Alignment Mistake
Today's post is all about a mistake I made this past week in the clinic. We all are not effective as we want to be all the time. It's important that we reflect on patients to continually develop and become more efficient as a clinician.
This past week I had a particular client who presented with hip and back pain. Something I see regularly in the clinic, especially with lifters.
When we were talking about her story she obviously wanted to get back to lifting again. She also mentioned that she had been to previous clinicians in the past and that she knows she has one hip rotated forward more than another hip.
Other topics were obviously touched upon that you would normally do in every evaluation, but I failed to realize how big of a priorty this particular patient placed on her "alignment".
Personally myself I do not hold much weight on the thumbs at the ASIS and eyeball alignment, then look at the malleoli and check their alignment as well. Reason being is that its not a very objective test for one, but the typical treatment associated with that is having the patient apply a small amount of pressure in the clinician to utilize a muscle to change alignment, then recheck a static alignment again.
However, the patient had obviously found these useful in the past or the clinician had her believe that this was a major role into why she was in pain.
I choose not to talk to her about these particular assessments simply because I do not use them as a clinician. I have found more valuable tools in checking "alignment", which are using the modified obers test, huruska lift test, among others.
Furthermore, when I talk to patients I avoid using phrases such as you are "out of alignment". I feel this promote fear in patients as well as learned helplessness that the body is fragile and requires the use of a clinician to "put it back into place".
The point of this story is to tell you I missed an opportunity for education. Simply because I do not use these phrases with my patients, does not mean that a belief has been deeply ingrained into a patient. This appeared to be the case with this particular client. Because while we got into some of the lifts she enjoys, worked on technique and made the exercise more comfortable to perform....She was still unhappy with the treatment because I never looked at her alignment....
When in reality I did do this through other testing she was just not familiar with. From my assessment I felt she had the ability to obtain the positions needed to properly perform certain lifts, and do so safely. I felt she just had a hard time finding and feeling the correct musculature that should be working during the activity due to positional errors in the lift. If you really read deeply into that, I am infact addressing the "alignment" by altering a position of a lift to better find and feel certain muscles working...
However, to her because I never educated on this particular logic. She was frustrated.
It was my fault.
Meet your patients where they are currently at. Play their game for the time needed, but educate them against false beliefs that create uncertainty. That will help you win them over time and help you start creating a more robust and resilient human being.