First of all - a 20 minute consultation is ridiculous unless you're simply strapping someone, checking an exercise and adjusting, or I don't know. This is therapy people, not a sheep pregnancy van where we shuttle people in for a feel and kick them out again. If I had a psychology counselling session and I was out in 20 minutes, I'd wonder what the point is.
Nevertheless, you work for someone who wants you on those time slots.
This post is following on from yesterdays blog post about how to implement the SFMA when you are new to it, in a 40 minute new patient consultation.
Janice arrives a few days to a week after the first consultation. After initial greetings and chats, I ask her about compliance and symptoms. She says she's tried to do the hip mobilisation exercise as per the video but isn't sure if she's doing it right. And she doesn't know if she got the right band from Rebel sport.
J: It's green, "will that do?"
"No" I say, it's too light - there isn't enough tension to distract the joint enough. "Don't worry,", I say, "you can keep green for other exercise, but you'll have to get the red one otherwise you'll be coming here all the time to get me to mobilise your hips."
Ok, we have checked compliance but we have to see how she's doing it.
I check her top tier MSF which is DP and her prone hip extension range, active and passively, and it has improved on last week's initial, but regressed from post-treatment, DP actively, FN passively. I check her exercise with a red band, how she's doing it - she had the band too distal to the joint and was breath holding and wasn't directing eyes and cervical flexion towards the foot she was reaching - missing out on the better part of the roll pattern.
Once I correct it, I recheck her passive range and it's beyond 50 degrees, with no back pain. Active is FN at 45 degrees. Her MSF is DN.
While I'm there, and knowing I am in a 20 minute session, I use the same red band and set her up for a band-assisted thoracic rib grab mobilisation, emphasising the lumbar-lock element of the drill, with bilateral hip flexion, plus the eyes and cervical rotation, and diaphragmatic breathing. I get hands on to facilitate the thorax rotation in addition to the band, to help her feel what the rotation should feel like. Her MSF is DN. I take a moment with her - the reason she came in was for back pain - we haven't treated her back yet and her back pain is gone by addressing her hips and thorax. That's an important moment.
The plan now is to stress the importance of the red band, use eyes and cervical flexion and diaphragmatic breathing on the hip exercise, then add the band-assisted rib grab with eyes and cervical rotation and breathing - 3 to 5 breaths per movement.
I'll see her next week. She is to do the exercises as often as she wants through the day.
Next week I'm going to check compliance, top tier Cervical Extension, MSF, MSR, MSE and key breakouts from hip and thorax and plan from there. Time's up. Notes, breathe, smile. I wonder why I haven't done it this way up until now - I didn't know I guess, thanks uni. I wonder if there's evidence behind the SFMA approach - hey Greg, can you shed any light on that? (Am I talking to myself?)