I hope you have enjoyed the 5 D’s as presented so far.  Here is the final #5.

5. Defense: Stay ahead of the curve! You ever heard the saying, “an ounce of prevention is worth a pound of cure”? Many quotes from history just sound smart and don’t mean much, but Franklin had it going on. It is always easier to prevent something from occurring, than trying to fix it; we all know this in all aspects of life. It is the same with muscloskeletal injuries. I don’t have to preach to the choir here. The way I get my point across in my theological mindframe is through the following drawing:



So, follow my written words with picture as if this were a Prezi.
1. I would say 50% of injuries that come into my office come from “out of nowhere”, meaning, no particular event or specific injury. The patient may say, “I just woke up with this one day”, or “after a long ride to the beach for vacation this summer, I noticed some ache but nothing more, then it turned to pain!”. We have all heard it in one regard or the other. Some of the stories from the country can be hilarious but I’ll spare you those now.
2. What I think happens is that the the buffer zone, or amount of activity that your body can endure, without having the pain threshold signal firing, changes day to day.
3. Representing through the letter “A” is young, active, healthy individual. This is back in the day when you didn’t know what pain was (other than spraining your ankle on the basketball court as a young lad).
4. Representing through the letter “B” is the young lad a tad older, with more spondylosis in the joints, not as active and drinks too much beer. Basically, not as healthy and the buffer zone before a pain signal fires decreases.  Mannerisms have kicked in and are programmed during ADLs. In other words, the daily grind has kicked in. The buffer zone here is even smaller. One in which tipping over to the “edge”, or “pain threshold”, has hit but you can hover over this threshold line with small changes in activity.  Pain is “tolerable” but enough for you to notice, possibly enough to take ibuprofen but not seek care.
5. Representing through the letter “C” is this older lad, but also one who may sit all day and then night on the couch. This is also represented by someone who compensates during other ADLs due to weakness, ROM loss, or just plain ‘ol motor control issues.   Mr. “C” typically will receive some type of outside assistance from a professional.
Any individual, at any time, can be anyone from Mr. “A” to Mr. “C”. They don’t have to just be lazy, but can be your over-training runner, over-zealous baseball pitcher, or on the other side of the spectrum, someone who has been bed-ridden due to illness and starts to have low back pain.

The question remains, what trigger takes the individual from being in the positive quadrant (no pain), to the negative quadrant (pain arises). I think it is simply microtrauma, wear and tear, not listening to other signals sent to your brain; or just a bad day (stress, hormones).

Manual therapy, education, changes in lifestyle (see past post here), and exercise can bring you back to the positive quadrant from the negative quadrant. One treatment can do this! However, we want the patients to get back to Mr. “A” as soon as possible, and stay there. We don’t want to revert back to Mr. “C”.  What keeps us from being Mr. “C” again…DEFENSE.

DEFENSE: Maintaining Mr. “A” to keep you from being Mr. “C”

I explain this (as I see it) to patients with good understanding.  Is it completely true?  Can’t tell for certain but it makes sense to me and works well to keep them adherent to HEP, cognizant of their daily activities and even helps me get them back in as soon as possible to see me if they go below the dreadful X-axis.

I hope you enjoyed the posts and please comment with your suggestions from your own practice patterns.



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