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“What do I do with this patient?”
This is a common question often asked by many therapists, and the suggestions are often many, even for the same patient:
- Changing motor control
- Looking at posture
- Manipulating several joints
- Mobilizing several joints
- Using instrument-assisted soft tissue manipulation (to “break up adhesions”, for instance)
- And on and on it goes…
As a student, it can quickly become a jungle of interventions hard to navigate through, where clarity often only emerges after one has gone through several of these schools of thought, and decided that ”The method is not the trick”.
As the years go by, it becomes increasingly clear that stating exactly what to do is hard.
What does becomes increasingly clear, however, is that stating what not to do is a much easier task.
What I don’t do
– I won’t fault you for being in pain.
– If I utilize hands-on treatment, you do not have “knots” in your muscles that I am “freeing”, you do not have any bones that are “out of place”, you do not have “adhesions” that I am “releasing”, and I am not breaking up “scar tissue”.
– If you have run-of-the-mill low back pain, you are not “unstable”.
– I will not use forces that are potentially damaging, leaving you with marks of abuse.
– I will not make you come in again for “maintenance”.
– You will not leave my office feeling more fragile than when you first came in.
– I will not make you feel guilty for slumping in your chair.
– I won’t reprimand you for any behaviors that are unhealthy (e.g smoking). My guess is that you’ve heard it all before, and are tired of people pointing it out.
– I’ll try my best not to create a potentially problematic future situation where you feel the need to be fixed.
– I will never not believe you.
“OK, but what do I actually do?”
– You remain vigilant of a serious condition.
– You assess the probability of if something is in need of healing.
– You try to make them less fearful of movement if need be.
– You explain what you think is going on. Provide them with a narrative that is both science-based and that contains the potential for hope and positive change.
– You help them find ways to move.
– You help them help themselves.
– Manual therapy can absolutely be a part of this process, but not always.
In the end, your care may be minimalistic (”What i do.”), but that does not make it simplistic.