A Chronic Patient

Dear all,

I am currently having my musculoskeletal placement. Hope all of you had a great first week....

First week of placement and I had this interesting chronic patient. Mr X is a 50y.o/Male, was referred for physiotherapy for bilateral ankle stiffness. Mr X had bilateral ankle stiffness due to his condition of vasculitis. He was diagnosed with this condition about 2 years ago and had gradually developed ankle stiffness since then. He had no previous treatment.

Upon assessment, there was decreased AROM in all ankle ranges especially dorsiflexion, decreased proprioception and strength. The treatment for Mr X thus far had been AP glide of the talus to improve dorsiflexion range, proprioceptive training and muscle strengthening exercises program.

Due to the long-standing condition, I am expecting very slow progress with Mr X musculoskeletal problem. On my first session with Mr X, I spent half the treatment time explaining to Mr X the reason behind his slow progress. It was really FRUSTRATING as I still can’t get the point across to him after 30mins. Whenever I get him to do any exercises, he kept emphasizing that he had been doing the exercises and exercises were not going to help him. (But I taught him new exercises!! And this is only his second physio session!!).

My supervisor had ‘warned’ me beforehand regarding Mr X’s attitude towards physiotherapy and that he was a challenging patient. Do any of you have any similar experience and able to provide me with some ideas on how to handle the patient? Thanks!!