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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 91 INFORMATION COLLECTION IS CRITICAL The strategic collection of information plays a key role in clinical reasoning for an evidence-based approach. In the pain management setting, we can collect information about the client's complaint by asking the following questions: • How do you think it began (pratfall, sports injury, lifting, failed surgery)? • Why do you think it hurts (overuse, underuse, abuse)? • What kind of movements trigger the pain? • When did it happen? Does the pain come and go? Is it an acute episode or chronic? • Where do you feel the pain? Can you point to the area with one finger? Such open-ended questions help us understand the client's point of view and make observations for inductive reasoning. Remember to keep the inquiry general: "Tell me more about your leg pain," rather than, "I see your MRI shows a disc herniation. Does your leg hurt when you bend forward?" After collecting information based on the client's perception of their pain complaint, we can proceed to yes-or- no questions that will aid in deductive reasoning. For example: Do you feel pain in your low back? Does your leg only hurt on one side? Does sitting flare your symptoms? Is the leg pain worse when you're under stress? When the client's presentations deviate from commonly seen clinical patterns, try new movements, techniques, or exercises. Feel free to improvise if it piriformis syndrome." In this example of inductive reasoning, the theory may or may not be true. To avoid going down the wrong path, we must include deductive reasoning. Deductive reasoning is a top-down approach that begins with a theory, supports it with observation, and arrives at a confirmation. For example, "The piriformis muscle can compress the sciatic nerve. All Mary's orthopedic assessments and radiology reports are positive for piriformis syndrome. Therefore, Mary has piriformis syndrome." In this example of deductive reasoning, the confirmation should be accepted only if the treatment changes Mary's symptoms. Just as there are weaknesses with inductive reasoning, there can be flaws in deductive reasoning. The most obvious danger comes in formulating and accepting the major premises. The assumptions must either be so self-evident that no reasonable clinician could possibly object or be ones that can be proven by clinical studies or physical observations, as in Mary's case. In science, there is a constant interplay between inductive reasoning (based on observations) and deductive reasoning (based on theory) as we get closer to the "truth," which we can only approach—not ascertain—with complete certainty. To get as near as possible to the truth, it is best to use a combination of both deductive and inductive logic. Starting with deductive reasoning, we can formulate a basic premise upon which all else can follow. Then, through clinical studies and inductive reasoning, we can verify the accuracy of that premise. There's an old saying, "If you have 10 years of experience, you don't want it to be one year that you've lived 10 times." allows you to explore the presentation further and better tailor the treatment to your client's specific needs. PRACTICE MAKES PROGRESS It is important that massage therapists are taught to understand and apply clinical reasoning in their pain management practices. Fortunately, clinical reasoning skills can be strengthened at any age and experience level. It may be helpful to think of it as studying how the "experts" become experts, then setting yourself on that path of continuous learning. There's an old saying, "If you have 10 years of experience, you don't want it to be one year that you've lived 10 times." Instead, you want a decade of experience characterized by a reflective, ongoing inquiry process that drives you to continue learning. Expertise is not a goal we reach—it's about making continual progress. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit

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