Evidence Based Physical Therapy Articles-Manual Therapy

When Not to Use Manual Therapy

A Hard Lesson Learned

Michael Rinaldi, PT, OCS

Ever had this scenario:

You've been seeing a patient for a five weeks and you've got them progressing very well.  You've got momentum with them and they're feeling better, believing in you and becoming a great success story.   Especially when you consider they were a wreck when they first started with you. 

But, you've finally got them turned around and today they come in and say they've been feeling great...nearly fully pain-free for the last five days. 

You both smile and you both pat YOU on the back!   : )

"So," you figure, "let's keep it going."   And you proceed to work on the patient, feeling great about yourself and your ability to get results with tough patients.

After the session your patients sits up, still happy, though not smiling as big as she was when you started the session.  You ask how she feels, and she says, "okay."      "Great!", you say and offer her a salutation goodbye.

The next session, you're excited to see her and ask how she's doing.  

"Terrible," she says, "I feel like I took a step back after the last treatment....I was doing so good!"

Your day is wrecked.

Hmmmm...... what happened???

Over the years, I've looked back at things done well, things done not so well; lessons learned from successes and failures. 

Abstaining from intervening still strikes me as one of the toughest things to do and I've figured out why.

It's counter-intuitive.

When a patient comes in, you feel compelled to intervene...to do something for the patient... to give them something.   After all, they drove in to see you, waited and paid their $30 co-pay, so you've got to do something.....right?

It's times like the above when the best course of action is to abstain from doing a procedure.  But TELL the patient that and WHY.    Very simply, when a patient is having a gain, let them enjoy it---don't always feel compelled to try and one up it.  They'll appreciate it much more than if they were doing fine before seeing you and had a setback after.  

For heaven's sake, they get less when the see their PCP--and usually have to wait an hour longer for it!

KEY POINT: If a patient says, "I'm feeling great!".... congratulate them and let 'em enjoy it.  Use the time to review anything they may be confused about otherwise, review goals, set new goals or take the time to educate them about something.   Then let them get on with enjoying a day of life without pain.   Skip the manual therapy.

This is a sign of a maturity..  The clinician has set aside time to reflect on situations and her responses and behaviors in them, and adjusts her practice habits to align with better practices. 

Better practice habits generally lead to better outcomes.

And a better clinician.