A recent inquiry from a friend and colleague whom I respect VERY highly.
"Where does DNS or the SFMA stuff fit into the new approach you have to therapy based on what you learned from the Mosely course? Or, are you using it but explaining things differently?"
I definitely am still using DNS and the SFMA. And I think it all fits in nicely. To give you a better appreciation, here's my typical framework, which I think you'll probably resonate very well with.
In my opinion, the clinical history is paramount. Here we can identify where the "condition" falls in the continuum between acute and chronic. Perhaps more importantly, the more astute clinician will be able to identify the goals of the patient, their thought process, their tendencies, their activity levels and behaviours, their coping strategies and ultimately, their understanding of their condition as well as the pain they are experiencing. While I'm listening, I'm paying attention to (amongst other things) their body language, they're level of anxiety (if present), and their ability to make eye contact.
From the above, I'll classify their presentation and formulate the most appropriate assessment and treatment strategy. And I'll always use the most appropriate dialogue and communication strategy based on what I find. If I feel they need more reassurance, they'll get it. If they need more gentle verbiage, I'll provide it. If they simply need to understand their injury, they'll get the explanation. If they need a kick in the you know what, then I'll give it to them. Rarely will the above and other communication strategies be in isolation. Typically it is a take a little from here and there, buffet-style, approach.
For acute traumatic presentations:
For acute non-traumatic presentations:
For the subacute and chronic presentations:
For additional therapy, I've been more keen on incorporating kinesiology tape with a neurosensory approach, as well as gentle touch and vibration. Based on Moseley and the pain science folk, during treatment I may have them cross their arms, I may use mirror imagery, and I may try to facilitate improved sensory discrimination (i.e. two point discrimination - "close your eyes and tell me if my contact on your skin is with one finger or two"). Though this is more likely to be included in the chronic cases. I think these approaches tap into specific areas of the brain (i.e. premotor cortex) that have recently been shown to play key roles in chronic pain therapeutics, so if I'm leaving it out, I'm not doing my job.
I created this blog to share my thoughts with others. It is not intended to be used for medical diagnosis, medical treatment or to replace evaluation by a health practitioner. If you have an individual medical problem, you should seek medical advice from a professional in your community. Any of the images I do use in this blog I claim no ownership of.