Hey guys...one prac to go!!!
I had an interesting patient who was referred to the outpatient clinic for OA of Lx spine and knees. She presented with 20 year history of Lx pain, pain in the Cx, Thx, knees, wrists...just about everything. This woman was so focused on pain, appeared depressed, was a single mother to an 8yo daughter and 22yo son (the son she rarely sees) and didn't speak english very well. After my subjective i walked out of the cubicle and thought "what on earth am I going to do with this woman? Objectively, ROM was WNL for everything except her knees, terrible posture, tight around the cervical region, Gr2+ muscle strength in the LL's.
So after being completely flustered about what to do, I eventually decided to take a hands off approach, with education+++, no mention of the word "pain", postural correction exercises, refer to hydrotherapy, muscle strengthening for her LL's. She came back next session with Lx spine feeling fantastic, decreased neck pain and primary problems now with her knees.
I guess I learnt a lot from this patient about chronic pain behaviours and how we really need to educate these patients (of which you can never do enough of) about avoiding activity cycling patterns, stress management, provide information about pain management and their condition and i feel that manual therapy really doesn't have to happen with all our patients. This woman is proof - she thought i'd worked a miracle just by correcting her posture! I think someone in this case could possibly become dependent of someone performing manual therapy and if you can give them some pain relief by not doing any, then it makes it so much easier from a management perspective.
Fan
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Hello Fan
I too know the challenges presented with patients who have chronic pain. They are very difficult to treat. I also find it hard to relate to them because we don’t know what their pain is like. My patient couldn’t even find a description for the constant pain she was experiencing. It’s great that you found a way to treat the patient without making their pain worse. I also found that a lot of education, postural exercises and hydrotherapy were great. One other technique which helped was trigger point therapy as they are often so tense from stress and good release of their muscles completely relaxes them. Suggesting little lifestyle changes made so much difference too.
Heidi
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