The following scenario has occurred several times at my office over the past few weeks: a patient presents for their first visit, for example with neck pain, shoulder pain, or sciatica, carrying with them a sheet of 6-8 exercises prescribed by a previous provider. In each scenario, the patient was instructed to perform these movements once or twice per day and was told to stop if the movements became too uncomfortable.

This approach is relatively common in modern-day healthcare. Since many providers are overworked and understandably have less time to spend with patients, it is becoming more commonplace for them to resort to pre-made, easily printable sheets of exercises for patients with musculoskeletal pain.

While this form of care is certainly time-efficient, is it the best practice?

From a 30,000-foot view, the answer would appear to be yes. As a general rule, we know it is vital to keep patients moving, off of potentially harmful medications, and away from becoming reliant on passive care. But when you get to the level of the individual patient, this approach lacks the specificity that is regularly required for patients with musculoskeletal pain.

More often than not, patients require movement in a specific direction to fully overcome their problem. This particular direction is called their directional preference and is determined through a specialized assessment called the McKenzie Method. Roughly 75% of musculoskeletal pain cases display this feature, regardless of where pain is felt (back, knee, elbow, etc.). The finding of directional preference essentially indicates that a patient’s pain is reversible with the correct movement. After a few weeks of consistent performance, there is an excellent chance of a favorable outcome.

The problem with prescribing too many movements at once, like those on the pre-made, easily printable sheets I mentioned earlier, is that it can be tough to know the effect of each individual exercise. Some movements may be beneficial to a given patient, others may be harmful, and the net result may actually be neutral. Other patients could have drastically different reactions to the same movements. This variability between patients is why assessment is critical, with the aim being to be as precise in our exercise prescription as possible.

Back to the patients who presented to my office having been prescribed 6-8 exercises by a previous provider. Despite months of diligent compliance, all were essentially unchanged as it pertained to their primary complaint. In each scenario, when we ran them through an assessment, it revealed that they had a directional preference. After performing this movement for several weeks, each patient had effectively turned their problem around.

These cases reinforce what I have seen countless times. While movement in general is certainly good for most people, it is moving in the right direction that makes a world of difference.

Dr. Jordan Duncan is from Kitsap County and writes a monthly health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.