 30s, fitness athlete, PT by schooling (not practicing)
recently opened up a multimillion dollar facility, difficulty making a profit
developed chronic left > right cervical pain
while IASTM, taping, cervical retraction, breathing training with The Capnotrainer all improved her complaints, up to 80%, they often returned
this patient is high stress and always has been (known her for years)
several months later, I saw her at the gym and she reported feeling great - what did it? She reported getting prescribed anti-anxiety medication completely alleviated her complaints
she eventually got off of them, but that time of high stress was not something I could get her to move or breathe out of!

3) Marathoner with chronic knee pain

mid 20s male with chronic left knee pain
in history, reported knee pain was when training or running with others who were slower than him
to see why 5 will give you 20, read my review of System of a Run, Chris Johnson's 2 day seminar
needless to say, without even changing his mechanics, doing any manual therapy, or treadmill assessment - as this was at a conversation over drinks after a running workshop, I recommended he run faster during his training
something about his race pace/form is likely more efficient than his slower pace
it could be something from his step rate, sound, or strike or any combination, but he ran it in 2.5 hours with no pain

4) Stay at home mother with acute neck pain

mother of 4 with acute neck pain
often responds to cervical retraction, light IASTM
has high fear avoidance with spinal pain (but not extremity pain) - the context is that she will not be able to lift/care for her children
normal treatment and education got her about 50% better
one of her friends is a massage therapist who spent about 1.5 hours giving her a full body massage while someone babysat her kids
after this, she responded much better to her home program and Sx resolved within 2 days

5) Personal Trainer with chronic low back and hip pain

late 30s personal trainer/marathoner who owns her own TRX studio
developed chronic hip/LBP after a hard session of squats and lower body workout
she ended up being a slow responder to ankle mobility
previous job was a drug rep - wore high heels for over a decade - most likely true tissue dysfunction
while working on her hip/lumbar mobility, which improved her complaints in every ADLs except squats and running, I also recommended she stop training in Vibrams and running in Nike Frees and move up to to a pair of shoes with a 10-12 mm drop
she reported she was able to run and train pain free shortly after changing her shoes
after a few months of working on her ankle mobility, she eventually was able to run in Nike Frees again, her preferred running shoe

What I learned from all these cases is that there is a solution to many cases, even if I didn't have it (or didn't think it would work completely as in case 5). Have a backup plan and a list of providers, coaches, dietician, functional medicine doctors, massage therapists, that you can refer patients to. Sometimes their physiology and nervous system need something other than what you can provide, but your job is to try with your toolbox and then refer out. Make it sooner than later, after having little to no lasting change in 2-3 visits in what seems like an otherwise healthy individual, they may need something you cannot provide. Patients are often still very thankful for the right referral and that still pays it forward.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...