For this week's post, I'd like to pose more of a question or consideration, instead of the usual content. As many of you know, I have written about cases several times in the past about examining and treating chronic "strains." In the outpatient setting, odds are you will frequently be presented with cases where the patient reports straining a muscle months/years ago and never fully recovering. In prolonged cases like these, the connective tissue typically has healed, or at least should no longer be responsible for the pain. At this point, the nervous system is typically the culprit for any remaining pain/limitation. This can be examined and treated with any of the techniques usually utilized for the neuromuscular system.
While this can readily be applied in patient presenting with chronic strains, I have recently been wondering if it is applicable to those with more acute injuries as well. With pain being a perception in the manifestation of the nervous system, should we expect there to be a significant difference in the acute setting. I'm not sure. I rarely am presented with patients complaining of an acute strain. Typically, people get hurt, then rest until it is better, or at least do some form of self-management. Occasionally, I have people come in for a free screen, where I do an assessment and provide a little treatment, along with my recommendation on how to manage the injury. I have had a few people come in with strain presentations, but show some improvement with repeated motions. Unfortunately, these clients don't typically follow-up, but there is still an improvement on display. I also often wonder how this could potentially apply to someone "risk" for a strain. If someone has a lot of neural tension limiting mobility, would a repeated motion or nerve glides decrease that risk? What are your thoughts and experiences on this?
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