(VIDEO INSIDE) Are you MORE than JUST a Manual Therapist?

I’ve never thought of myself, my professional designation, my purpose, my “WHY” as JUST a Registered Massage Therapist/Manual Therapist. There are very few medical professions that afford a patient an extended period of time (I personally schedule treatment times at 60-90 minutes) which permits the therapist the ability to really get to know the patients history, habits, challenges, etc…

A recent patient of mine complained of daily migraine headaches. As I calmly took my time inquiring about all aspects of his life (work, personal life, activities, interests etc) we discovered that he has an addiction to playing cell phone games… Angry Birds, Candy Crush….

I can honestly say I’ve never seen these games as I have blackberry and nothing runs on it! LOL! Even if it did, I wouldn’t use my time for this purpose, but that’s me.

He’s been to his MD, had MRI, CT scans of his CNS, had been to see a neurologist, and both only wanted to prescribe Antidepressants. This is a road the patient was opposed to. Since we had had positive results from previous treatment, he thought he’d try Manual Therapy for this current migraine issue.

Using Research in Practice

Taking my time, not feeling rushed to get the patient on the table to do something, I took a few minutes and searched for some research on cell phone usage and migraines. A quick search informed us of the following:

1: Lin IM, Peper E 2009 in their paper:  Psychophysiological patterns during cell phone text messaging: a preliminary study. Appl Psychophysiol Biofeedback. ;34(1):53-57 

“The results indicated that all subjects showed significant increases in respiration rate, heart rate, SC, and shoulder and thumb SEMG as compared to baseline measures. Eighty-three percentage of the participants reported hand and neck pain during texting, and held their breath and experienced arousal when receiving text messages. The study suggests that frequent triggering of these physiological patterns (freezing for stability and shallow breathing) may increase muscle discomfort symptoms. “

2: Migraine: A Chronic Sympathetic Nervous System Disorder
Sympathetic activation is a primary component of the physiological stress response. Stress is the most commonly cited cause of migraine. Thus, the SNS offers an unequivocal link between known causes of migraine and a specific biological system.

We Know that changes in respiration rate, heart rate, experienced arousal… are symptoms of an increase in SNS, Fight Flight Response. This patient was playing the cell phone games regularly throughout the day and daily over an extended period of time.

So what’s the solution?

What’s the “FIX?” What’s the most effective course of treatment for this patient? What’s the FID of treatment? What treatment modalities, activities would you recommend, prescribe? What anatomical structures would you focus on? Would you assess his posture while playing the game, making suggestions of postural correction and stretches/activities to minimize the neurological effects of the stagnation of movement while playing the games? Would you recommend he see another medical professional that has a scope of practice that enhances your treatment affects for the migraine condition?

My initial thought was to suggest that the patient to do one of two things:

1: Hand me the cell phone so I could delete the game!
2. Delete the game himself!

Change Habits, Don’t Break Habits

BUT… knowing that this was a long standing HABIT, I knew from reading research into Habits, that cold turkey has NOT been shown to work effectively.

Every habit follows a simple 3-step loop pattern:

1. Reminder (the trigger that initiates the behavior)
2. Routine (the behavior itself; the action you take)
3. Reward (the benefit you gain from doing the behaviour

To change a habit, you must address the old craving. You have to insert a new routine while keeping the same cues and rewards. It is easier to adopt a new behavior (routine) if there is something familiar at the beginning (same old reminder) and end (same old reward.) Almost any behavior can be transformed if the cue and reward stay the same.

Similar to initiating a graded FID activity/exercise routine, we decided to incorporate a reduction in FID of the habit and have the patient come up with his own suggestion of a substitute routine.

Informed consent was then established to start manual treatment to the affected MSK faults making an attempt to desensitize and being some balance to his ANS.

Simplify

Interest in the patients main complaint, patient education, therapeutic contract agreement, informed consent, manual treatment, follow up appointment scheduled for reassessment and progress assessment.

What do you think?
Too Simple?
Common Sense?
What was missed?
I’d love to hear what you would do.
Leave me your comments below!