As a PT I’m always wanting to learn how to get patients better faster. Like Jimmy Johns freaky fast. Its rewarding and exciting to see the quick responders. However, some people generally don't respond quickly. I'm sure there's a lot of reasons, but basically we can get a quick neuro response. We can't override the body's response to their pain or tissue tightness or inflammation. These people can still get much better but we have to be patient. And in fact a steady progression is in fact the quickest way. I've recently learned sometimes, just sometimes, slower is better.
This is a tough pill to swallow but we need to know when to apply the ‘tortoise strategy’ to our patients. So who is appropriate for the ‘tortoise strategy’?
- patients who report their pain at or higher than a 7/10. According to the VAS, they should look like this:
(sorry, I don't get the faces on the VAS)
- pain at rest. This typically rules in derangement issues however.
- low functional outcome measures or high disability noted on outcome measures
- pain that occurs in mid range or well beyond end range in AROM and PROM
- AROM<<PROM.
There's a lot we can do outside of modalities for these patients too, including pt education. In fact pt education has been shown to decrease their pain faster, make the patient less fearful, be more compliant with exercise and exercise more frequently, and participate more in PT (thus decreasing attrition). Pt educ should include:
- education on positioning of comfort
- activity modification
- education on the healing process.
- education on complianceSo there's a few things I look for before I even consider techniques like dry needling or manipulation. Anything else you guys slow down for? What other interventions do you apply that seem to work well?
