Let’s say I am helping someone fix her shoulder derangement. If I have the correct diagnosis, I expect significant improvement quickly with an exercise in a specific direction - and eventual 100% return to normal. Let’s say we figure out that direction (often it’s extension or functional internal rotation). By finding that positive response to that direction of movement, we confirm our diagnosis and therefore establish a reasonable prognosis.
Now, here are other factors that could affect the ability to get the problem 100% resolved: patient’s shoulder position at work, at play, while sleeping; patient’s compliance with the home program; patient’s performance of the exercise; stress level; diet; lifestyle factors (eg smoking); other health issues; environment; genetics; patient’s belief system/expectations; how the problem affects the patient’s life; and other people’s input/opinions.
For this reason, I often use the words “should,” “likely,” and “in most cases.” Yes, there are many problems that, in my head, I think are 100% fixable; but I know that, until something is 100% fixed, it’s not a given. There are numerous factors when it comes to addressing problems with the human body and mind. As a clinician, I set expectations based on interpreting all the available data. -- Laura
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