When someone comes in with a long-standing problem that has not been resolved by another therapist, I ask a number of questions during my assessment, the answers to which lead to more questions (and answers) that help me formulate a treatment plan or plan of care.  During my fact-finding mission, I look at the patients’ postural habits while we speak to try to resolve their concerns as it relates to their pain and discomfort. Beyond the medical intake form, my questions include but are not limited to:

Have you suffered an injury?

Depending how early treatment was begun could affect the outcome. There are treatment protocols that could prevent further aggravating the affected site of injury by:

1. Did you treat the area of injury using the rest, ice, compression, and elevation (RICE) method
2. Have you noticed whether your pain level or ROM increased or decreased
3. What other therapy have you tried, with or without success?
4. Are you on medication for the condition
5. When did you suffer the injury
6. How did you find our clinic

This last question is important (they all are), because if the patient is near here, then they may be more compliant to their treatment plan.

Do you have trouble walking?

By doing a gait analysis, it allows the therapist to see if there is any ankle, knee, hip or low back involvement that may be contributing to the area of concern. 

What position do you sleep in?

If you are a stomach sleeper, it puts pressure on your low back, thereby aggravating your vertebrae and the muscles surrounding your spine.  Aggravating factors may include a soft mattress, which allows for an unnatural sway to your back and  affects your neck muscles as you turn your head to breathe.

Try this instead:

1. Sleep on your back with a pillow under your knees to alleviate your low back discomfort.
2. Try sleeping in a side-lying which takes the pressure off your low back.

Can you raise your arms over your head? 

If you have difficulty with this movement (as when combing your hair or putting on your coat), it could signify adhesive capsulitis, (also known as frozen shoulder, a condition to which diabetics have a predisposition).  The limited range of motion could be from a previous injury, where therapy may be appropriate.  Until you see a trained professional who can diagnose this condition, heat the affected area and then do Codman exercises.

Do your fingers go numb? 

This issue could have a number of aggravating factors:

1. If you are a smoker, you may have developed Raynaud’s syndrome which affects the smaller vessels that supply blood to the extremities
2. If you sleep with your arm over your head or tucked under your pillow, you may be compressing the brachial plexus. Try instead to sleep with your arm down.
3. It also could signify carpal tunnel syndrome, which is caused by compression of the median nerve.

Do you clench or grind your teeth?

1. Are you stressed? Who isn’t these days, but it could manifest in a tight jaw. See your dentist for possible intervention (plate for grinding/bruxism).
2. Perhaps you need help in releasing the muscles of the jaw to prevent TMJ. There are therapists that specialize in this area of treatment.

Are you happy with your posture?

1. Are your shoulders at ear level or your head in a forward position. Focus on dropping your shoulders down to relax the tension in your neck or look at doing Anterior Translation of the posterior scalene muscles.
2. If you spend a lot of time in front of the computer, it’s better to raise the screen instead of your shoulders.
3. Do you slouch in your chair or couch, if so place a pillow against your low back to decrease the sway in the lumbar curvature.

Since you are now aware of your posture, learn to sit and stand tall while keeping your back and neck in proper alignment.

Do you exercise? 

1. You should allow for a 15-minute warm up and cool down to prevent muscle strain.
2. Drink plenty of fluids to prevent dehydration. 
3. Take an Epsom Salt Bath to dissipate any lactic acid build up in your muscles.

A therapist should be asking questions similar to the above to pinpoint your area of pain or discomfort and with proper testing, will be able to treat accordingly.

If you need further treatment with a Registered Massage Therapist, Chiropractor, Physiotherapist, Acupuncturist or other allied professional it may be warranted to alleviate your area of pain and discomfort. See your Doctor if pain persists.