My favorite part of the initial evaluation is the history. That initial interaction, sets the stage for the subsequent visits. Many patients are nervous, especially if they received a lot of the standard gloom and doom from well meaning, but misinformed providers or loved ones.
Most of the patients walking through your door will respond rapidly even with "chronic pain." Only a small percentage are centrally sensitized or have an underlying disorder which slows down or prevents your current approach from working rapidly. Just because a patient had their function limited or pain for a certain time does not mean you won't be able to hit a home run in the first few visits. We've all had that patient with knee or back back for longer than they can remember yet, still feel 80% better after the first visit.
Some patients are convinced they're a mess, and they've been to so many other providers. For your own prescription and outlines of care, plus to alleviate their anxiety, here are 5 Ways to Tell If Your Patient is a Rapid Responder
1) Their Symptoms are Intermittent
- just went over this in a MMT video, here's the link
- the short of it is, intermittent Sx = times when the nervous system is not threatened, chances are they're a Rapid Responder
2) They have recovered from similar episodes with or without care
- is the patient's entire ecosystem healthy enough so they recovery from other or similar episodes?
- often they see clinician X, go for 20-30 visits, and they recovery - if it's been that long, was it really the clinician or just time? Tough to tell, but if they've recovered before, chances are, they can do it again
3) With previous flare-ups, "enter treatment here" really helped
- I almost tune out to what a patient received as treatment when it comes to previous providers, it may be the best evidenced based care in the world, or terrible
- I really care about two things
- what were they taught for HEP, and overall education of their condition and recovery
- did it help rapidly
- patients will often say, manipulation, IASTM, Needling, etc all helped but only lasted 2-3 days
- that's where I know it was a failure of the HEP, most likely in dosing
- if whatever magical treatment they received improved their symptoms/function for hours or even days, all they have to do is dose the appropriate home program high enough to Keep the Window of Improvement Open
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4) They have an open mind to your approach
- we're all in sales, if the patient doesn't buy in to your treatment and overall approach, good luck!
- being a Rapid Responder means their entire mental and physical ecosystem is open to suggestion and ready for changes
- When I think back as to all the patients I had difficulty with, many of them were non-compliant, or we flat out didn't get along for whatever reason
- pro-tip: if this is happening to you - refer to a trusted colleague or co-worker
- I've swallowed my pride, referred a patient to a co-worker and his pathoanatomical approach was just was she needed
5) Their Symptoms Are Still Significantly Better on Visit 2
- making huge changes on initial evaluation is always a thrill for both clinician and patient but that does neither of you any good if they are back at square 1 on follow up
- if they have all of the above points, AND you gave them the appropriate HEP to maintain improvements between visits, the majority of the changes should remain
- I used to tell patients I wanted "most" of the improvements in function, mobility, and pain to stay between visits
- now that I treat people once every 2-3 weeks, all that self treatment, I expect most of them to be better, not just where I left them at the end of visit one
- education and self treatment are the only things a patient can take home, no matter how much they want to take your "magic hands"
- emphasize the HEP, not the treatment
- when a passive/manual approach makes rapid changes, frame it that "this was applied so that you can now perform your home program and loading strategies pain free." It's up to you to keep it!
The last bonus tip is that honestly, unless you work specifically with a certain population that are non or always slow responders, chances are, the patient in front of you is a Rapid Responder.
If you've tried your best, and the patient is compliant, know your limits and refer out. I've had very grateful patients refer me a ton of their friends and family because I was the person who referred them to the clinician who finally was able to help them. Ask yourself, when was the last time I made a breakthrough 6 weeks into care?
Learn these strategies and how to simplify your assessment and treatment approach at a #manualtherapyparty or click below to do it online with the MMT Premium Community!
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