Don’t Fall For The “Ultimate Modality” Hoax
A couple of weeks ago, we looked at a Bialosky paper on the mechanisms of manual therapy.
I liked several things about the paper; for one, it showed us how all techniques we use result in neurophysiological responses in both the peripheral and CNS to help with pain inhibition.
Secondly, part of the paper’s reason was to try and find a construct that could be used for future research since we now know there are more than just techniques that influence our clinical outcomes.
With that, we have developed a framework any of us can use to have better clinical outcomes, so here it is.
The All-New Modality Framework To GUARANTEE Successful Treatments
As we all know, every good treatment technique in our industry comes with a good acronym.
When I think back to college, there was MRF, CST, MET, MLD, and probably a host of other ones I’m forgetting.
I still use some of these techniques in practice today, essentially because they feel good and my patients like them.
However, with our new treatment framework, we’ve come up with a four-level system that will get you and your patients the results we’re all so desperately looking for.
This four-level system has four acronyms: EPN, TPN, MPN, and SFN.
Let’s take a look at how to implement this in practice. Because 60% of the time, this works every time!
EPN – Educate People Nicely
This is an essential factor to start any treatment. Quite often, people come in with certain expectations for what they want and expect from their visit.
Sometimes they have been to other practitioners who are still using old narratives, leading to specific belief systems around the pain they are experiencing. They may even believe their pain is a result of their hip or rib being “out”.
Perhaps they’ve been told a specific muscle needs to be “released”, or a ligament on their liver is twisted (yes, I’ve been told this).
Whatever thing it is, we have a responsibility to educate the person on what is going on and start changing their belief system around those narratives.
However, those beliefs are often deep-seated, and attempting to blow it out of the water on the first visit may not lead to a solid therapeutic relationship.
So there are a couple of ways we can handle this.
Just giving little bits of information with each session and gradually changing their beliefs is one way. As pointed out to me by some colleagues, another is to ask them: “how can I support you”?
Once you have offered support and helped them, they may ask you for advice or what you think is going on. This opens the door to deliver some education and gives them control over this framework. The more control they have helps in building their resilience, which we should be shooting for.
Now that we have provided a bit of education, next comes the treatment part.
TPN – Touch People Nicely
I have to give Eric Purves credit on this one.
Give people what they like.
One of the great things about many of those techniques we learned in school is how great they felt. Since we know that every technique is just a neurophysiological input that helps create change let’s figure out how to touch people in a way that feels best to THEM.
For some people, a nice light touch feels great; for others, they like a firmer or deeper treatment.
It’s essential to ask them if they like this because of how it feels or because they think deep is necessary for the treatment to work?
If it’s the latter, we may have to go back to EPN and demonstrate that a deeper painful treatment isn’t necessary and gradually show them how we can make a difference by doing something else that just feels really good.
If it’s because a deeper treatment feels excellent to them, this is TPN for them, so continue on.
MPN – Move People Nicely
I’m a huge fan of movement and graded exposure.
As my career goes on, I’ve come to my own realization that most orthopedic tests are simply a version of graded exposure. You get a person to move their shoulder a certain way, then get them to do it again right away or after treatment, and sure enough, that body part goes a bit farther.
Whether you do this before, during, or after treatment and the person can now move a bit farther, it feels nicer; this helps build confidence in that movement.
The more encouragement we can give them that movement is safe and actually helps their pain experience, this will contribute to MPN and a better outcome.
SFN – So F@!*ing Nice
So now that we’ve done EPN, TPN, and MPN and we know what feels really good for the person on your table, next comes SFN.
This happens when we’re using the patient’s favourite technique (and they are quite possibly drooling while facedown), and all you hear is the patient say, “that feels sooo f@!*ing nice”!
This is quite possibly the pinnacle of our new framework for a couple of reasons. Patients love it when things feel SFN, and I like swearing.
The Truth About This Framework
So this post was done a little tongue in cheek, and obviously a fair bit of sarcasm.
I have no issue with courses that have a great acronym; many of them are great courses. However, the narratives behind them have to change and be brought up to date with manual therapy’s actual mechanisms.
It would help if you also didn’t have to pay for specific modalities, “five to seven levels of mastery,” to become certified as a “provider.”
Another issue is that since we know all techniques work the same, we need to stop seeing things like “we guarantee this will get your patients better, faster!” There are so many factors to a treatment that to make this statement is quite simply false, the technique itself will not do this and to advertise it as such is just plain unethical.
What we need to do is look at each patient as an individual. Talk to them about their expectations, what they like, demonstrate how movement is safe, and help them get to the point where they feel SFN in their own body.
This can take time and a lot of practice to accomplish.
Still, if we look at each treatment as an opportunity to learn more about the person in front of us, rather than how a new shiny modality can change our practice, we’d probably be a lot better off. I know our patients would be as well.
Let’s focus on EPN, TPN, MPN, and SFN so we can help people build resilience and confidence in their own bodies. And I promise we’ll never come up with a new modality with seven tiers to change your practice. Just do what feels nice to people and do what feels good to THEM.
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