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I see more and more patients presenting with complex pain patterns. I wonder if this is just me or is this happening to many other therapists?

Certainly therapists attending workshops over the last couple of years have commented that this was their experience also.

Therefore subjective assessment has been increasingly important. At the workshops we have discussed that this part of our assessment procedure can be often brushed over, or never looked at in enough depth like objective assessment.

When you start to investigate what people have to say about subjective assessment, many of the findings have been categorised into ‘flags’.

• Yellow flags are about the Person (thoughts, feelings, behaviours)
• Blue flags are about the Workplace (work and health concerns)
• Black flags are about the Context (relevant people, systems and policies).
  (Borrowed from TSO Shop)

The flags can help others who may be required to read our notes, if we are sick or for insurance purposes. They help to create a picture of information gathered at the subjective assessment.

The question I would pose would be, ‘Does this just create more tick boxes, or does it provide a clearer context in which to lead our subjective assessment?’

I believe there is a need to be confident in being able to create a good rapport with our patients. Maitland states in Vertebral Manipulation 5^th Edition “Skill in communication is necessary if instructions are to be given to a patient, so that the possibility of being misunderstood is to be avoided. The learning of this skill requires patience, humility, clarity and self criticism. Without them, good rapport with patients will not be achieved”.

I believe we have to have systems in place, but still maintain good rapport to gain the full picture. With the full picture we can tailor the best treatment for our patient; a treatment which will enable them to feel most comfortable.

There is some interesting research by Lorimer Moseley, (Moseley GL et al 2004 A RCT of intensive neurophysiology education in chronic low back pain. Clinical Journal of Pain 20:324-330) about by which explaining to the patient all about their pain, they achieve a quicker and more successful outcome to their problem.

I have found I can achieve this at the point of subjective assessment, leading to the patient feeling much more at ease, leading to an increase in my findings during the objective assessment.

I’d love to hear your thoughts on this. Please leave comments below.

This is the first time we have presented, a workshop on assessment and treatment plans. The aim of the workshop was to break down piece by piece to gain a clearer understanding of the information given at the subjective assessment, making observations of our own assumptions, Asking how do we check this information out. Drawing on NLP meta positions, to greater understand how we get into rapport with our patients. We went on to investigate objective assessment, how we gather information taking a broader view of active, passive, resistive. Exploring the value of the resistive tests, as this test is often best used to re-assess, also to find that one muscle that is inhibiting full recovery.

We got some valuable feedback,

When asked what was the course highlight for you?

“Openness and honesty – being confident to trust your instincts. Feels more comfortable to sink in with the ‘wave'”
Angela Ashworth, Hendrickson Method Practitioner

“Analysing method of assessment and treatment plan and identifying when to stop treating an area. Will help me to have greater clarity of thought and therefore give more precise treatments.”
Elspeth Hirst , Hendrickson Method Practitioner

“All the pearls of wisdom from ‘seasoned campaigners’ and feedback given during hands on sessions”
Charles Petch , Sports Massage therapist

“As always Sue made me take a closer look at the way in which I approach treatments. Sue inspires me to strive to learn more”
Lisa Moustacus, Massage Therapist

Muscle Energy Technique

This one day workshop aims to give therapists a confident understanding of the science behind MET, how it can be used to establish new resting tone and improved neurological functions.

The Lower Quadrant day will explore METs for lumbar spine, hips, knees, ankle and foot.

Students will:

• Gain a broader understanding of the neurological basis of MET;
• Gain confidence in the differing methods containing MET CR – CRAC – PIR – RI etc.;
• Gain a new understanding regarding the amount of pressure required;
• Concentrate on the Lower quadrant and how to engage just one muscle at a time;
• Learn how to achieve pain-free treatment that halts secondary inflammatory response.

This workshop will be evidence based with all support literature fully referenced.

To find out more, please visit our Events Page.

My summer reading included Explain Pain. I’m a Therapist who treats many people in long term chronic pain through injury, stress, unresolved sporting injury and I’m always on the search for new information.

Explain Pain by David Butler & Lorimer Moseley

The book ‘Explain Pain’ aims to give clinicians and people the power to challenge pain and to consider new models for viewing what happens during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery.

Butler and Moseley explain with all its facets of pain, how understanding ‘why’ emotions, thoughts beliefs and behaviours are important in perception of pain.

Offering varying reasons of when someone is in pain, basically it is the brain which decides whether something hurts or not, and only if the brain reads that the body in under threat. This did give reason to how different patients, having the same condition can be in such different levels of pain. They bring together the patients experiences of pain and neuroscience, no purple areas.

I found that they present their complex knowledge simply and engaging with cartoons for your patients to help them understand the mechanisms of pain of their pain. Enabling the person not to feel so afraid.