The last of this series (because I don’t want to get into dosing of modalities… which is likely a whole paper or video topic in and of itself), is about the Dosing of Manual Therapies.
PS If you’ve not check out the previous blogs in this series, you can find them via these links:
Here, I have two case examples I want to share.
The first case is Human – sorry folks! Anyways, I was contacted by my cousin. She had neck pain with radiating symptoms down her arm. She called me up and explained that she usually goes to the chiropractor, but thought she’d call me instead this time. This was years ago, and I was still treating some humans from my home office back then. I thought, “FANTASTIC! I’m going to make such a great impression and she’ll be a client for life.”
So, she comes to her appointment. I assess her neck… yep, neck pain, likely the result of a degenerative disc and some nerve root compression causing the radiating pain down the arm.
I proceed to treatment. I did a lot of traction. I tractioned likely at a grade 3+ level (Maitland’s grading system). I was determined to make her completely pain free by the end of the appointment. AND, she was! I succeeded.
However… I should have been smarter! What happens with inflamed nerves? They are pissy! So, while I managed to make an immediate change, I failed to take into account the rebound effect for when the pressure slowly crept back onto the pissy nerve. So, she was good when she left her appointment, but over the next two days, she was flared back up again. Her verdict, ‘Physio doesn’t help my neck.’
Fail… not only did I NOT prove MYSELF to be the practitioner she needed, but I also condemned all of my fellow physiotherapists for this person’s neck pain there on! Fail, because I overdosed the manual therapy!
The second case is about my current Borzoi, Xana. When I came home from England and the IAVRPT symposium, I found our new young Borzoi to be limping on a hind leg. She looked more rounded in her topline as well. When I asked my husband what had happened while I was away, of course the answer was, “I don’t know. Nothing. I didn’t see anything.” (Okay, that response there is a blog for another day… but let’s continue on!)
So, I examined her. The problem seemed to stem from the sacroiliac joint. Leg was good. Hip was good. Back was good. SIJ and piriformis were not. So I proceeded to attempt to mobilize the joint.
Now, if you have ever worked on a young Borzoi, you will know that they are ALL ABOUT THE DRAMA! They have zero pain tolerance. They are not mentally tough. They over-react. They are Drama-zois!
As I’m working on her, she’s crying. She’s flinging her head around to mouth me. She’s trying to collapse. She’s giving me those ‘eyes’… that “How could you betray me like this” look! So, I backed off. I tried to do very little. I tried to be more gentle. I used laser instead.
All good, except it didn’t work. She was no better the next day, or the day after that. I asked myself, who I be this ‘sensitive’ if she weren’t my own dog? No. The answer is ‘no’. If she weren’t my own dog, I’d tell the owner, “I’m going to have to be mean for a bit. She’ll cry, but then she’ll be better. Can you handle that?” Then I work on the joint, with the force needed to make a change. Not excessively, but with the right amount of force.
What had I done to my own puppy? I underdosed her manual therapy.
Subsequently, I have utilized my husband’s help to ‘hold Xana’ so that I could do the mobilizations needed while he comforts (and restrains) her. She’s been much better since AND has forgiven me as well!
So, there you go… two examples of Not-Quite-Right Doses of Manual Therapy.
Let me know your thoughts!
Until next time… Cheers!