Hi all,
I am currently treating a patient with severe muscles tightness and secondary joint hypomobility (leading to limited ROM) in the lower Cx and mid/upper Tx spine. The client has had these episodes (that usually last for a couple of weeks) periodically over the last couple of years and has come to the clinic each time (a few trees have been cut down to build her file!!). They are very much related to her study habits as a med student where she says she often studies up to 14 hours straight with no breaks.
The client maintains that she comes to the physio clinic when these episodes occur, as a preventative measure, because if she doesn't she begins to feel disabling pain in her neck and between the scapulae. The client is always happy with the treatment she receives at the clinic which includes STM, myofascial release, PAIVMS to Tx/Cx spine, stretching and education. As a private paying client the client is obviously very lucrative for the clinic.
So you may ask what is Nico going on about here?!!
It just seems that all the education in the world reguarding her study habits, posture and ergonomics can't seem to change her behaviour. The client knows that if she adopted some of the advice including frequent breaks, getting a better chair etc.. her symptoms would disappear. For instance I mention that she should break from study every 20 min and walk/stretch and she responds with "yeah I know, I've been told all this before". The client is just a very driven person and is so busy in other areas of her life to implement the strategies given to her. The client would rather deal with the symptoms when they occur than deal with the root problem.
Does anyone have experience with a pt/client like this and what strategies did they use to affectively get their point across?
Something to think about too. Is it ok to keep on taking this clients money knowing that you are making her happy but not effectively dealing with her loading/postural disorder? I can imagine this kind of client would be a common occurance in private practice. Anyway something to think about if you want to.
Take it easy.
Nico
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3 comments:
Hey Nico,
I had a few similar experiences last year when I was doing sports training at a footy club. When the guys would get injured I would give them exercises as well as doing manual therapy on them. Often the guys would not have done their exercises when they came back to training the following week such that I would have to go through all the education again.
I guess with these patients there is only so much you can say to them and then its up to them to act upon and use your advice. There is only so much you can do in their 30-60min session, where there is plenty they can do on their own. In the private practice world I'm sure we will all see these sorts of patients who are frequent attendees for Rx without doing their own HEP- nothing we can do about it, just think that the more patients you see in the clinic the more nice dinners you can attend!!
I think you've done all you can in terms of education Nico, its up to her now to relax a little from the study and take a break!!
Hey Nic and Deb,
I do find this an interesting situation as I can relate to both sides of this story. Back in my basket ball days I use to do a similar thing to what this patient is doing. I am very inflexible and often become very tight if I do not address this issue and allow it to progress it often evolves into lower back or neck problems. I was able to see the pattern and the tightness building and therefore before I got an injury I would visit our physio for stretches and mobs to help loosen things up. It was very effective and I found it was very hard to effectively stretch yourself the same way with the same relief that a physiotherapist can.
Personally, I think she is being smart and aware of her body. There are many types of therapy including preventative therapy. Massage therapy is often used ahead of time to help prevent more severe injuries from developing. Think of it as maintaining your car with regular check ups. People service their car even if nothing is wrong with it in order to help prevent future break down.
By providing this preventative treatment this opens our cliental and the services we provide as physiotherapists. I think you need to look at it from the view that you are helping her avoid future pain. Nic by doing your treatment you are helping her live a pain free life! I say of course you should continue.
Good luck with the rest of prac
Dani
Interesting case, Nic - and good comments D & D.
Here is one thing you may want to consider: taping.
A house-mate who was studying hard ++ went to see his favourite physio and came home taped-up in the mid back area, between (around?) the scaps.
I did not get an account of the PT's clinical reasoning, but my guess is that he was taping to unload structures / position the pt in good posture / provide proprioceptive input to reinforce good posture. Whatever the case, it worked.
It is probably too dodgy to jump in there and start taping, but it might be worth asking your clinical tutor if he / she has ideas; or if you email the key comparable signs to Diane Hopper, she might be willing to show you a trick or two.
Good luck Nico.
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