Assessment skills are key to objective treatment protocol.
- Great old saying that if all you have is a hammer, then everything looks like a nail. This couldn’t be any more true in the manual therapy world. One must understand when their techniques are indicated and contraindicated. One must also understand when, how and where these techniques are performed and where they fit into the overall treatment protocol of any patient.
- To be able to achieve this even just adequately, having competence in pathological knowledge, history taking, subjective and objective assessment is essential. Understanding the biopsychosocial model of patient care is paramount. Applying all these skills in a thorough history will give you the means to truly understand where your manual therapy skills sit within an overall treatment protocol.
Exercise prescription and load management are key to long term success.
- Most patients present to us with some form of pain during daily movement. This can be due to a plethora of reasons, all of which you will understand after a thorough assessment.
- Once you have applied your initial treatment strategy, got the patient moving freely again, exercise prescription and load management are the keys to maintaining long term success for the patient. Exercises to educate and empower the patient to self maintain (mobilise their stiff bits, stabilise their floppy bits, condition their weak bits) and then manage the ‘amount they do’ so they don’t overload any vulnerable tissues.
- Our manual therapy intervention are simply mediums to achieve these goals
Soft tissue work is key to reducing pain and range of motion inhibition to exercise prescription. The less pain and the less range inhibition during movement, the less fear the patient will have in attempting and completing given tasks, giving more efficient and effective results.
- ‘Fear to move’ is one of the main reasons people seek help from health professionals. This can range from ‘fear to move your neck’ that exacerbates a headache, to ‘fear to bend forward’ that potentially aggravates an old discy issue, to ‘fear to role over’ due to an grumpy facet joint. These fears can stop someone playing sport (fear to serve a tennis ball due to potential shoulder pain), stop someone completing work tasks (fear to type due to probably wrist pain), fear to complete home duties (back pain when washing dishes).
- Exercise prescription is commonly used by many practitioners for all presenting patients, including the complaints suggested above. But what if these exercises further irritate the symptoms? What if the patient can’t perform them properly due to ‘fear avoidance’, pain during the exercise, stiffness that reduces the adequate biomechanics to perform the task properly? All these things reduce the patients enthusiasm to attempt the exercise, let alone complete the exercise or complete them adequately. This is a major hurdle to patient progression. This is a major concern for patients who begin to lose trust that the protocol is going to achieve the goals they want to achieve.
- This is where Soft Tissue Therapy is so strongly indicated. Not to ‘fix’ the patient but to reduce their fear to move. Alleviating trigger points, increasing fascial/connective tissue range, swelling reduction, myofascial mobility, joint and neural mobility, pain reduction, etc. Reduce or eliminate these inhibitors to pain free movement and you reduce the fear to move. Fear free movement hastens the process of exercise rehabilitation and daily functional movement at home, work and play. This is a powerful medium to successful protocol setting that you possess in your hands and mind.
Any Therapist can hand out exercises, only those with great hands make the process and prognosis an efficient one.
- Handing out exercises is a skill in itself. Knowing the most applicable can often be bound in your education background, exposure to good mentors and environments, experience and sometimes that amazing thing called intuition (some have it, some don’t!). Then there is sets and reps, load management and the inevitable nuances to each individual and then those motor moron patients who just can’t seem to get even the basic movement patterns. Even when you get all this right, what happens when there is pain or range inhibition to movement? As stated above, all this exercise prescription can be constrained.
- Those with ‘good hands’, those that understand what technique is indicated (and contraindicated!), those that can apply a manual therapy intervention with competence and confidence will be those that afford their patient the means to perform exercise tasks, to move at home, at work and at play, with the least fear to do so.
- What are ‘good hands’? Its just not knowing where, why and how to press and poke. What is involved? What makes ‘good hands’?
- those that have the science and art of manual therapy to a point where they are competent in the application of numerous techniques to indicated tissues.
- Those that understand what place within the overall protocol that manual therapy sits. It is not a standalone intervention.
- Those that are able to apply the biopsychosocial model to each patient, adjusting language, expectations, demeanour and providing the patient with education and empowerment
- Those that can verbalise pain science to a ley persons level to educate and empower the patient and reduce their fear of pain
What are the take homes here?
- ‘Great hands’ are key to reducing fear avoidance to exercise and movement