The Truth is Out There

Information is a vital component to a successful outcome for a physiotherapy consultation. In fact it can sometimes be the only thing that is required for the complete resolution of a patient's symptoms!

One example that springs to mind is a supermarket checkout attendant who came to see me complaining of one-sided back and shoulder pain. On questioning it transpired that she had recently been confined to the same checkout always scanning the shopping in the same direction. After discussion with her superintendent she was able to change checkouts during a working day and scan the shopping in the other direction. Lo and behold her pain disappeared!

It is now accepted by just about all medical practitioners that pain doesn't just have a purely physical component but psychological and social factors can also contribute or even drive pain. Stress can cause stomach ulcers, rashes, irritable bowels and headaches so why not musculoskeletal pain? Another patient I saw was a computer programmer who complained of right arm pain and numbness. His pain appeared to be due to repetitive use of mouse and keyboard but treatment aimed at his neck and arm together with ergonomic advice wasn't doing the trick. On further discussion, the patient mentioned that at around the time of the start of his symptoms he had begun working with an updated version of a programming language. He felt he had not had adequate training, and, after some persuasion he spoke to his bosses, who sent him on a training course, and very quickly his symptoms diminished as his knowledge and confidence increased.

These are fairly extreme cases but it highlights that often the best resolution to pain is achieved by what can be called a multi-factorial approach addressing external stressors as well as physical symptoms.

These two patient examples highlight how information given BY THE PATIENT was vital to recovery but information given BY THE THERAPIST can also be equally important. A simple example we physiotherapists see all too often, is a patient who has been seen in a busy A and E department after, let's say, twisting an ankle. The patient has been given crutches and told to use them to help them walk. Six weeks later the patient's ankle is still swollen and sore and the crutches are starting to look a bit worse for wear too. If the patient had been told to see a physiotherapist after a few days, or even just to start putting more weight onto the foot as the pain decreased, recovery could have been a lot quicker.

I remember when an experienced and successful physiotherapist told me that during his first assessment of a patient he always asked what the patient thought the cause of their problem was. I thought this question would be met with the response "you tell me, you're the expert" but, more often than not, the patient is relieved to discuss their thoughts and concerns. A powerful example, but one that is seen on a regular basis, is a patient who comes in with left shoulder pain and, after examination, the therapist is confident in his diagnosis of, say, frozen shoulder or impingement. However, on asking the patient if they have any thoughts about the cause of their pain, they admit to a fear that the pain may be due to heart problems. A therapist is able to give a clear and accurate diagnosis and hopefully allay the patient's fears. Often this can have an extremely positive effect on pain levels.

Talking of the power of information, it should be remembered that the internet provides limitless medical facts and discussion but at times this information can be confusing, conflicting and plain frightening. I feel it is natural and right to be inquisitive about why you are in pain but if this self research leaves questions unanswered or creates concerns then it is helpful to address these during a consultation with a physiotherapist.

Information given by the medical practitioner should be correct and realistic, but the language used can be extremely influential on a patient's recovery. Talk of "crumbling spines", "twisted pelvises" and "worn out joints" are not only inaccurate but can condemn someone to a lifetime of anxiety, fear of exercise and stress.

A good physiotherapist should explain their findings clearly, in understandable terminology with realistic targets for recovery and avoid alarmist language. These findings have to be underpinned with a detailed and professional physical examination and careful questioning. A good patient should not be afraid to explore all contributing factors for their pain and to discuss any concerns they may have.

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