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I’m sure you’ve heard of the saying, “Look Ma, No Hands!” and may have said it yourself when you first took your hands off of the bicycle.  I like to teach my interns this type of approach after performing a treatment to re-assess the patient, as in a post-treatment assessment.

I have used this approach for quite some time but a recent post by Dr. Religioso over at really got me thinking further.  Thanks to him for the brainstorming and make sure you go over to the post, “Top 5 ways to get more out of your manual techniques” and check out #2.

Let me explain further.  We want to be able to show a within-session improvement after our treatment, right?  We want to be able to show the patient an immediate improvement in their concordant symptoms.  Concordant is important, as I will come back to this.

Nevertheless, you can accomplish re-assessment by testing pain, ROM, centralization, etc.  OR, it could be decreased pain pressure threshold as the clinician re-tests on a particular joint, trigger point, or other structure that initially was highly sensitive and painful to touch.  OR, it could be more mobility, alignment, symmetry noted at a particular segment from a clinician standpoint.

The two latter points create bias, bottom line.  Clinician Influence with Patient Agreement Bias (Yes, I made this term up). Palpation: Are we pushing, or feeling, with the same amount of force or are we slightly pushing less so as to disguise a difference?  Mobility: Can the patient really feel the difference if the clinician feels the joint moves better before and after?  Some can yes I can see that, but for the most part; no.

As for post-treatment re-assessment, use the concordant symptoms that the patient arrived with to make your assessment and decrease bias.  More than likely they aren’t saying the joint moves less or very tender to touch.  They will have LE symptoms (peripheralization) if they bend forward, they will have pain when they turn their neck one side or the other or they may have pain initially upon standing in the plantar aspect of the heel.  Test these; but more importantly, let the patient test these.

Use your hands as treatment, but as to the re-assessment, remember….no hands and therefore, no bias. 




  1. This was a much needed read. I am trying to integrate this into my practice more and more. The only issue becomes when someone has a long standing condition. I’m note sure how many 75 year olds with chronic knee O/A we can get better within 1 session.

    I agree with all your points and I think it’s not only good practice to assess and reassess, but it’s also good for business!

    Thanks for the great read Harrison!

  2. Thanks Jesse for the comment! I agree that I have been integrating this concept for the last 6 to 12 months myself. Something to think about and make you really know (while you are thinking on your commute back home) that you really changed symptoms, and not manipulated someone. Makes you sleep better at night!

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