Show Don't Tell Pt.3 - The Power of Interoception

Show don't tell. Part three. Now we're going to talk about how we actually use the setup and we use the information they've given us during the history to get them to really feel and understand what it is that we need to be addressing. So if you haven't watched parts one and two, make sure you do. Part one, we talked about why it's important to integrate different learning styles and why we have to get them to feel it in order to believe it, and how that actually removes the need for a lot of traditional patient education that doesn't work very well. Part two, I talked about during the case history. I'm letting them know what I'm expecting to find in the exam because I'm linking what they are feeling currently, their pain, with visual and verbal information that links it all together. So it makes sense. Now, by this point, you should have them ideally going, yeah, that sounds right. I hope I've got that. Because then they're going, you know what you're talking about here. If I've got that, you'll be able to help me. Now we're going to talk about in the exam, we actually show them what is going on. So there's two things that you can do here. One is the obvious one that most practitioners do. Two is the less obvious one that I, not a lot of practitioners, will actually do. And if they do, they don't do it correctly. So now what we want to to do is we've got how they've been feeling with their symptoms. We've linked that to a visual and a verbal explanation of what's going on. Now we're going to link it back into a felt feeling of where the actual problem is. Now, you can do this in different ways. I know some people use muscle testing for this. For example, I prefer to do it in motion palpation, because it's the easiest thing for patients to understand. It's less of a conceptual leap because they're going, I can feel something's not moving. And it makes sense to them that an adjustment would improve the movement. So we start the examination fairly quickly. I want them sat on the bench behind me. And you'll remember from last time I said, have an image or a model, whatever you have, ideally you want to have it so they can see it as you're assessing them. So my patient, the visual that I've shown them, like a picture of the spine, where I've said, this is where I think we'll find the issue that's on the screen. So they're sat behind me here, facing towards the screen, looking at that. I then come around behind them and I start doing a motion palpation scan. So I'm just going up the spine to feel where there's any areas that are restricted. Now, one of the things you'll get in this, the obvious one, is where the pain is. And you do want to get this. You want to recreate the pain. You want your patients to go, yeah, that's it. Because now they know you found the pain. And that's important because if you don't and you cannot provoke the pain, it's a little bit more of a leap for them to go, you've definitely found the issue. You can. And sometimes it's not possible to find the pain, but ideally you want to find that quickly because then they go, oh, you know what? I'm feeling good. We can both agree that the pain coming from there, but that doesn't necessarily mean that's where I'm going to start my treatment. Doesn't mean what I need to free up. I might find if I got pain at L5, that that's also locked up, in which case, okay, I'm going to cue them into that, but I might find it's locked up at L1,2. And actually the TL is really jammed, and that's why the lumbar sacral is overworking. I need them to feel this. So what I will do is I'll scan up and if they go, oh, that's the pain go, right, that's the area we're talking about, where it's inflamed. That makes sense. That's where your pain is coming from. We've got to get that. Calm down now. Let's find out where it's coming from. And I will scan up the spine and if I find, for example, the TL is really locked, and I'm very careful with my language, I don't say, how does that feel? I say, do you feel that? Because if I say, how does that feel? If they don't feel pain, they'll probably go, okay, because they think I'm looking for the pain and they're focused on the pain. And they'll go, okay, meaning they think, well, if it's not painful, it's not relevant. Whereas if I go, do you feel that? They might go like, yeah, like it's. It's a little bit stiff or something like that. But I'll prompt them. So I'll say, do you feel that? And then when they say, yes, I will go, what does it feel like? Or how does it feel? Now they've told me they feel something. If they go kind of, I'm not sure, then what I'm going to do is I'm going to give them a comparison. So I'll go further up the spine to an area that's moving well and go, do you feel how that springs? Like there's some bounce under my hand. Yeah, yeah, I can feel that. Okay, do you feel that? And again, I'm going back to the stiff area. And ideally they're going to go, oh, yeah. I'm like, what do you feel? And they might go, it's not different. Whatever it is. I go, right, that's the problem. And then literally the reason they're facing the screen is because I will lean past, I'll point to the screen kind of over their shoulder. Remember I told you about that problem there? That's what I'm finding here. That