So we are continually asked, “Hey, so how is what we’re doing for my hips and my ankles going to help me? My knee is what’s bothering me.” Or, “When I went to PT before, they gave me a hot pack and used this sound machine to decrease my pain. Then they just gave me some exercises and none of it was as hard as this. Why aren’t we working on those things?”
Well, needless to say, this is not something we hear too far into treatment. After any real length of time, our patients realize the method to our madness. That said, I find myself repeating a similar analogy that I find helpful and I hope you will too.
Me: Take a look at our door over there. It has three hinges. All of those hinges are in perfect working order and the door opens and closes just fine, right?
Pt: Right. Ok. So.
Me: So, let’s say I remove two of the hinges. Will I be able to open and close that door?
Pt: Probably, but not for a long time.
Me: Right! It will open and close but after a little while that hinge will start to make a noise, then it may loosen. Once that process has started, it won’t be long before the entire hinge comes loose from the door frame and the door will no longer open or close at all. That makes sense, right?
Me: So what might a person who doesn’t know a bunch about doors say about this situation?
Pt: They would probably say you have to replace that hinge.
Me: YES! That’s probably what they would say. Now, what would an experienced carpenter say about that door?
Pt: Replace the other hinges and the door will work better.
Me: Exactly. Now, there is still a problem with the bad hinge. Until we address what caused this entire process in the first place, we will not have completely addressed the issue. If the “fix only the painful part (aka the obviously bad hinge)” method worked, you wouldn’t be in PT for round 2.
From a purely academic standpoint, this is just a way to explain regional interdependence (RI) without using those words. This construct of Movement Economics (our more patient-friendly concept of RI) we feel improves our PT buy-in and the overall therapeutic alliance.