Hi everyone,
congrats on getting through another placement. I Just wanted to briefly discuss a patient who presented in the clinic with LBP. She was diagnosed with a chronic hypomobility disorder L4/5 5/S1 and had been receiving physio treatment for several weeks. On the day I treated her, she reported pain scores of 9&10/10 for all Lx ROM. Paivms were even worse… every segment I touched whether it be central or unilateral appeared to reproduce the pain. I quickly realised that pain was not going to be a very useful outcome measure, but what was I to do for treatment? Objectively there appeared to be reasonable segmental movement occurring at Lx segmental levels with mild hypomobility bilaterally at L4/5 5/S1. After discussion with my supervisor it was decided that the most effective treatment for this patient at this stage did not include manual techniques, rather education and a graduated exercise program focused on improving functional tasks. I am told that in recent studies of chronic pain patients, providing education about the chronic pain cycle alone has been shown on MRI to have an effect in reducing pain. I thought that was pretty interesting….I am yet to read the literature myself, but I thought i may as well give it a go. In this case, the education combined with a low intensity gym program of 3 minutes on the bike and treadmill and some core stability work in functional positions had a better effect than the previous sessions of manual treatments. There is still a long way to go in completely resolving her pain, but she appears to be content with the knowledge of what has caused this pain response and what SHE needs to do to improve it.
Good luck everyone for the PCR and thanks for all the comments and suggestions over the past few weeks.
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Hey Jess,
I never had a chronic pain pt myself - but Will and Jess did - so we had a few discussions about what to do with them with our supervisor. Sounds much like what you did. No hands on - keep the manual techniques at bay! Lots of education, reassurance, lots of just talking and an exercise program. I still find the concept of how it all occurs a little confusing, so I too need to do a little more reading!
As Donelle has mentioned we did have quite a good discussion about other students patients in our clinic with similar stories...and we went to a talk given by a dct on exercise and chronic back pain. All which points to exactly that...education being paramount, with general fitness and strengthening programme, pacing advice, using a diary/log to chart exercise/activity etc, encouragement to get back to being involved in other things in life....and as our supervisor said you being interested, caring, listening to them and addressing problems in a down to earth sensible way goes a long way to getting gains with these patients!Not that it is that simple, but a start!
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