At my outpatients clinic.
Here is my patient, right sided hip pain, pelvis, goes down lateral thigh, into the calf, medial three toes are numb, or P&N all the time. Pain is constant, increases from 3/10 to 8/10 randomly, no pattern of aggravating factors. Woke up one morning 6 weeks ago with hip pain and over following days the pain spread. The patient has had four private physiotherapy treatments over the last 2 weeks for hip, shoulder, Cx pain and migraines, with some benefit.
NTPT → Straight leg raise was +ve, sensitised with DF.
Light touch → had altered sensation on lateral margin of the foot.
All other neural tests were clear.
Hypomobility of the lower Lx segments was also found.
There are a number of facets to this patient. Having been to a physiotherapist she is telling me what she thinks I need to know, rather than allowing me to ask questions. Long and the short of it, the subjective took a long long time. Being overweight palpation generally was very challenging and I question the accuracy of my PIVMS/ PAIVMS.
I went on to treat the neural hypersensitivity by PIVMS lateral flexion in left sidelying.
She had a referral for a CT of her pelvic region however had lost it and was not interested due to the radiation exposure. This patient does not take medication and was not interested in taking anything, NSAIDS etc. She had an appointment at the end of the week with her other PT as the PT had suggested that he could work in conjunction with the Curtin Clinic for the best outcome.
Here in lies the debate, treatments from different PTs doing potentially contradictory treatments and having the patient paying and travelling all over the place. The patient understood that it may not be in her best interest to have different people treating her condition at the same time and was happy for me to speak to the PT.
The call was made, the PT knew the patient and expressed that he thought it a good idea if we treated the lower back/leg problem and he would continue to treat the neck, shoulder and migraines.
My supervisor and I are not convinced on the basis of continuity, however I can see that if either practitioner is only going to treat one area then for the patient to have her needs met then it may be necessary. Why doesn’t the private PT give her a double session and treat both, considering they are likely to be linked anyway? No vertebra is an island.
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I am finding the same issues on my current musculoskeletal outpatient's clinic Jill. Patients are presenting with symptoms and are also being treated elsewhere, not always by a PT (chiros etc).
This week I had a very similar pt to what you have described. On the afternoon that I treated her, she had already seen a Chiro that morning that had taped her lower back. Obviously I had to Ax her Lx, which included PAIVMS and PPIVMS, which can be very difficult with the Lx strapped.
I had a real problem convincing the pt that I needed to remove the tape in order to Ax and Rx her properly. I eventually convinced her (as the pt was very attached to the tape due to it decreasing Sx), and was able to Ax and Rx her accordingly.
I guess in an ideal world the pt would not need to be seeing a number of PT's, as in your case. Within my subjective Ax, I am focusing on how the previous Rx helped the pt (your Rx or someone else)? Whether the aggravating factors are becoming easier (call previous PT to find out more from his/her Ax)? And, has the pain and pattern of pain improved? (centralized in your case). These may give insight as to what type of treatment is benefiting the pt.
Great comment Jill, this is an area that can be frustrating. Keep us updated on how this pt progresses in your safe hands.
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