Challenge: What do you do when a patient presents with multiple issues in the same visit, and you do not have time to address all of their concerns?
Clinical problem solving requires the ability to prioritize.
1. Pain
If pain is the overriding issue, use the Numeric Pain Rating Scale to determine which region is most impaired by the pain. You can ask the patient to rate pain on the scale of 0-10, with 0 representing no pain and 10 as the worst pain imaginable. Offer to work on the area with the greatest pain first, then address the other regions in turn, based on severity. If there is Trigger Point pain with muscle spasm, Positional Release may be beneficial to reduce the abnormal muscle guarding and restore the normal threshold for excitation of the monosynaptic reflex. Ischemic compression may also help.
2. Disability
Another way to manage multiple areas of impairment is to decide which problem is restricting their activities the most. There are many disability indices available to quantify the level of disability for a particular body part or activity. Question the patient: What specific activities are you having difficulty with? Are there movements you are unable to perform due to this issue?
3. Motion restriction
Observe what movement patterns are most limited in flexibility. If the restriction is interfering with daily functional activities, select interventions to improve mobility to the most limited region first. If you are familiar with myofascial release work, you may use the General and Local Listening assessment to identify areas of facilitation, and begin treatment in those areas. After treatment, reassess using the Listening skills to measure how effective the intervention was. Listening skills are introduced in our Evidence-based Myofascial Release with Craniosacral Therapy course. Dr. Jean-Pierre Barral, DO taught the technique as part of the Visceral Manipulation series.
