Patients!

Hey All!

Apologies for the late post!

Recently on my musculo prac, I came across a really difficult patient. Difficult for several reasons:
Widespread pain, almost ¾ of the body chart was filled up with pain levels rating from 7-9/10. She had pain covering her entire (R) half of the trunk, front and back, (R) arm, low back pain, with pain referral down both legs.
Very impatient, especially on initial assessment, she just wanted me to get on with the treatment, and stop asking her questions, and assessing everything.
Also I suspected a lot of psychological/yellow flag issues: long history for pain (8 yrs), and single mum with severly disabled child.

Obviously given her problematic areas, there was a lot of assessing to do, and especially when I was getting very vague and unhelpful answers, I had to keep asking the same questions in a different way to get a clear answer. At one stage she got very angry and upset at me “stop asking me the same questions, enough assessment, just start the treatment”, she even took the assessment form off me, and started filling it out herself to speed things up.

I tried to explain to her why I was doing such a thorough assessment, especially because we didn’t have a diagnosis, and also because there were so many affected areas, we needed to find out what the limitations were in order for us to treat properly. Don’t really think she was convinced, and I think she held really high expectations, and wanted to be “cured” straight away.

Anyway after an extended assessment (over 2 sessions, initial primarily focusing on THx and follow up on shoulder), I came up with the following problems: Supraspinatus impingement 2° poor posture and GHJ hypomobility, multi-segmental thoracic hypomobility, tight musculature and costovertebral strain. Lucky for me, I didn’t have to look into LBP, because she was referred from the Dr, I just had to focus on what was written on the referral “chronic thoracic pain”.

Next hurdle was deciding where to start with treatment. I initially started with the thoracic spine, but got very minimal improvements, the patient reported slight bit of relief. On the second visit, I looked into the shoulder, and after treatment, consisting of shoulder mobs and STM, there was significant improvements, both subjectively and objectively. Currently I’m seeing this patient 2 times a week, for an extended consult, so I can treat both her thoracic and shoulder problems.

As a result of this experience, I’ve learned the importance of verbalizing to the patients what we’re assessing, why and the findings. I find myself having to think about what I’m doing, and what the assessment findings mean, and having to rationalize treatment. Which hopefully will come in handy for the PCR.
Also I’ve learned that I don’t have to tackle all the problems at once, sometimes its just trial and error, and I just have to pick a point to start, and work from there.
As for the patient, there have been steady improvements. Considering I found her difficult initially, and hard to build rapport with, I’ve found that we get along much better, are able to have good chat. She’s also more tolerated as I do my re-ax, especially because she’s seeing improvements as well.

Rev