The director of the network’s outpatient clinics had spent the better part of 90 minutes discussing interventions for low back pain and how she initially began to to work with patients using mobilizations. Then she discovered that some of the patients that did not respond to mobilizations could find relief with a McKenzie approach; she called these the “discy folks”. But there were still those who did not get better, so she explored Janda. Today she is excited because she discovered the work of Sahrmann six months ago. Throughout her presentation, she mentioned the science of pain only once, with a slide to illustrate the potential utilization of TENS.

I politely listened, without interruption, until the end when she began to field questions. I asked, “I am curious, what role do you think that the brain plays in the patient’s pain experience?”

“Well, I think that you can try to concentrate on your posture for a given period of time to keep yourself in positions that may relieve your symptoms for a while, but that can only work for so long.”

After the day (that included other inservices as well) had concluded, we were encouraged to try to keep our patients in the network. As a home care provider, I am being “asked” to refer my patients to the network’s outpatient clinics.

That ain’t happenin’.


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