The patients perception of us (PTs) having manual handling expertise is not reduced or diminished by the provision of lighter/non coercive touch. It's reduced by the explanation we provide.
I'm seeing a patient now who was seeing a chiro for ART, and is confident that it cured her "psoas pain", but she continues to have pain in the hip region, although it's changed somehow, and continues to interfere with her desire to train for long distance off-road races. So, whatever the chiro explained to her about ART apparently instilled some measure of confidence in his manual skill, just not enough to completely fix the problem. I don't think the explanation for pain relief provided by an ART practitioner is defensible. It includes fairly coercive manual interventions that are heavily based on an explanation that emphasizes muscular dysfunction.
This is just the kind of "manual handling expertise perception" that we should be concerned about promoting in the culture of treatment for non-pathological pain. To the extent that more aggressive or coercive handling of the patient reinforces patients' erroneous beliefs about why they hurt, it might also reinforce passive coping strategies, which have been shown to predict increased disability.
I think the biggest mistake therapists make is that they give up too soon on educating the patient. It's hard to do, requires some "tough love", and, for those of us who rely on referrals from medical people, may threaten that relationship as well.
Shouldn't we do it anyway?
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