3.5 Years and 3 Truths

Posted: June 14, 2012 in Uncategorized

As a student, something I have prided myself on is taking every opportunity to learn from others. No matter what the profession, I am a true believer that their is always some piece of knowledge I could gain from picking someone else’s brain or even simple observation.

And yes, as the cliché goes,

Sometimes it’s just as important to learn what NOT to do…

But that’s not what this post is about.

After about 3.5 years of face to face contact, reading, watching DVD’s, and my own thoughts, I think I have finally found a few truths.

No matter the technique, the profession, the patient, or the person, I truly feel as if what I am about to tell you holds true for everyone.

As a therapist, you should believe in this.

As a patient, your therapist should believe in this.

Most of the following ideas go hand in hand, as you soon will see.

1) Don’t chase the pain

This  has become the en vogue phrase in recent times (or maybe not so recent, I’m just relatively new to the game). The great Dr. Perry Nickelston has even named his business Stop Chasing Pain. When someone names their business after an idea or thought process, it must be legit.

Another quote is by the famous Dr. Karel Lewit

He who treats the site of pain is lost

I’ve spoken about it before, but let me say it again. As a rehabilitation specialist, we certainly want to address the area that hurts. However, it’s even more important to address the cause of that hurt.

Sometimes, this appears to be magic. Seriously, when a person has low back pain and the only thing that makes that pain go away is a shoulder treatment, it’s a life changing experience.

2) Assess-Treat-Reassess

In gross generalizations, it has been my experience that most therapists miss the last part of this process on a pretty consistent basis. They ask how the patient is doing, treat the patient, and then allow them to go on their merry way.

With that, I believe an opportunity is missed to see if what we did was actually effective.

A quick example: A patient reports shoulder pain when they try to comb their hair. You treat the patient (treatment method in this case is not important) and then the patient leaves.

What should have been done? After treatment, ask the patient to pretend to comb their hair. Hell, actually have them comb their hair. Lord knows they probably need it! Ask them how that feels after treatment. Or my favorite question, “If it was a 10/10 when you came in, what is the pain now? This will give you a clear-cut, quantifiable way of measuring your treatment.

Your patient should feel at least a little better following treatment, leading me to #3…

3) You should observe some positive change during the treatment session

This point is super important. I think in school, we often learn to put together treatment plans that span minimally a few weeks. For some reason, we also believe this means we shouldn’t start seeing results from our treatment until that span of weeks has passed. So, if the treatment plan called for 2 visits at 2x/week, we wouldn’t re-test that patient until those two weeks are up.

Quite frankly, this is a huge mistake.

As I’ve learned from Dr. Liebenson and Dr. Doerr, we as the therapist, know we are on the right track when an immediate change is made. Realize, this change may not stick. In fact, if the case is complex, the patient may come back for the next visit with exactly the same pain.

If our treatment does not make an immediate change, start to wonder:

  1. Is my diagnosis correct? (maybe the problem is something not muscle, joint, or movement related)
  2. Is my treatment correct? (maybe I am manipulating a joint that already has too much movement)
  3. Is my patient doing something outside the office that is causing this to come back? (posture, activity, exercise selection)


As I stated earlier, through my education and experience so far, I have come to these few conclusions. Again, technique and treatment methods are not important. In fact, that is exactly the point. The reason why I believe in these 3 truths is because they should apply to every single treatment ideology and method.

Thanks for reading!


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