area I showed you, this is what it feels like. So now they go, oh, he's explained it visually. I can conceptually get it, but. But now I've got the felt experience too. So that's what I'm looking to do there. Because I want them to feel it, but I'm very careful with the language. If you say, you know, how does that feel? They might go, okay. I really want them to tell me that this is. Yeah, it's different. It's uncomfortable, it's stiff, it's not right. It might be sore as well. But that is much, much better than me telling them now, some patients just do not have the interoception of feeler. Some of them will go, oh, I don't know what I'm supposed to feel, or, no, it feels about the same. In which case I'll go, okay, that's fine. That tells us the brain isn't that aware of what's going on here at the moment. That's something we want to improve. But basically, here's what I'm feeling. This area bounces nicely under my hand. This area, I don't feel that. And what that tells me is the joints here aren't moving. Now, I love dynamic disc designs, drawing flyers, models. They're very dynamic, they're great. But you can do this with anything. You don't have to have a model. But if it's a facet issue, what I'm then going to show them is show them the model and go, what I'm feeling as I'm going up the spine. I do this for all of them, whether they felt it or not. I'm going up the spine and I'm pushing here, and I'm just feeling for some wiggle. I just want to feel. Does that wiggle a little bit? Only a millimeter or two. And that shows me that these two joints back here can move. If they can move, I'm happy. So that area felt higher up. It's springing, it's wiggly. That's great. When those joints are locked, it feels blocked. So remember, when I press there and it didn't move, that tells me these joints are locked. And that's going to create stress on the area or that's going to create stress, further link it back to their symptoms. There. That's how I'm going about it. You don't have to use motion palpation. You can use things like muscle tests and you can use other ones. But really what you want to get them feeling, it is something that they can feel. I'm going to pick on leg length because it's one I used to use, and it's an obvious one a lot of chiros use. They can't feel a leg length difference. This won't work for that. It needs to be something where they can feel a difference. Either it's muscle activation, either it's pain to a degree. But that will only cue us into where the pain is. Ideally, for me, it's movement. So we've set them up. We've said, this is where I expect we're going to find the issue. I've sat them on the bench and I'm going up. And remember, if we find the pain, great. That tells you that's where the pain is coming from. Let's see what's causing that. And then when you find the stiff area, do you feel that? Yes. How does it feel? And if they can't feel it, give them a comparison there. At this point, you've gotten to understand, okay, there's something in my spine that isn't working. Something is locked. It makes total sense of them. If you're going to adjust that, that that's what you're going to do. It's not my total exam. Obviously, this is something that I do fairly early on because it gets them to feel like not only we found a problem, but, oh, Chris predicted this. Like when he showed me what he thought he was going to find, he went and find that. So we've got them from hoping, like, oh, I hope I have that, because it sounds like he knows what's going on. And when we do find it. They go, oh, brilliant. Now I'm feeling hopeful, now I'm enthusiastic. Now I feel like I'm in good hands. And the fact that I was able to predict an issue makes them think, wow, he's really good. I bear in mind I haven't predicted the location. I haven't said, I reckon It'll be L23, because I don't know, I've told them, I reckon this area is really unhappy and being overworked and it's likely because of a problem here or further up that things aren't moving. So you can adapt this there as well. But I haven't tried to predict the segment beforehand. I can't do that. That's not possible. But I'm at least going, here's what I reckon is going on. And then they're sat on the bench and I'm going to see what I told you. That's what's happening here. If you can get them doing it now, they feel and they understand there is a problem in my spine where things do not move properly. It makes total sense than that you would explain to adjust it. You know, I'm not going through the reporter findings yet. We'll go through that next time. We'll talk about how we then get them to see and feel the difference and really see the value in what you're doing. But right now, at this point, they're already going, brilliant. He's found the problem, he knows what's going on. It makes sense to me and it explains all my symptoms. So we've gone felt symptoms, you know, verbal and visual conceptual explanation in the logical brain, and then we've gone back to felt experience of now I can feel there's something there as well. Do that and trust me, your patients will already trust you more. You'll get better buying. You'll have to spend less time explaining. What we'll do next time is talk about how we prove the value of our care and show them how much it actually did.