Funnel

Question 1

the fab 5 questions?

Answer 1

BD (nerve root? which joints)
TF (fixed or not)
C or I (Drg, NRE, chemical)
W - Show Me, & consistent or variable?
Obstruct (Drg until proven otherwise)

Question 2

Bonus question after Fab 5

Answer 2

Better? (consistent or variable)

Movement improved?

Question 3

4 reasons why behind Return to Function on visit 2 (maybe visit 3)

Answer 3

1. reduce fear
2. Self diagnostic
3. Value Add
4. Good health
   and they stop focusing on stupid nagging symptom and more on getting back to normal lifestyle

Question 4

How does early return to function reduce fear?

Answer 4

shows themselves - I can have sore muscles, without worsening my spine or breaking back

Question 5

how does early return to function turn people in self-assessors?

Answer 5

they test 1-2 functional baselines before and after therabands

• gives internal locus of control for return to function
• shows if they can handle load -> if no, then basketball is a bad idea, no lecture needed

Question 6

I just crushed a derangement that they had for 30 years, why do I need to add theraband exercises to treatment for a value add

Answer 6

human psychology- they need change/something new every visit

Question 7

Is simple theraband exercises really gonna make a difference for their health?

Answer 7

19k LBP articles/year, and they all agree movement is the best thing for low back pain

Question 8

what theraband exercises does IMC regularly prescribe?

Answer 8

wall toe raises
sliding wall squats
bicep curls, upright row, military press

Question 9

form cues, details for theraband exercises

Answer 9

#1 is neutral spine
wall squats- shoulders and butt against wall, down to knee comfort
military press - may need lighter band

Question 10

3 criteria for deciding when to do early return to function

Answer 10

1. HEP is staying the same
2. Pt requests return to their usual activities
3. lesion is controlled, stable, understood

Question 11

what is goal timeline for early return to function

Answer 11

Visit 2!
unless still fiddling with force, direction, etc
- you’re still doing something new, so no need for value add

Question 12

what is goal timeline for introducing prophylaxis

Answer 12

Day 1!!!!

Question 13

Example script for introducing prophylaxis

Answer 13

“Getting you over this episode is a goal, but I’ll be honest. It’s not the main goal. Research shows that, whether conservative care or surgery, 50-60% of MSDs will reoccur.”
“Don’t worry though, with our HOW to your problem that we’re going to figure out together, we’ll make it a <10% chance your problem comes back.”
“My goal is to give you a program for a lifetime.”

Question 14

Example script for after a patient confirms their Body Diagram to you

Answer 14

“That’s great. That’s fantastic actually. Whenever I see people with this, over 80% of them are in the group where one direction of movement, that we’ll find together, will rapidly resolve their problem. This is regardless of age, how long they’ve had the problem, or what’s on their Xray or MRI. Today, and maybe the next visit, I’d like to focus my exam and our time on finding out if you’re part of this 80+% that will get better very quickly. Is that ok?”

Question 15

Example script for asking permission for spinal screen with extremity issue

Answer 15

“Mr. Jones, there’s a group of people I see every year (month?) that’s had a lot of treatment on their joint with no results. And when I screen their spine, we get resolution.”

“Look, I know you fell on your knee, and I know your doctor- he’s one of the smartest people in the city, and I’m pretty sure it’s your knee, but I really would hate to miss one. Screening your spine will only take a few minutes, then we’ll go back to your knee. Is that ok?”

Question 16

Main thing to think out aloud to patient during initial assessment(s)

Answer 16

comment whether a piece of info suggests they’re a rapid responder (2-3 weeks), or more likely a remodeling issue that takes 6-8 weeks