Usually 40% of my patients go into back spasm in the holiday season from stress and lifting etc during SI rehab, but most of the year it is 10-20% at any given time. Did something happen in the universe because for the first time ever outside of the holiday season I have a good 40% in spasm, several admit it was from emotional stress (major trigger) Is this just me?

One of the reasons I see so much failed TMJ treatments in my clinic is because their actual cause of it was missed. They get night splints, scans, injections etc but no lasting relief. Years ago, I started to ask myself why are these muscles locked down around the TMJ. I had an insight, they were stressed! Clinching was subconscious to them and a lot were grinding in their sleep. I also saw a pattern, that these patients also had neck hypertonicity, headaches a lot of the time in addition to TMJ. In these patients they had too much stress. I call these "Stress injuries". When I identified that root cause for them was stress I would tell them that and they would argue with me saying I am not stressed! Most people live at constant level of stress that they are unaware of I found. I asked them to meditate but patient after patient refused so I gave up on that as I realized I had better luck asking them to change their religion! (literally) A great help was a GOOD CBD 3x a day at a dose they feel relaxed at in 2.5 hrs. Side note: I have found TMJ patients to be the least complaint patients I have ever worked with! What has worked for you?

I am working with a patient in her 30s who has had SI joint pain and Achilles tendinopathy for over a year. Clinically, this should be pretty straightforward for me. I would normally put her on my protocols and generally expect her to improve. The problem is she is not responding to either rehab program. Problem after problem after problem. This is unusual for me because I do this all day, every day, and I honestly can't remember the last time I saw this. Some patients improve and then have a flare-up in the middle of treatment, but to not feel any different at all is very strange for me. When I realign her SI joints, she has no pain. When I perform a posterior mobilization of her talocrural joint, her pain is immediately relieved. This confirms that these mechanical issues are contributing to her symptoms. Now I just need to make the changes "stick," if you will. I taught her several acupuncture points to stimulate with a TENS unit, which immediately relieved her low back pain. As soon as I showed her, her response was the same thing I've been hearing for weeks: "Yeah, but it's so bad." I put an SI belt on her and it instantly relieved her pain. I told her to use it until we could strengthen her adductors to help control the outflare. She replied: "Yeah, but it's so bad." No matter what solution I provide, I hear the same response. I've had patients who couldn't perform the Mulligan bike-tube mobilization for posterior capsule tightness because the tube irritated a tender area. In those cases, I simply reposition the tube and the problem is solved. I find a workaround. With this patient, she says she simply cannot do it. I've honestly never seen anything quite like this one. I'm starting to suspect that she may be subconsciously sabotaging the rehab process. It resembles classic pain catastrophizing: you provide a solution, and the patient immediately focuses on why it won't work without ever really trying it. These patients are not as common as I think many providers believe, but when I encounter one, my heart sinks.