Pain is in the body part (sometimes), the brain/mind (always). The “driver” (originator, instigator, locus) and the key to recovery, resides in those experiencing pain. Whether we use the analogy of a lock and key or a maze, the only way that we can locate the driver and solve the puzzle is by using the right key (lock analogy) or right route (maze) for this person. The adaptive therapist has many keys on her chain to try in the lock. The best clinical decision maker knows the evidence AND reads the patient well, choosing the matching key for this person. Using manual therapy OR exercise OR a modality OR education alone, one can pick a lock occasionally and use the right key occasionally.
The best clinical decision makers pick the right key the first time using these skills collectively:
Look – this presentation
Listen – this person
Feel – this body
Remember – past similar cases
Read – because evidence matters
My patients’ beliefs about what will work for them CAN BE stronger than my ability to create or improve their belief in my approach. Both are #placebo. Neither belief structures (placebos) are shameful or wrong. Each can be used for good or misused with good intention.