Joe Muscolino The Art and Science of Kinesiology

Comment

Comment by Erik Dalton, Ph.D. on December 11, 2009 at 3:38pm

Medical history-taking often is unstable, according to psychiatrist Arthur Barsky, MD. "Patients frequently fail to recall (and therefore under-report) the incidence of previous symptoms and events; tend to combine separate, similar occurrences into a single generic memory; and falsely recall medical events and symptoms that did in fact occur," Barsky explains.

In both acute and chronic neck/back pain clients, history often relates to individual personality characteristics, state of health and mind at the time of recall, and preformed beliefs about symptoms and prognosis.

Most of us would agree that clients also are less likely to recount distant events accurately than they are more recent occurrences. Therefore, some of us may find it beneficial to incorporate these factors when interpreting a client's history:

1. Establish anchor points or memorable events that might help clients recall their symptoms.
2. Encourage clients to convert generic memories of symptoms into more concrete episodes.
3. Ask clients to recall their symptoms in reverse order, starting from the present.
4. Take the history in a similar way each time.

Questioning clients about events surrounding traumas or work-related injuries during the therapy session often reveals new and helpful insights. The addition of touch not only calms nervous system hyperexcitability, allowing thoughts to flow more freely, but also triggers tissue memory as the injured area is being worked.

Accurate, focused assessment is crucial, particularly in chronic cases, since time might have elapsed since the event(s) leading up to the painful condition. Therapeutic outcomes sometimes improve dramatically as we begin developing creative, yet consistent methods of helping clients present an accurate portrait of their past and present musculoskeletal health problems.

Comment by Joseph E. Muscolino on December 11, 2009 at 1:52pm

Well, we definitely have a "point - counterpoint" on the time issue.

I will add a few notes on the concept of the history...

I figure that approximately 80% of the time, my diagnosis/assessment is "relatively" complete at the end of the history. That is not to say that I know "exactly" which tissues are the causative elements, but I have a sense of the direction of the problem...is it disc, etc. When I follow with the physical exam, most of the time it is to confirm what I suspect with my history.

The other thing I would like to add into the mix is something that professor of mine back at chiropractic school used to say...that is..."Don't ask the patient what is wrong with them, tell them what is wrong with them." In other words, their history can only tell you what they think, but it is up to your skills to determine what the problem is.

Heck, I'll throw one more great saying into the mix: "Give them a little of what they want, then give them what they need."

30 years, eh Tom? How old are you? :)

The first time I ever met Bob King, I said to him, "You know, you are an icon in the world of MT." He shot back, "That's what happens if you stick around long enough!" Bob has such a great wit!

I am at 25 years myself.

Joe

Comment by Whitney Lowe on December 11, 2009 at 1:21pm

Another interesting slant on the "time" issue. Back in the early 90s I was working at an orthopedic clinic affiliated with Emory University. The treatment model for all the PT services there was tightly time driven. Massage sessions were scheduled on the half hour all day long. While I don't think it is the ideal time format for most of the type of work I was doing, that environment did more than anything to teach me about being efficient in my analysis and treatment of the primary issue. I really learned a great deal about getting something done with the client in a very short period of time.

Comment by Robert Downes on December 11, 2009 at 11:32am

Hi Thomas, check out the book "What Every BODY is Saying" by Joe Navarro. He teaches med students and MDs what a patient's body language is "saying."

Comment by Stephen Jeffrey on December 11, 2009 at 11:31am

Hi Tom
" you never get the full story on the initial history-taking in any case". so true

Can you or anyone else give a full explanation of homeplay. I can only guess at mo.

Comment by Thomas Myers on December 11, 2009 at 11:12am

That's funny - the longer I go, the shorter my sessions seem to get. I would parse it as: after 30 years (break my arm patting myself on the back), my work has become effective enough so that I can give the system the info it needs to make its next step with about 30-45 minutes worth of input. More is pouring tea into a full cup. I agree that optimal time varies, and the newer a person is to the 'kinesthetic absorption process', the longer it takes. As for 'homeplay', well, that's another topic altogether. Way overused, in general.

While I agree about a complete history and allowing the client a full vent on the first go-round, at the same time I am often listening more to the tone of voice than the details (the client can only report to me about what's on his or her surface, not the depth parts where all lies in the subconscious), and I am waiting for a 'go!' signal inside myself, secure in the knowledge that I am going to find out more as we progress: "Gee, your liver feels stuck" "Oh, yeah, I guess I didn't tell you about that cirrhosis / auto-accident / bout with cocaine" - you never get the full story on the initial history-taking in any case.

Comment by Stephen Jeffrey on December 11, 2009 at 8:21am

Thanks Robert.

Comment by Robert Downes on December 11, 2009 at 6:44am

Hi Stephen, check out the book "The Lost Art of Healing: Practicing Compassion in Medicine" by Dr. Benard Lown ISBN: 0345425979. He talks about the essential importance of listening and taking a coplete history.

Comment by Stephen Jeffrey on December 11, 2009 at 6:37am

Hi Joseph, maybe those MTs offering 90 mins minimum are the way to go ? and of course "it depends" on so so many things. But just to stick with the time factor for a moment.
How many of you see chronic clients who have already seen a long list of "professionals" but never been allowed to explain in detail their compliants ? Allow them that opertunity, listen intently, empathise and in effect they will lead you to what treatment is needed, you do not know better than them.
Only in private practice have I been able to do this, in all other work/clinic situations the domination of the ticking clock can annialate/neutralize effective theraputic treatment.

Regards steve

Comment by Joseph E. Muscolino on December 10, 2009 at 10:22pm

I am also intrigued by Steve's question about the optimal length of time for a session. I will start with the usual caveat that there is no one optimal anything for anyone and the best answer is always (as Whitney likes to say) "it depends."
Having said that, I will address this question from the point of view of being the client of massage. When I get a massage, I usually receive an hour and a half, and that amount of time is usually appropriate for me to have about half of my body worked. This is considering that I have specific myofascial complaints that I want addressed.
And... I do know of a few MTs that only book 90 minute sessions.

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