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Athletic development specialists dedicated to the art and science of excellence in movement

Tucson Therapy, Training, and Treatment Think Tank Meeting: November 2013 Highlights

This afternoon we had the pleasure of Skyping into a the Tucson Therapy, Training, and Treatment Think Tank meeting organized by Dr. Kevin Fay, DPT at Proactive Physical Therapy.  With feature presentations by Dr. Jonathan Tait on nutrition and John Woolf, PT on pain science, it was a great opportunity to stay in the loop with some very sharp minds in our former home base.  Below are a few bullet points I jotted down from the meeting.  The main take home point (and a common thread to link each presentation) is that optimal care is about relationships.  Transcend a narrow focus on techniques and create a partnership between clinician and patient/client for the best long term outcomes.

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Behavior and mindset are most important factors in nutrition success.  Far more important than calories and micro managing food choices. 

“Relationship centered care.”  Patient and clinician are partners in healing process.  Patient centered care may devalue clinical expertise; clinician centered care tends to ignore patient goals.  Avoid these pitfalls with focus on the relationship.

Do you have unconditional positive regard for your patients?  Can be difficult at times but is essential.  What happens after you get out of pain?  Patient needs long term goal for success, even if their only short term goal is to “not hurt anymore.”

Barriers to change.  Even with right mindset, patient will not succeed without external support (Family , work, friends, etc).  Diet example...husband desires to lose weight, but wife expects him to eat her cooking for her own validation.   

What to do with those for whom pain is part of their “normal”?  Living without pain can be discomforting to someone who has lived with chronic pain.  Athletes lose an excuse for poor performance.

What “Sense” does it make for people?  Critical to understand how people translate feelings into imagery (sight, smell, taste, touch, hearing).  Goes back to fostering relationship between patient and clinician. 

Patients perform cost-benefit analysis of coming to appointments.  Must provide transformative health care relationship for them to see benefit as greater than cost

People invest more in personal training than treatment (self pay versus insurance)

Readiness to change.  Recognize the ecology of change.  Change in one area effects changes elsewhere.  A positive change in one area may create a negative elsewhere (“If I heal, that means I must go back to work”; “If I’m not hurt anymore the coach will expect me to perform).  Ecology is why people create self imposed barriers to change. 

Healing is a story – everyone trying to make sense of where they are and where they are going.  Delicate balance to deal with sometimes questionable beliefs without disturbing patient's outlook (example: patient who is convinced by their accupuncturist that they can't heal until their qi is aligned properly...).  

Pain is chemistry, mechanics, and psychosomatics

Healing process (The same whether US with westernized medicine or in jungle of South America with a mystical shaman)

  1. Expectation and motivation to heal
  2. Relationship (most often missing, but helps get closer to the necessary motivation)
  3. Ritual

Most people are motivated for something; you as clinician might not agree with it but they are motivated

Instead of asking “how is your pain today?” ask “what is feeling better?”; If patient perceives “less pain”, they are still perceiving pain.  Clinician must create new pathway in nervous system to focus on the positive (neurocognitive restructuring).  Diverting focus away from pain forms mental “cushion” for whatever pain is present

Stretching may irritate the body’s subconscious protective impulses; Tightness is often a long term sympathetic response where muscle is shortened for a reason; mechanical changes via stretching may cause flare up.  Priority is to lower patient’s arousal level first before focusing on mechanical interventions

Why not to stretch hip flexors? – Patient may be using hip flexors for stability to compensate for low back instability; Also note psychosomatic issues

Loss of mobility.  Ask where is the breakdown (Table, standing, gait)?  Why is it happening (lack of mobility/stability)? 

Janda lower cross.  Not fully supported in literature, but still a useful construct

We are products of our environment; we get comfortable not using certain qualities.  Especially important to challenge elderly patients/clients 

What do you tell your patients about foam rolling (why do we think it works)?  We know it has minimal mechanical effect, but how to deal when people THINK certain changes are happening that really aren't?  

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