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  • Dr. Richard McIlmoyle BSc, DC, PgCPain

Understanding the WHY is the MOST important thing.

This applies to all aspects of manual therapy.


WHY is the patient in front of us seeking help?

WHY is the patient in front of us seeking OUR help?

WHY does the patient in front of us hurt?


Too few practitioners ask these questions or dig into the why the individual is in the clinic in front of them. We do a cursory job of it with intake forms or in a structured interview where we ask

  • Where it hurts

  • What is the mechanism of injury

  • What makes it feel better.

  • YADA YADA YADA.....

Ben Cormack made a statement in his course "Functional therapeutic movement" when he was here in Victoria that stuck with me. (To paraphrase without all the F@#$'s etc... ) "Patients don't come into your office because of pain...they come in because their pain is impacting their life"

If we don't take the time to find this out we are likely making assumptions and imposing our beliefs on our patients. I can't tell you how many times in the past, I have not done this well or at all. I would have a realization, after a couple of treatments, that what I thought was the patient's goal, was is in fact my goal, for them. (being referential to my past self (Dr. Dick)) I now think "Don't be a Dick".


WHY me? Why has the patient chosen me is an important piece of the puzzle, because it will most likely speak to patient expectations. Are they expecting SMT because I'm a chiropractor? Are they expecting to not get cracked, because the person who referred them had a great outcome and we didn't use SMT? Were they referred by a massage therapist to whom I taught neurology and the RMT believes that the patient is a complicated "neurology case". All these ideas play a role in how this interactions will play out.


Why are they hurting enough to seek care? Was it an acute injury that is not resolving in an expected time frame, or is it a pain that came on mysteriously where the patient is seeking an explanation for the origin? Is it stopping them from doing something now or are they worried it is going to prevent them from something in the future?

The answers to these questions provide targets for therapy and an opportunity to help patients understand the multiple factors at play when pain is experienced. Tissue load, immune modulation, cognitive bias, emotional state...


WHY does what any of us do, help people hurt less.


Understanding the mechanism of analgesia that are provided by our interactions with patients can bring us to be better clinicians and help a broader range of individuals.



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