I’m doing my musculoskeletal outpatients prac at Curtin and I have a patient who has presented pre-low back pain - he would like physio to prevent him from experiencing the low back pain he has had in the past. Seemed fairly straight forward, we’d go through TA/core stability, bracing, lifting techniques, etc… That’s what I thought until we started going through the history of his low back pain. He had one previous acute episode of low back pain while living in
After assessing the length of his major LL muscles I found that his had quite good flexibility for a 30 year old man. The length of his hamstrings was increased using hold-relax and rather than focus on the LL muscles of normal length I chose to work on improving his core stability, progressing his TA/MF exercises, glute max activation and strength, posture/ergonomic advice as well as maintaining the length of his muscles with a stretching program.
My problem came when trying to explain to my patient why we were going a different direction with his treatment to his previous physio (ie. core stability instead of LL massage). He was happy with his treatment and HEP and he also stated that he was impressed with the thoroughness (if that’s a word) of his assessment at CPC and that he felt his previous physios just rushed his assessment in order to get him in and out of the door faster. I explained to him that based on my assessment his muscle length was improving and we now needed to focus on his lumbo-pelvic control and strength.
I was able to please my patient with my rationale for treatment but it got me thinking what would I do if I was forced to contradict another’s opinion? Has anyone been put in a situation like this and how did you manage to persuade your patient that your way is the right way (or the right way for now)?
1 comment:
Hey Shani, sounds like you did a great job! You managed to get through to the pt with some education without making the previous treatments seem 'wrong'. I think this is a fairly common occurrence with pt's suffering from LBP as it can be caused (and perpetuated) by so many factors. I was once in a similar situation, where I did my assessment and found a pt who was getting chronically strained hamstrings, due to a lack of through-range srength. This pt had seen numerous physios and paid heaps for treatment, what I did was EXPLAIN to him the reason for his recurrent injury and teach him a few simple ex's (bridging, SLBridging, drop-catches, etc). He was so happy to understand the reason for his injury and this definitely improved his compliance to perform the HEP. I guess it's always a balance, if we are to be the best ambassadors of the profession as well as performing the best treatment from our Ax, even if it goes in a different direction to previous treatments. I think the best way to approach this is exactly what you did... EDUCATION! I mean after all that is our primary job! Well done! xx
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