Another blog on importance of communication...

Hi everyone,
This week I have started my placement in Musculoskeletal. It has been a really interesting week with various different patient conditions coming up. My blog this week is on a patient who stood out to me and I learnt something from.

This patient was a 69 yr old male who presented with “excruciating pain” 9/10 at the lower buttock with referred pins and needles down his entire posterior leg. His aggravating factors were any loading positions such as walking or standing- his pain increased to 9/10 within ~2mins. At rest, he had a constant ache which was 2/10 pain levels. On Ax he had slight reduced ROM with significant hinging at L2-3- his pain symptoms were reduced with flexion & lateral flexion away from painful side (i.e. opening up the spine reduced symptoms), very hypomobile Lx spine (L1-L5) on PAIVM findings, normal neurological signs (power, sensation & reflexes) and +ve NTPTs.

After consulting my supervisor about his symptoms we diagnosed him as having an inflamed nerve at possibly L3/4 L4/5 which was causing his referred pins and needles as well as his severe levels of pain. This patient has been seen by various other health professionals prior to coming to us- including Doctors, various Chiropractors and an Occupational Therapist all which did not have any affect. The Dr however, had diagnosed him with possible sciata and booked him in to have injections into his facet joints 4 days later to help reduce his inflamed nerve. I wasn’t sure what the best way to treat this gentleman was, as I knew that his symptoms could change significantly after his injections. I decided that physical therapy would not help him at this stage so I decided to go with the management option and not actually treat him as such. I educated him about why he was getting the pain and strategies he can use to help relieve the pain (i.e. flexion to open up the area where the inflamed nerve exited). We spent awhile discussing this and he was so thankful that he finally understood what was going on with his symptoms and why he was getting the pain. He stated that of all the therapists he had seen no one had bothered to explain why he was getting the pain.

This experience showed me that communication with patients is so very important in explaining to them the causes of their symptoms. This post supports Bini’s post earlier and again highlights the importance that we as physiotherapists have in educating patients about their conditions and our role in helping them to regain function.

Hope everyone enjoys their next wk of prac- not long to go now :)
Debs