It seems to me that most of our treatments are tailored to how the patient “feels”. If it’s body image with their pelvic alignment then I try to focus on an impairment and see if the patient’s reassessment changes. Adam’s article focuses on the power of listening to our patients. I find this extremely difficult especially if the patient is a talker. My question is how do we better facilitate conversations at least during the evaluation? I agree with Myra when it comes to reassessment because patients need to see a change not only for a buy in but also for relief either that me physical, mental or both. Then again what sets us different then chiropractors? They do manual work as well. I don’t know if they reassess but some patients do feel better after and sometimes it stays the same or they get better. I definitely say that having the knowledge behind why we choose a technique gives us a higher probability of creating a positive change.

I agree with Bialosky: stay away from contraindications and apply your skill based on your clinical reasoning. If manual therapy worked 100% of the time then we wouldn’t have people arguing against it. Obviously there’s skill through confidence and we see our patients for 30-60 min per session. What they do outside the clinic is not our responsibility. Life is life and people will continue to live it how they please.

Education is definitely a theme! I try to use words of “this is irritating causing a muscular response” or to support manual therapy I say “Have you ever touched something hot and then grabbed your finger and rubbed it?” I don’t explain the science behind hypersensitizing receptors but I explain how manual therapy is beneficial. Going back to reassessments, I use this as a HUGE learning tool. Those who say “my arm is the issue” I show them how I move their neck and that reproduces THEIR symptom. I try so hard to find some comparable sign (my hope it’s the primary) in each treatment. Those who are the pro athletes make it challenging but I have to stress that tissue somehow or else why are they here? I still have difficulty finding the ideal comparable sign. What do you do when you can’t find that one thing causing their pain? As well, we see patients after plenty of other treatments and I ask them to explain to me what their pelvic alignment means to them? If it doesn’t make sense to them then I take the route of Alex and explain the “teamwork” approach for the body to work as a whole.

Moral of the story: Listen, educate, find a comparable sign, reassess, move what is stiff, decreased hypertonic tissue, and listen/ educate again. Of course using clinical reasoning and getting creative is part of the fun.