Using Evidence Based Practice To Avoid Fear Tactics

Sometimes I just have to shake my head.

I’m sure we’ve all heard the same kind of things in our clinics when patients go to other practitioners.

“I have compressed discs in my spine, I’m out 14 degrees here, 12 degrees here and 8 degrees here”

Yeah, I probably have all that too, but I’m not in any pain.

“I went to this other therapist, and they said I’d probably never get better”

Well that’s not true.

Then there’s my favourite (I wish there was a sarcasm font).

“Well the muscle pain you’re having stems from something that happened when you were a child, it’s going to be really hard to get rid of it”

I’m sorry about whatever it is that happened, but that is going to take some counseling to help, you should talk to your doctor about a referral to a mental health professional to get the appropriate care.

Sometimes I wanna phone up these other practitioners and ask what the hell they are doing saying things like that to a patient but apparently I’m supposed to be professional or something.

Instilling Beliefs In Patients

As therapists we play a role in which we can be either effective or detrimental.

There is a strong correlation where what we say to a patient has a huge impact on their improvement or just instilling fear that makes them have to keep coming back in for more therapy.

Unfortunately instilling fear in patients with the language we use has become more of a marketing gimmick than using our words to help a patient.

This is called the “Fear Avoidance Model”.

The fear avoidance model shows that patients can develop pain as a result of fear and avoidance behaviour. Typically it is referring to a patients fear of movement as it might cause pain.

However studies have shown how this model can be developed in other ways.

If a patient can’t make sense of the pain (which is part of our job to explain to them), have some societal beliefs associated with past experience or have a diagnosis of something that can’t be fixed are all things that can be associated with this fear avoidance model.

If a patient comes in for treatment and already has some of these underlying issues, we have the opportunity to either correct or reinforce what is going on with them.

We can have a strong influence on those patients beliefs and in turn can influence those beliefs in a positive (or negative) way.

If we decide (and it is a decision on our part) to use negative language like “tissue damage, out of alignment, or structural problems” we can change a patients beliefs for many years to come. One study showed that it can even lead to feelings of increased vigilance, guilt and worry.

The same study showed that if we take an approach of providing reassurance, which increased confidence we could positively influence a patients movement and activity.

So, imagine if just the way you communicated with your patients, made them want to adhere to their home care and gave greater outcomes overall in their treatment?

Photo by: PublicDomainPictures

Improving Communication For Better Outcomes

So where do we go from here?

We are always going to have other therapists and practitioners who use scare methods like I mentioned at the beginning.

I’m pretty sure a little piece of me dies inside whenever a patient tells me about these things they’ve been told.

In the case of the patient saying they have compressed discs and are out of alignment, well I’m pretty sure if they x-ray’d me they would find the same thing however I’m not in any pain. In fact Todd Hargrove wrote a great article on the topic that we have used on this site, which you can read here and is a good reference to show a patient when they are worried about imaging and disc issues.

The way we communicate has to involve positive reinforcement, with good explanations of what is going on with the patient.

Being able to describe to them that pain is just the nervous system reacting, not tissue damage, is a hell of a lot better than reinforcing some old beliefs or scare tactics.

There is a new model of rehab being developed that outlines four elements that could lead to better outcomes:

Knowing the person and building a supportive relationship
Effective education and information exchange
Goal setting and action planning
Fostering positive, realistic, cognitive and self framing.

Those four steps represent a golden opportunity for us as Massage Therapists.

All four steps are well within our scope of practice and we quite frankly have the opportunity to reinforce those steps more than any other practitioner due to the time we get to spend with patients. Because we get to spend so much time with our patients our ability to build that supportive relationship is paramount to what we do.

Even being able to read the mood of our patient who we have built that relationship with can make a difference in the outcomes of their therapy.

As much as the terms “evidence based”, or “research based practice” gets thrown around (I know some of you don’t like it), there is sound justification to making this a part of your practice. Research is actually showing us the importance of how we communicate with our patients. There is even studies that show how contextual factors like a therapist and patients features can contribute to outcomes. Now I know there is no way you can do anything about your features, but you can do something about all the other things we discussed. Staying up to date on new research, working on communication skills and not being afraid to “forget” some of the things we used to know goes a long way to establishing ourselves as the more trusted source of therapy in our communities. Being able to educate a patient when they come in, helps to build that supportive relationship and puts you at the forefront of their healthcare as a professional. Help your patients to set goals aligned with their home care by making them positive and realistic. Our biggest job is always going to be education. Educating our patients and explaining what is happening to them is a key factor in getting them back to their activities of daily living. Unfortunately as other practitioners use fear to market their practice, they make our jobs just a little bit tougher.

Jamie Johnston

As the creator of the site, I hope you like what you’re reading. I’m a Registered Massage Therapist in Victoria BC, former Massage college clinical supervisor, First Responder instructor, hockey fan and volunteer firefighter. Come hang out on the facebook page, where we can share some ideas about how to improve the perception of the Massage Therapy industry.