When you are unable to help your patient

When this happens in my practice I become very  frustrated. 

First I try everything that I've been taught to do. Then I spend countless hours trying to figure out a treatment that I haven't been taught to do that may help. 

When I am out of ideas I do the following:

- I am honest with my patient 
- I apologize for not being able to resolve their problem 
- I refer them to someone who I think can 

Many years ago I had to have this conversation with a particular patient who I felt needed an internal coccyx mobilization.  At the time did not know how to perform one so I explained to the patient that I did not know how to perform a particular treatment that might be of benefit to her and provided her with the contact information a therapist who could help.  I explained that I felt that we had reached a plateau in our treatment and I didn't feel that I could progress her any further at this time. 

Years later I ran into her again and when she saw me she smiled and happily stated "You were the only one who ever admitted that they couldn't help me". In other words, she respected my honesty. 

Some good  things happened; 
I learned how to perform an internal coccyx mobilization and after I learned this technique, I gave her a call and explained that I had been taught some new things since we had last worked together and would she be willing to let me try to help her again.  

As a result she became one of  my best sources of patient referral.

Treating Function and NOT Range of Motion

This is blog that I wrote a while back. I wished that I had posted it last week as I had just been referred a challenging patient.

I have now wasted the better part of 3 visits trying to increase the Range of Motion of 1 joint rather than addressing function. 

I stress in my class to focus on what the patient cannot do functionally to guide your evaluation and treatment by asking “What activity or activities do you have difficulty performing”.

This strategy is beneficial for the following reasons:

1. We now have functional goals which are vital for insurance reimbursement

2. We now can break the activity down into its components and determine where the dysfunction is and what type of dysfunction exists.

3. As a result we will be able to provide the appropriate treatment to restore function.

I was recently given such a case study and asked to evaluate and treat the following functional limitations.

1. Patient is unable to negotiate stairs
2. Patient is unable to balance on one foot to don clothes

Significant patient history is the following:

1. Total toe replacement over 5 years ago on the R.
2. Trendelenberg gait on the right

When we observe this patient we notice the following:

1. Bilateral pronated feet
2. Right hallux extension, approximately 3 degrees in neutral
3. Diminished push off phase of gait.

My evaluation will be as follows: 

1. For negotiating stairs I will evaluate:

1. ROM of dorsiflexion with the knee bent in stepping (going up and going down)
2. Pelvic Depression with the leading leg on descending stairs
3. Hamstring Contraction

2. For Single leg Balance I will evaluate:

4. PROM of the hallux to neutral
5. AROM of the hallux in flexion
6. Observing where motion occurs (motion = instability) Single leg balance

I will practice what I preach next visit.

A Therapist's analysis of Jean Claude Van Damme's split

 

Watch the video and follow along. JCVD's split is not so perfect.

Using the Principles of Diagnostic Motion Evaluation, Here are the dysfunctions that I found:

1. At the very beginning of the video you will notice that his Right foot is externally rotated. We do not  know if this is a Structural or a Non-structural Dysfunction.

 If you do not know the difference between a Structural and Non-Structural Dysfunction, click here.

2. When the trucks are moving you will notice non-sequential movement in his Left mid thigh and compensatory movement in his pelvis.

This is a Structural Dysfunction because the movement of the trucks is causing Passive Range of Motion.

The exact location of this Dysfunction is in middle of his left thigh.

The motion is in the Open Chain. Although his feet are on the ground the definition of an Open Chain motion is when the Distal Structures (his legs) move about a stationary Proximal structure. (his pelvis and trunk)

To treat JCVD, you would palpate along the middle Left thigh cumferetially for a restriction in the Connective Tissue and release it using a treatment for restrictive tissues; such as mobilization or massage.

Once treated Jean Claude would have his perfect split.

If this make no sense to you then please check out my video on Diagnostic Motion Evaluation. Using this technique literally changed my career.

Just yesterday I achieve 15 degrees of motion in a knee patient by mobilizing her ankle and lower leg.

Jean Claude Van Damme, not so perfect split

69 million viewers have watched Jean Claude Van Damme's split between 2 moving trucks on you tube. If you are not one of those, I have included it above, just click on the movie to see.

I did not read all 41 thousand you tube comments, but I am curious if any one else noticed the dysfunctional motion in JCVD's epic split?

Many of you logged on to the instructional video for Diagnostic Motion Evaluation, if you understand DME then you will see that Mr. Van Damme does in fact have a dysfunction.

Test your knowledge:

Is the dysfunction on his right or left leg? where does it occur and is it a structural or non structural dysfunction?

Let me know sigproed@gmail.com

Not sure?

Click here for a review of DME, it can change your career.

Just yesterday, in less than 1 minute I gained 20 degrees of hip extension in an elderly patient by mobilizing his lower posterior IT band.